CREATING THE ATTRACTIVE FACE
Every elective cosmetic facial procedure that a plastic surgeon does is to create a more beautiful or attractive face. Many patients that undergo aesthetic facial plastic surgery today have a very clear idea in their mind as to what deficiency they have and what procedures they think will give them the improvement they are seeking. Some may ask if what they are seeking will create a more attractive face and others may ask what else or what the plastic surgeon may suggest.
Between discussions and computer imaging, most of the proposed facial procedures can be determined. But there is no doubt that facial attractiveness is highly subjective and personal factors of age, race and ethnicity influence how attractiveness is perceived. There are large numbers of facial measurements that can be done from anthropometric studies, but in the end the phrase ‘Beauty In The Eye Of The Beholder’ trumps any objective assessment.
While the determination of an attractive face may be subjective, there are well known guidelines that can be assessed and measured to help guide a surgical plan. They include symmetry, proportion and gender specificity.
While no face is perfectly symmetric, the closer the two sides of the face match the more attractive it will seem to be. Most observers, even close friends, do not usually notice many facial asymmetries. But each individual does as they spend a lot more time looking at themselves everyday and many asymmetries can be glaringly apparent in pictures due to their static nature. In my experience creating symmetry, even if never perfectly achieved, is a key feature in improving facial attractiveness.
The concept of facial proportion comes directly from anthropometric work that dates back to DaVinci. The horizontal assessment of facial thirds is the simplest and the most useful facial proportional measurement. Numerous forehead and lower facial procedures (jawline, chin) can be done to affect these facial ratios. The vertical fifths apportionment of the face is equally valid but less easily changed by surgery. There are also lots of facial angle measurements which are helpful to individual features but few are rigidly tied to an absolute attractiveness effect.
But many of these important gender features that create attractiveness are not based on pure numbers but underlying skeletal features that have developed due to hormonal influences. For example, the male forehead angles back more, is less convex and has a brow prominence with a visible brow break. Conversely, the female forehead has a minimal brow protrusion, no brow break and a greater convexity that is more vertically inclined. The male nose is higher with a straight dorsal line and a tip that creates nasolabial angle of around 90 degrees. Conversely, a more feminine nose can have a slightly concave dorsal line with a higher tip position and a more open nasolabial angle. The most obvious gender feature between men and women is the jawline where the differences in chin and jawline shapes are well known.
In the end, changing a face with the intent of enhancing attractiveness is a balance between striving for better symmetry, proportion and gender accentuation. How to put these three facial components together in a surgical plan is a mixture of objective and subjective assessments and the procedures needed to achieve them. This gestalt approach to facial reshaping is critical for success and requires a lot of experience to ever develop the amalgamated thinking to optimize facial outcomes.