The increased demand for facial cosmetic surgery has come from a more diverse, informed, and selective patient population from all walks of life. Virtually no two patients have the same background or cosmetic objectives. However, the classic tenets of beauty including phi, symmetry, averageness, youthfulness, and sexual dimorphism can be applied to persons of all ethnicities to assist in objectifying the abstract concept.

Keywords

Multicultural appearances

Definitions of beauty

Facial appearance

Divine ratio

Facial symmetry

Attractiveness

Key points

Introduction

In today’s world, beauty has a very important place. People are instantly judged as being outwardly attractive or not, and increased beauty confers remarkable advantages socially, reproductively, and professionally. Beauty crosses ethnic boundaries and has a huge cultural and economic impact.

The ancient Greek poet Sappho (seventh century bce) stated What is beautiful is good. A century later, Plato postulated that what is good and true is beautiful.1 Literature is filled with examples of villains being ugly and the ugly being evil. Meanwhile, the beautiful hero often swoops in to save the day. That being said, beauty has been a recognized entity for centuries yet we still struggle to define it. The irony is that most of us know it when we see it.

The face is a prime symbol and representation of the self. We carry photographs of the faces of our loved ones on our telephones or have them on our desks; our faces are displayed on our passport or driver’s license to indicate who we are; it is the faces of criminals that adorn the news each night and the faces of famous persons on the covers of magazines. Our faces are the chief site for conveying our voluntary and involuntary emotional expressions.2 Our faces largely define who we are and what kind of mood we are in.

Is facial beauty a simple or complex idea? Are there a set of ideals or measurements that aesthetically pleasing faces across all ethnicities have in common? Those are questions that provoke lively conversation and debate even among experts of facial analysis. Beauty was once considered to lie in the eyes of the beholder. This was a way of saying that beauty was subjective and ill-defined; a certain face may appear attractive to some people but unattractive to others. However, more recent studies have supported a more objective and well-defined concept of beauty. Certain concepts of facial beauty may indeed be timeless. Those concepts include symmetry, averageness, youth, and sexual dimorphism. Many studies have looked into the details of these characteristics.

The modern society is a truly globalized one and this has a definite impact on the perception of beauty. Interracial couples have increased, there is ubiquitous migration, and heightened economic mobility allows for a blurring of ethnic identity.3 Mixed races and nationalities are the new norm, and this blending of traits often leads to aesthetically unique and beautiful outcomes. Patients can rarely be characterized as fitting in a narrow mold with predictable surgical desires. People who identify with a certain ethnicity may want to erase, preserve, modify, or even enhance those specific inherent traits. Surgical goals must be tailored to the individual now more than ever.

Although many ideals of beauty are stable, surgical trends and techniques seem less enduring. Rhinoplasty has evolved into a far less destructive, less “operated on” appearance in the past decade. Blepharoplasty is trending toward fat preservation and redistribution. Few patients are looking for dramatic changes and most vehemently fear the surgical look. Surgical trends have often chased seemingly whimsical fads, whereas perhaps we should be more focused on the classical tenets of beauty.

Beauty has a critical role in mate selection, with more attractive persons being unconsciously perceived as being more fertile. It takes energy and natural resources for a body to create a beautiful exterior, and animals that are burdened with illness need to spend internal resources to fight off disease and cannot afford to devote energy to creating a beautiful, symmetric, or colorful exterior.4 Attractive features confer an increased reproductive fitness, because sexually selected characteristics evolve much more quickly than naturally selected characteristics.5 The beautiful are more likely to get better grades in school, to be hired for a job, and to receive higher salaries.2 The drive to be beautiful is innate because nature stamps the more symmetric and youthful appearing as a beautiful individual, disease free, genetically fit, and fertile.4 Beauty is a strong driving force in the world of nature and humanity alike.

Phi

The ancient Greeks believed true beauty was represented by a golden ratio, phi, of (a+b)/a = 1:1.61803399….6,7 This has also been called the Divine Ratio because it is found throughout nature and is thought to represent perfect harmony. It is the ratio obtained when a line ABC is cut such that AB/AC = BC/AB. It has been used much in such well-known entities as Egyptian art and architecture and the Fibonacci sequence, and it is also found in basic geometric shapes, such as the pentagon and decagon. It is also found in the spiral of seashells, such as the nautilus; in the human mandible and its growth rate; in the spiral of DNA; and in the human figure and face.8,9

Phi has been studied extensively and some studies have found it to be inexact. Pallett and coworkers10 found that individual attractiveness is optimized when the face’s vertical distance between the eyes and the mouth is approximately 36% of its length, and the horizontal distance between the eyes is 46% of the face’s width. This differed from the classic golden ratio of .38. He deemed his findings the “new” golden ratio and believed it to match those of an average face. Similarly, Schmid and coworkers11 found that a face length to width in proportion less than the golden ratio are seen as attractive in female faces. Others have found phi to fit the female face more closely than the male face.12 Furthermore, Pallett and coworkers10 hypothesize that changing one’s hairstyle may alter the perceived face length or face width, and their related length and width ratios, therefore affecting the perceived attractiveness of the face. Phi is a universal reference point for beauty, and it has certainly stood the test of time. However, its use does seem somewhat limited and it must be supplemented by additional mechanisms of facial evaluation.

Symmetry

The role of symmetry has been investigated as to its involvement in facial beauty. Most studies indicate that symmetric female and male faces are seen as more attractive than asymmetric ones. Some studies go so far as to say that there is a direct correlation with facial symmetry and attractiveness. This could be a result of symmetry alone, or it could be because symmetric faces are closer to the average than asymmetric ones.13 Additionally, having a symmetric face seems to confer an advantage in sexual competition14–17 because facial symmetry has been suggested to reflect a person’s phenotypic and genetic condition.18 It seems that an asymmetric face is not unattractive merely because it is asymmetric, but because the asymmetry implies moving away from the average, which in turn decreases reproductive fitness.

Averageness

Averageness and beauty initially seem to be mutually exclusive concepts. However, multiple people have studied this idea and a recurrent theme is that beauty and symmetry increase with increased averageness of facial features. Some people believe that facial averageness is the characteristic that contributes the most to facial attractiveness in women.13 In 1979 Symons19 performed a study where multiple single faces were artistically melded into a composite face. The composite face became increasingly closer to the average as the number of faces generating it rose. By increasing the number of faces it was also found that the composite face was increasingly more...