The concept of beauty has changed over time and does vary amongst different cultures. But the basic tenets of beauty, proportion and symmetry, are timeless and unchanging. Thousands of years ago Nefertiti was considered the most beautiful of all women with her arched brows, high cheekbones, and slim nose. In the 1950s, Grace Kelly was viewed as a natural beauty because of her very symmetric and proportioned facial features and small slightly upturned nose. Leonardo Da Vinci was the first to apply scientific and mathematical analysis to the study of the face. Contemporary studies have confirmed the importance of symmetry and balance of facial features. If a line is drawn done the center of one’s face and mirror images are of made of each half, the closer these two reconstructed faces match the more attractive one is deemed. The classic example is that of Denzel Washington whose two facial halfs look remarkably similar. Lack of symmetry and proportion is a major reason why many patients seek plastic surgery for facial appearance improvement.
One of the important elements of facial beauty, if not the most important, is symmetry. The more symmetric the two halfs of the face are, the more attractive one is rated to be. This is frequently seen in illustrated TV commercials and print ads. When the person shown is sick or ill, their face is drawn slightly off or asymmetric. When they are treated and cured, their face becomes symmetric. Look carefully at pharmaceutical advertisements. This has also been proven by a well established photographic technique, pairing two halfs of one’s face. (two rights and two lefts made by mirror images) The closer the two halfs look the more attractive one’s face is.
It is well known that one of the major contributors towards the perception of an attractive face, albeit a man or a woman, is the proportion of certain features. Known as indicators of facial beauty, disproportionate and asymmetric features are the main reasons many patients seek plastic surgery procedures. One can debate endlessly why this is so, but we are fundamentally driven to an attractive face from an innate drive of evolution and the desire to procreate. Attractiveness is desireable because it is perceived, right or wrong, to be associated with better genes.
But what are some of these features and can they really be changed by plastic surgery? For women it is bigger eyes, a rounder forehead, a smaller nose, well defined cheeks, larger lips and a chin that is not too prominent. For men, slightly prominent brows, a nose with a high dorsal line, well-defined cheeks, and a strong chin and jaw angles are associated with more masculinity. Short of the size of the eyes, all of these facial features can be modified by differing plastic surgery techniques.
The one desireable facial feature that both men and women share is the value of high and well-defined cheek bones. It is probably the only facial feature whose size and prominence is considered attractive for both sexes. It is also the one facial feature that I never receive requests to be reduced. (short of Asian patients and this more about the zygomatic arch width not anterior cheek projection) Few patients, if any, really want smaller cheeks.
What is it about high cheekbones that makes them some desireable? Many say that they feminize a face. If high cheek bones contribute to greater femininity, then why would it be attractive on men? The caveat is that it is only an aesthetically desireable facial feature in a man when it coexists with a stronger jawline as well. Strong cheekbones on a man with a small jaw or chin does not make for an attractive face. It is the angularity of the three defining points of a male face, the cheeks, chin and jaw angles, that makes for its aesthetic desireability. Such well-defined facial skeletal highlights equates with a strong and virile personal character. (and maybe the chance to pass along some good genes)
The benefits of cheek augmentation in either a man or a woman must take into consideration these aesthetic and gender differences. While cheek enhancement can be done with injectable fillers, I am reserving my comments here to the insertion of implants. Injectable fillers are largely a good trial method to determine the merits of proceeding to a permanent cheek augmentation in my opinion. Cheek implants in women should be softer and more round to provide volume but they usually don’t need to be angular or cross onto the zygomatic arch or encroach upon the lateral orbital rim area. This can add too much width which is not usually feminizing. Cheek implants in men often need to be more angular and add more height. They are beneficial to help balance out a strong jawline or should be done in conjunction with chin and jaw angle augmentation.
The cheeks can contribute significantly to one’s facial attractiveness. But it needs to be considered within the context of the whole face. The balance of one’s facial features is what makes for gender-specific facial beauty.
In plastic surgery, we continually strive to make every face that we operate on better. Sometimes the facial problem is easy and the surgery straighforward. Other times, the facial problem is more difficult to identify and takes more careful analysis. Knowing what makes a face attractive is important of we are to try and change a face to make it so. We know it when we see someone attractive but it may be hard to know why we think so. Beauty is thought to be subjective and emotional and the question of what makes a face attractive can seem to be impossible to answer. Research studies in the past ten years or so, however, has shown that there is a scientific basis to an aesthetically-pleasing face…and it can be specifically measured.
A beautiful face should be symmetric from side to side. The most attractive faces are those that have a remarkable amount of evenness between the right and left sides. This has been demonstrated through a photographic mirror-image technique. A picture is taken and a line is drawn down the middle. Two faces are then made by flipping over the mirror image of one side to make a complete face. Then compare a ‘right-sided’ face to the ‘left-sided’ face. The closer that these two facial images look, the more symmetrical and attractive is that face.
The relationships between the size and shape of the forehead, nose, eyes, lips and chin should be harmonious and not distracting. There are very specific measurements consisting of angles and ratios between these facial structures that create favorable proportions. The study and science of facial relationships is known as anthropometry and every face can be easily analyzed on paper. (there are software programs that can do it today in a matter of a few minutes)
Youth is always equated with greater attractiveness and the face is no exception. Increasing lines, wrinkles, and sagging of the skin makes a face look more aged. But symmetry and good facial proportions can still make the aging face very appealing.
Don’t forget that facial expressions, how often the eyes and the mouth moves and in what direction, can negate even the most imbalanced face. Smiling is far more attractive than frowning! In and of itself, it aids in making the face more pleasant. There is no one who isn’t favorably moved by a big and inviting smile.
Our goal as plastic surgeons is to make faces more attractive. This is accomplished by improving symmetry between the two sides of the face, putting certain facial features such as the nose and chin into better balance with the rest of the face, and giving the face a more youthful rested look.
Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.