New "golden" ratios for facial beauty

The Concept of Ideal Lips of Caucasian Female: An Anthropometric Analysis of the Lower Third of the Face

BACKGROUND

The demand for lip-redefining procedures has been rising in recent years, thus creating the need for reliable and detailed reference sources on aesthetic female lips. This study investigates the morphology of the lower third of the face, including the lips and jawline, of attractive young Caucasian females.

METHODS

A semi-automatic photogrammetric analysis of the faces of professional female photograph models (n=400) of the Caucasian race aged 18-39 was performed. Angular, linear, and surface area parameters were evaluated. A graphical summarization of the average facial shape of all analyzed attractive females was generated as an average body contours (ABC) image.

RESULTS

The height of the lower third of the face equaled 0.32 ± 0.02 of the total facial height. The average lip width was 48.06 ± 3.34 mm. The upper vermilion height was found to be significantly lower than the lower vermilion height (6.47 ± 1.36 vs. 11.64 ± 1.46 mm, p < 0.01). The lip obliquity angle was found to be 1.05° ± 0.79°. The area surface of the upper lip vermilion was considerably smaller than the vermilion of the lower lip (p < 0.01).

CONCLUSIONS

This is one of the largest studies on attractive Caucasian females' lips and lower face morphology. The data it provides, including the graphical presentation of the aesthetic lower face as an ABC image, may provide physicians with valuable guidelines for lips rejuvenation and reconstruction procedures.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

There Is no Universal Standard of Beauty

This article discusses the various factors that contribute to facial beauty and the different contexts in which they are significant. The authors examine the roles of the golden ratio, ideal proportions, symmetry, and specific facial features in what constitutes an attractive face. They also investigate the influence of cultural and evolutionary perspectives on facial beauty and the impact of social media on our perception of beauty. The article provides a comprehensive overview of the topic and emphasises the significance of facial beauty and its impact on our lives. The authors acknowledge that the concept of beauty is difficult to define with absolute precision, and that the objective-subjective argument regarding facial beauty remains unsolved. However, they argue that physical attributes undoubtedly influence perceptions of attractiveness, but beauty extends beyond surface-level features. They also suggest that embracing diversity in beauty standards fosters a more inclusive society that celebrates the unique qualities of every person.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

3D evaluation model of facial aesthetics based on multi-input 3D convolution neural networks for orthognathic surgery

BACKGROUND

Quantitative evaluation of facial aesthetics is an important but also time-consuming procedure in orthognathic surgery, while existing 2D beauty-scoring models are mainly used for entertainment with less clinical impact.

METHODS

A deep-learning-based 3D evaluation model DeepBeauty3D was designed and trained using 133 patients' CT images. The customised image preprocessing module extracted the skeleton, soft tissue, and personal physical information from raw DICOM data, and the predicting network module employed 3-input-2-output convolution neural networks (CNN) to receive the aforementioned data and output aesthetic scores automatically.

RESULTS

Experiment results showed that this model predicted the skeleton and soft tissue score with 0.231 ± 0.218 (4.62%) and 0.100 ± 0.344 (2.00%) accuracy in 11.203 ± 2.824 s from raw CT images.

CONCLUSION

This study provided an end-to-end solution using real clinical data based on 3D CNN to quantitatively evaluate facial aesthetics by considering three anatomical factors simultaneously, showing promising potential in reducing workload and bridging the surgeon-patient aesthetics perspective gap.

Comparison of 1 Year Nasal Tip Projection Results of Triple Cartilage Combining Suture (Flexible Tongue-in-Groove) and Classical Tongue-in-Groove Techniques

Objectives: In the present study, we compared patient satisfaction with classical tongue-in-groove (TIG) technique and triple cartilage combining suture (TCCS; flexible tongue-in-groove) techniques applied to the nasal tip in rhinoplasty. Methods: In this retrospective study, 80 patients who underwent rhinoplasty operations with TIG or TCCS techniques applied to the tip region were included. There were 40 patients in both groups. All patients in groups 1 and 2 were evaluated by the criteria written below at preoperative, postoperative first month, and postoperative first year: (1) Rhinoplasty Outcomes Evaluation Questionnaire (ROE), (2) tip projection (cm), (3) nasal dorsum length (cm), (4) tip projection ratio (Goode), (5) nasofrontal angle, and (6) nasolabial angle. Results: The patients were followed up at 84.32 ± 19.38 months in the TIG group and 87.47 ± 18.01 months in the TCCS group. Our results showed that preoperative, postoperative first-month, and first-year tip projection (P = .013, P = .022, and P = .020, respectively), and nasal dorsum length values (P = .009, P = .020, and P = .020, respectively) of the TCCS group were significantly lower than those in the TIG group. There was a positive correlation between the postoperative first month and postoperative first year ROE scores. Lower preoperative tip projection ratio (Goode) values and higher nasolabial angle values were related to higher ROE scores showing patient satisfaction. Conclusion: For the patient satisfaction after tip rhinoplasty, lower projection ratio (Goode) and higher nasolabial angle values were related to ROE scores. Although there are no significant results, lower tip projection results in the TCCS group may be related to more patient satisfaction due to natural appearance.

Truth Lies in the Depths: Novel Insights into Facial Aesthetic Measurements from a U.S. Survey Panel

BACKGROUND

Aesthetic facial bone surgery and facial implantology expand the boundaries of conventional facial surgery that focus on facial soft tissue. This study aimed to reveal novel aesthetic facial measurements to provide tailored treatment concepts and advance patient care.

METHODS

A total of n=101 study participants (46 females and 55 males) were presented with 120 patient portraits (frontal images in natural head posture; 60 females and 60 males) and asked to assess the facial attractiveness (scale 0-10; "How attractive do you find the person in the image?") and the model capability score (MCS; scale 0-10; "How likely do you think the person in the image could pursue a modelling career?"). For each frontal photograph, defined facial measurements and ratios were taken to analyse their relationship with the perception of facial attractiveness and MCS.

RESULTS

The overall attractiveness rating was 4.3 ± 1.1, while the mean MCS was 3.4 ± 1.1. In young males, there was a significant correlation between attractiveness and the zygoma-mandible angle (ZMA)2 (r= - 0.553; p= 0.011). In young and middle-aged females, MCS was significantly correlated with facial width (FW)1-FW2 ratio (r= 0.475; p= 0.034). For all male individuals, a ZMA1 value of 171.79 degrees (Y= 0.313; p= 0.024) was the most robust cut-off to determine facial attractiveness. The majority of human evaluators (n=62; 51.7%) considered facial implants a potential treatment to improve the patient's facial attractiveness.

CONCLUSION

This study introduced novel metrics of facial attractiveness, focusing on the facial skeleton. Our findings emphasized the significance of zygomatic measurements and mandibular projections for facial aesthetics, with FI representing a promising surgical approach to optimize facial aesthetics.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Post-oncological full-thickness eyelid defect reconstruction: An aesthetical overview

Purpose of the current study was to introduce a new detailed aesthetical subunit (ASU) involvement chart to localize the defect configuration on the eyelids, and, to evaluate the aesthetical and functional outcomes of the post-oncological full-thickness eyelid defect reconstruction surgery by using a modified aesthetical rating guideline. Medical records of subjects who were diagnosed with a primary malignant full thickness eyelid tumor involving the eyelid margin and underwent full-thickness eyelid defect reconstruction surgery between April 2016 and May 2022 were retrospectively reviewed. Age, sex, pathological diagnosis, follow-up time, the ASU of the eyelid involvement, and surgical methods used to reconstruct the anterior and posterior lamella were examined from medical records. The reconstructed eyelid photos were scored according to the modified aesthetical rating guideline to analyze the aesthetical and functional outcomes of the surgeries. A total of 31 subjects were included to the study, and the overall mean aesthetical score was 3.5. Seventeen subjects with aesthetical scores greater than 3.5 were included in the more aesthetically pleasing (AP) group, and 14 subjects with aesthetical score less than 3.5 were included in less AP group. Anterior lamella repair was mainly performed using myo-cutaneous flaps in the more AP group and multiple flap combinations in the less AP group (P: 0.13). Posterior lamella reconstruction was performed using tarso-conjunctival tissue in both groups. In more AP group, tissue scarring, lash line disruption, eyelid thickness, and retraction or ectropion scores were significantly higher when compared with less AP group (P:0.03, P:0.03, P:0.02, and P:0.01, respectively). Subjects with fair eyelash color were significantly more common in more AP group (P: 0.009). The ASU involvement chart and outcomes of the current study may aid novice surgeons to determine which method will provide the best result for an individual patient for full-thickness eyelid defect repair and may offer some insight into the different surgical techniques used for repairing similar wounds.

The ideal shape of the female jaw angle: An online survey

The aim of this study was to determine the characteristics of an attractive white female jaw angle in the three dimensions. An online survey of photographs of celebrities and laypeople was used to rate their attractiveness using 6 questions and a 3-item Likert scale. If ≥ 80% of participants rated a model as having attractive aesthetic features, it was considered attractive. The following features were considered important: a gonial angle in profile of 125.5° and in anterior view of 142°, an intergonial-interzygomatic width ratio of 0.83 and the vertical position of the jaw angles at the level of the stomion or upper lip. Surgeons can use these consensus criteria to help design a jaw angle implant, define orthognathic surgical strategies, or shape the angle using injectables.

The average three-dimensional face for different sex and age groups in a Dutch population

The increasing use of three-dimensional imaging calls for reference models representing large parts of the population. The aim of this prospective study was to create templates depicting facial maturation in the younger age groups. Healthy Dutch volunteers were captured, without selection of inclusions. Three-dimensional average faces were created using MATLAB, for both genders in four age groups (4-8 years, 8-12 years, 12-16 years, and ≥16 years). Variation within the groups was calculated and depicted on an average face with a green to red colour scale, corresponding to standard deviations between 0 and ≥ 3 mm, respectively. Measurements of the distances of eight peri-oral landmarks were provided as ratios. The statistical analysis was performed using ANOVA and Tukey's test. Three-dimensional reconstructions of the average face and their first principal component were created for each gender and age group. The first principal component comprised the facial width for each group, and the variation of landmarks was low. All ratios showed an increasing trend with increasing age, except for the ratio of philtrum width to mouth width. This study is novel in comparing facial morphology by means of ratios and in creating average faces for the different young age groups. These data provide useful insights into facial maturation, which might be beneficial for facial surgeons.

Beauty is in the eye of the employer: Labor market discrimination of accountants

This research investigates labor market discrimination based on physical appearance in Israel’s Certified Public Accountant firms. Using a survey questionnaire, we showed that accountants in managerial positions prefer to hire more physically attractive candidates. This beauty premium is larger among the five biggest Certified Public Accountant firms and can be explained by the perception that attractive candidates possess essential traits for becoming successful accountants. An important implication of our results is that even among accounting firms, where professionalism is well defined, discrimination against candidates based on traits such as physical appearance can ineffectively eliminate suitably qualified interns.

The Concept of an Ideal Lips of Caucasian Male: An Anthropometric Analysis of the Lower Third of the Face

BACKGROUND

The lips play a significant role in determining the aesthetic perception of a human face. However, there is little data on the perioral region morphometry of attractive males.

OBJECTIVES

This study investigates the morphology of the lower third of the face, including the lips and jawline, of attractive young Caucasian males.

METHODS

A complex semi-automatic photogrammetric analysis of faces of male photo models (n=300) of the Caucasian race, aged 18-39 years old, was performed. Linear, angular, and surface area parameters were evaluated. In addition, an Average Body Contours (ABC) image was created, providing the graphical summarization of facial size and shapes of all analyzed individuals.

RESULTS

The height of the lower third of the face equaled 0.35 ± 0.03 of the total facial height. The average lip width was 50.98 ± 3.74 mm. The upper vermilion height was found significantly lower than the lower vermilion height (5.9 ± 1.62 vs. 11.15 ± 1.88 mm, p<0.01). The lip obliquity angle was found to be 1.01 o ± 0.73 o. The area surface of the lower lip vermilion was considerably larger than the vermilion of the upper lip (p<0.01).

CONCLUSIONS

The vast amount of morphometric data, including the novel presentation method as an ABC image, on the attractive male's lower third of the face, may provide the surgeons with practical guidelines for lips surgical and nonsurgical rejuvenation procedures. It may also support the perioral region reconstruction and sex reassignment surgery in achieving satisfactory results.

Facial Surface Anthropometric Features and Measurements With an Emphasis on Rhinoplasty

BACKGROUND

Facial features and measurements are utilized to analyze patients' faces for various reasons, including surgical planning, scientific communications, patient-surgeon communications, and post-surgery evaluations.

OBJECTIVES

There are numerous descriptions regarding these features and measurements scattered throughout the literature, and the authors did not encounter a current compilation of these parameters in the medical literature.

METHODS

A narrative literature review of the published medical literature for facial measurements used for facial analysis in rhinoplasty was conducted through the electronic databases MEDLINE/PubMed and Google Scholar, along with a citation search.

RESULTS

A total of 61 facial features were identified: 45 points (25 bilateral, 20 unilateral), 5 lines (3 bilateral, 2 unilateral), 8 planes, and 3 areas.A total of 122 measurements were identified: 48 distances (6 bilateral, 42 unilateral), 57 angles (13 bilateral, 44 unilateral), and 17 ratios. Supplemental figures were created to depict all features and measurements utilizing a frontal, lateral, or basal view of the face.

CONCLUSIONS

This paper provides the most comprehensive and current compilation of facial measurements to date. The authors believe this compilation will guide further developments (methodologies and software tools) for analyzing nasal structures and assessing the objective outcomes of facial surgeries, in particular rhinoplasty. Moreover, it will improve communication as a reference for facial measurements of facial surface anthropometry, in particular rhinoplasty.

Puzzle Facelift: A non-surgical, whole treatment for facial modelling and rejuvenation

The assessment of correct anatomy of face and the evaluation of the dynamic interplay between anatomy and function, in order to get an overall improvement, is a leading topic in aesthetic surgery and has increased its impact in the recent years. A non-surgical impact technique reduces both post-treatment discomfort and the overall cost. Obtaining the simultaneous correction in forehead, nose, lips and chin means obtaining an overall improvement in face view. Likewise, the high predictability of the procedure and the absence of alloplastic implant, bone re-absorption and scars have to be considered in non-surgical aesthetic medicine. In conclusion, a single-session of profile correction using HA filler should be proposed to patient, every time the aesthetic practitioner sees a coexistence of forehead, nose lips and chin defects.

Machine Learning-Based Facial Beauty Prediction and Analysis of Frontal Facial Images Using Facial Landmarks and Traditional Image Descriptors

The beauty industry has seen rapid growth in multiple countries and due to its applications in entertainment, the analysis and assessment of facial attractiveness have received attention from scientists, physicians, and artists because of digital media, plastic surgery, and cosmetics. An analysis of techniques is used in the assessment of facial beauty that considers facial ratios and facial qualities as elements to predict facial beauty. Here, the facial landmarks are extracted to calculate facial ratios according to Golden Ratios and Symmetry Ratios, and an ablation study is performed to find the best performing feature set from extracted ratios. Subsequently, Gray Level Covariance Matrix (GLCM), Hu's Moments, and Color Histograms in the HSV space are extracted as texture, shape, and color features, respectively. Another ablation study is performed to find out which feature performs the best when concatenated with the facial landmarks. Experimental results show that the concatenation of primary facial characteristics with facial landmarks improved the prediction score of facial beauty. Four models are trained, K-Nearest Neighbors (KNN), Linear Regression (LR), Random Forest (RF), and Artificial Neural Network (ANN) on a dataset of 5500 frontal facial images, and amongst them, KNN performs the best for the concatenated features achieving a Pearson's Correlation Coefficient of 0.7836 and a Mean Squared Error of 0.0963. Our analysis also provides us with insights into how different machine learning models can understand the concept of facial beauty.

Aesthetic Eyelid Measurements of "Beautiful People": Gender Differences and Application for Thyroid Eye Disease Patients

There remains a paucity of studies investigating measurements of periocular structures of people popularly seen as “beautiful.” Such measurements may be helpful in establishing postoperative goals and measuring aesthetic outcomes. This study (1) identifies aesthetic measurements of the periocular structures in idealized celebrities, (2) determines gender differences in such measurements, and (3) compares these measurements to patients who underwent surgical repair of upper eyelid retraction associated with thyroid eye disease.

The Ideal Lips: Lessons Learnt from the Literature

Defining the ideal dimensions and proportions of the human face has been attempted for centuries, popularised in the Renaissance period by artists including Leonardo Da Vinci. The lips are part of the lower third of the face and are central to lower face aesthetics and the overall symmetry of the face. They also place an important part in conveying facial emotions and expressions. Full lips with well-defined Cupid's bow have always been associated with youth and beauty. The approval of hyaluronic acid use for tissue augmentation and the prevalence of social media have caused an exponential increase in lip augmentation procedures (Linkov et al. in Arch Plast Surg 46(3):248-254, 2019), as such researchers and aestheticians have focused on characterising the ideal lips mathematically to help guide clinicians. This narrative review will summarise the available evidence in the literature pertaining to the ideal lips, taking into account age, ethnicity and gender differences. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Chinese Aesthetic Mask: Three Forehead and Five Eyes-Holistic Processing and Facial Attractiveness

Human face processing has been attributed to holistic processing. Here, we ask whether humans are sensitive to configural information when perceiving facial attractiveness. By referring to a traditional Chinese aesthetic theory-Three Forehead and Five Eyes-we generated a series of faces that differed in spacing between facial features. We adopted a two-alternative forced-choice task in Experiment 1 and a rating task in Experiment 2 to assess attractiveness. Both tasks showed a consistent result: The faces which fit the Chinese aesthetic theory were chosen or rated as most attractive. This effect of configural information on facial attractiveness was larger for faces with highly attractive features than for faces with low attractive features. These findings provide experimental evidence for the traditional Chinese aesthetic theory. This issue can be further explored from the perspective of culture in the future.

Putative ratios of facial attractiveness in a deep neural network

Empirical evidence has shown that there is an ideal arrangement of facial features (ideal ratios) that can optimize the attractiveness of a person's face. These putative ratios define facial attractiveness in terms of spatial relations and provide important rules for measuring the attractiveness of a face. In this paper, we show that a deep neural network (DNN) model can learn putative ratios from face images based only on categorical annotation when no annotated facial features for attractiveness are explicitly given. To this end, we conducted three experiments. In Experiment 1, we trained a DNN model to recognize the attractiveness (female/male × high/low attractiveness) of face in the images using four category-specific neurons (CSNs). In Experiment 2, face-like images were generated by reversing the DNN model (e.g., deconvolution). These images depict the intuitive attributes encoded in CSNs of the four categories of facial attractiveness and reveal certain consistencies with reported evidence on the putative ratios. In Experiment 3, simulated psychophysical experiments on face images with varying putative ratios reveal changes in the activity of the CSNs that are remarkably similar to those of human judgements reported in a previous study. These results show that the trained DNN model can learn putative ratios as key features for the representation of facial attractiveness. This finding advances our understanding of facial attractiveness via DNN-based perspective approaches.

New Surgical Technique: Bidirectional Forehead Narrowing and Eyebrow Lifting Using Regional Flap Mobility

We describe our experience with bidirectional forehead narrowing and eyebrow lifting (BiNaLi), a surgical technique we have been practicing for several years to correct facial esthetic issues of patients such as long forehead, high hairline, and low eyebrow level, which helps us achieve forehead height reduction with eyebrow lifting, using 1 incision line in a one-stage procedure.

The Influence of Each Facial Feature on How We Perceive and Interpret Human Faces

Facial information is processed by our brain in such a way that we immediately make judgments about, for example, attractiveness or masculinity or interpret personality traits or moods of other people. The appearance of each facial feature has an effect on our perception of facial traits. This research addresses the problem of measuring the size of these effects for five facial features (eyes, eyebrows, nose, mouth, and jaw). Our proposal is a mixed feature-based and image-based approach that allows judgments to be made on complete real faces in the categorization tasks, more than on synthetic, noisy, or partial faces that can influence the assessment. Each facial feature of the faces is automatically classified considering their global appearance using principal component analysis. Using this procedure, we establish a reduced set of relevant specific attributes (each one describing a complete facial feature) to characterize faces. In this way, a more direct link can be established between perceived facial traits and what people intuitively consider an eye, an eyebrow, a nose, a mouth, or a jaw. A set of 92 male faces were classified using this procedure, and the results were related to their scores in 15 perceived facial traits. We show that the relevant features greatly depend on what we are trying to judge. Globally, the eyes have the greatest effect. However, other facial features are more relevant for some judgments like the mouth for happiness and femininity or the nose for dominance.

Item Features Interact With Item Category in Their Influence on Preferences

Low-level visual features are known to play a role in value-based decision-making. However, most previous studies focused on the role of only a single low-level feature or only for one type of item. These studies also used only one method of measurement and provided a theory accounting for those specific findings. We aimed to utilize a different more robust approach. We tested the contribution of low-level visual features to value-based decision-making of three item types: fractal-art images, faces, and snack food items. We used two techniques to estimate values: subjective ratings and actual choices. We found that low-level visual features contribute to value-based decision-making even after controlling for higher level features relevant for each item category (for faces, features like eye distance and for food snacks, features like price and calories). Importantly, we show that, overall, while low-level visual features consistently contribute to value-based decision-making as was previously shown, different features distinctively contribute to preferences of specific item types, as was evident when we estimated values using both techniques. We claim that theories relying on the role of single features for individual item types do not capture the complexity of the contribution of low-level visual features to value-based decision-making. Our conclusions call for future studies using multiple item types and various measurement methods for estimating value in order to modify current theories and construct a unifying framework regarding the relationship between low-level visual features and choice.

The Changing Face of Beauty: A Global Assessment of Facial Beauty

Beauty is difficult to define. The US population becomes more diverse by the day. Thus, traditional stereotypes of beauty in various ethnic groups become less applicable as diversity increases. Often, new and uniquely beautiful facial features and proportions emerge as different ethnicities converge. With the increased diversity in facial appearance comes increased variability in patients' goals. A successful cosmetic surgeon will cultivate an understanding of aesthetic ideals in different ethnic groups, nurture discussions with patients to determine their aesthetic goals, devise a surgical plan for each patient, and develop and refine the necessary surgical skills to perform the procedure.

Filtered beauty in Oslo and Tokyo: A spatial frequency analysis of facial attractiveness

Images of European female and male faces were digitally processed to generate spatial frequency (SF) filtered images containing only a narrow band of visual information within the Fourier spectrum. The original unfiltered images and four SF filtered images (low, medium-low, medium-high and high) were then paired in trials that kept constant SF band and face gender and participants made a forced-choice decision about the more attractive among the two faces. In this way, we aimed at identifying those specific SF bands where forced-choice preferences corresponded best to forced-choice judgements made when viewing the natural, broadband, facial images. We found that aesthetic preferences dissociated across SFs and face gender, but similarly for participants from Asia (Japan) and Europe (Norway). Specifically, preferences when viewing SF filtered images were best related to the preference with the broadband face images when viewing the highest filtering band for the female faces (about 48-77 cycles per face). In contrast, for the male faces, the medium-low SF band (about 11-19 cpf) related best to choices made with the natural facial images. Eye tracking provided converging evidence for the above, gender-related, SF dissociations. We suggest greater aesthetic relevance of the mobile and communicative parts for the female face and, conversely, of the rigid, structural, parts for the male face for facial aesthetics.

The Mathematical Analysis of the Aesthetically Pleasing Eyelid

PURPOSE

To analyze and quantify the characteristics and parameters of the eyelid and adnexa of males and females and correlate these findings to an aesthetically pleasing score.

METHODS

This is an Institutional Review Board approved study involving healthy male and female volunteers. The margin-to-reflex distance, palpebral fissure, inferior scleral show, tarsal platform show, and brow fat span were measured using Image J digital photographic analysis and the images were scored by 110 non-ophthalmologists. The eyelid parameters were compared between the groups with Student t tests and the total aesthetic score was correlated to the measured parameters with Pearson's correlation coefficients (r). This study was HIPAA-compliant with protection of individually identifiable information.

RESULTS

Twenty male and 22 female participants were included and divided into 2 groups based on the aesthetic score. The average aesthetic score was 3.06 for males and 3.36 for females. None of the eyelid parameters were found to be significantly significant between the 2 male groups. In females, both inferior scleral show and tarsal platform show were significantly lower in the more aesthetic group. A greater margin-to-reflex distance correlated with increased aesthetic appeal. The ratio of brow fat span/tarsal platform show was not significantly different between the 2 female groups.

CONCLUSIONS

Quantifying goals are important for the surgical and nonsurgical management of the eyelid and periorbita. Beauty is considered to be subjective and is comprised of various criteria. However, this study reveals that the female sex may have certain quantifiable goals for eyelid parameters that are considered more aesthetically pleasing.

The Esthetic Difference of Chinese Beauty Evaluated by Two Different Human Races Based on Three-Dimensional Average Face Analysis

Supplemental Digital Content is available in the text

Purpose:

The aim of this study was to establish a new method of facial soft tissue analysis based on 3dMDface system and to find the different esthetic preferences of Chinese beauties from the Chinese and Indian evaluators perspective.

Methods:

Three-dimensional facial images of 242 females and 168 males were evaluated and ranked by 8 Chinese and nine Indians using a 10-point visual analog scale (VAS). Total 120 subjects in 2 panels (from Chinese perspective and Indian perspective) including 30 male and 30 female faces with top 30 scores were analyzed with the “average face” method respectively. Then 17 linear measurements, 13 curve measurements and 14 ratios of 4 average faces were calculated and compared with the divine proportion.

Results:

Distinct differences were founded based on the average face analysis. Similar total facial types were preferred by both Chinese and Indian evaluators, while Indian evaluators preferred a wider male face with a protrusive lower lip. Delicate noses with lower nose ridge but protrusive lower lips in females were more acceptable by Indian evaluators. The differences of linear measurements were limited in 2.0 mm except the facial width, lower facial width, upper facial height and forehead height while curve measurements differ distinctly as the table shows. No ratios equal to the divine proportion were founded.

Conclusion:

The 3D Average face based on stereophotogrammetry is a feasible method to analyze the facial characters and discrepancy of esthetic preferences. Chinese and Indian evaluators have some certain differences when judging beauties. Attractive faces have some certain ratios but not the divine proportion.

Subjectivity and complexity of facial attractiveness

The origin and meaning of facial beauty represent a longstanding puzzle. Despite the profuse literature devoted to facial attractiveness, its very nature, its determinants and the nature of inter-person differences remain controversial issues. Here we tackle such questions proposing a novel experimental approach in which human subjects, instead of rating natural faces, are allowed to efficiently explore the face-space and "sculpt" their favorite variation of a reference facial image. The results reveal that different subjects prefer distinguishable regions of the face-space, highlighting the essential subjectivity of the phenomenon. The different sculpted facial vectors exhibit strong correlations among pairs of facial distances, characterising the underlying universality and complexity of the cognitive processes, and the relative relevance and robustness of the different facial distances.

The signature featureTM : A new concept in beauty

Signature Feature^TM (SF) is a universal, yet highly personalized treatment approach to aesthetic facial enhancement that applies to all patients, independent of age, gender, or ethnicity. Its philosophical basis maintains that a patient's beauty is anchored by their most distinctive invariant features (invariant features like eyes, nose, cheekbones, or jawline), and preservation of such signature features should be an essential consideration in any aesthetic treatment plan. The principles central to the SF concept include: (a) identifying the patient's most distinctive signature feature, (b) matching the patient's persona to their signature feature while preserving alignment with their cultural/ethnic aesthetic, and (c) highlighting the patient's signature feature by increasing the "signal-to-noise" ratio between the strength of the signature feature and those factors that may be interfering with it (lines, wrinkles, and sun damage). Every patient represents a new combination of treatment challenges which are not only related to the patient's physical baseline characteristics but also by their subjective self-perceptions. This subjective gray area is where the SF treatment approach has the greatest contribution to the patient's positive self-perception and self-esteem, as the practitioner can help the patient realize their own personal brand through enhancement of their signature feature using an array of aesthetic options.

The Association Between Facial Proportions and Patient Satisfaction After Rhinoplasty: A Prospective Study

Hypothesis

Rhinoplasty is one of the most common aesthetic surgeries. The aim of the study was to evaluate facial proportions and patient satisfaction with the appearance of their nose after rhinoplasty compared to preoperatively.

Methods

This cross-sectional study was conducted at Islamic Azad University, Mashhad Branch. Eighty-two candidates with indications for primary cosmetic rhinoplasty were selected. Facial proportions and patient satisfaction with their nasal appearance were evaluated before and 6 months after rhinoplasty. Patient satisfaction was assessed using the Rhinoplasty Outcome Evaluation questionnaire.

Results

Eighty-two patients referred for cosmetic rhinoplasty (13.4% men and 86.6% women) with a mean age of 28.5 (6.4) years underwent open rhinoplasty and were evaluated. Facial proportions, including nasofrontal, nasolabial, and nasomental ratios increased significantly, while the nasofacial ratio, nasal tip projection, columellar show, alar base, and nasal length reduced significantly after rhinoplasty (P < .05). Furthermore, patient satisfaction with the appearance of their nose increased significantly after surgery (P < .001).

Conclusion

All of the facial proportions changed significantly following rhinoplasty. Although patient satisfaction with nose appearance increases significantly after the operation, there is no significant association between patient satisfaction and facial proportions. As beauty is a subjective, relative and qualitative issue, facial proportions may not be a proper tool to determine facial beauty and predict the satisfaction rate following rhinoplasty.

Proportions of the aesthetic African-Caribbean face: idealized ratios, comparison with the golden proportion and perceptions of attractiveness

Background

In the absence of clear guidelines for facial aesthetic surgery, most surgeons rely on expert intuitive judgement when planning aesthetic and reconstructive surgery. One of the most famous theories regarding “ideal” facial proportions is that of the golden proportion. However, there are conflicting opinions as to whether it can be used to assess facial attractiveness. The aim of this investigation was to assess facial ratios of professional black models and to compare the ratios with the golden proportion.

Methods

Forty photographs of male and female professional black models were collected. Observers were asked to assign a score from 1 to 10 (1 = not very attractive, 10 = very attractive). A total of 287 responses were analysed for grading behaviour according to various demographic factors by two groups of observers. The best graded photographs were compared with the least well-graded photographs to identify any differences in their facial ratios. The models’ facial ratios were calculated and compared with the golden proportion.

Results

Differences in grading behaviour were observed amongst the two assessment groups. Only one out of the 12 facial ratios was not significantly different from the golden proportion.

Conclusions

Only one facial ratio was observed to be similar to the golden proportion in professional model facial photographs. No correlation was found between facial ratios in professional black models with the golden proportion. It is proposed that an individualistic treatment for each ratio is a rather better method to guide future practice.

The 12-point Revitalization Guide to Pan-facial Application of Injectable Fillers in Older Women

Soft tissue filler augmentation for beautification is a common aesthetic request from women who wish to enhance facial features. These interventions are performed in both younger and older women and can result in exaggerated or over-augmented lips and cheeks. This unsatisfactory outcome in older women might be due to the inappropriate application of filler enhancement principles that are based the characteristics of a young face. These existing principles do not necessarily translate well to an older face due to underlying facial skeletal changes associated with aging. Mature women might prefer subtler corrections that do not significantly alter their faces, but rather refresh and revitalize their current appearance. Here, the author presents a 12-point revitalization guide, based on personal experience, as an approach for the pan-facial application of calcium hydroxylapatite and hyaluronic acid fillers specific to the aging female face that can result in an understated and age-appropriate appearance. Three illustrative cases are also presented.

Female Facial Attractiveness Assessed from Three-Dimensional Contour Lines by University Students

BACKGROUND

Three-dimensional (3D) images could provide more accurate evaluation for facial attractiveness than two-dimensional (2D) images. The 3D facial image could be simplified into gray scale 3D contour lines. Whether female facial attractiveness could be perceived in these simplified 3D facial contour lines should be determined.

METHODS

A series of 100 2D photographs (one frontal and two lateral views) and 3D contour lines extracted from 3D facial images of females were projected onto a screen. Each image presentation lasted 5 s, and the evaluators marked their impression of each image's facial attractiveness on a five-point Likert scale within 3 s of its presentation. The evaluation of the 3D contour lines was performed twice, 2 weeks apart. The evaluators were university students.

RESULTS

High consistency (r = 0.92) was found for the first and second evaluation of 3D facial contour lines for female facial attractiveness. The judgments of unattractive face were more consistent than the judgments of attractive face. Male students tended to give lower scores than female students in the evaluation of female facial attractiveness.

CONCLUSIONS

Female facial attractiveness could be evaluated by 3D facial contour lines. 3D facial contour lines should be one of the key factors of facial attractiveness.

Art or Science? An Evidence-Based Approach to Human Facial Beauty a Quantitative Analysis Towards an Informed Clinical Aesthetic Practice

BACKGROUND

Patients often seek guidance from the aesthetic practitioners regarding treatments to enhance their 'beauty'. Is there a science behind the art of assessment and if so is it measurable? Through the centuries, this question has challenged scholars, artists and surgeons.

AIMS AND OBJECTIVES

This study aims to undertake a review of the evidence behind quantitative facial measurements in assessing beauty to help the practitioner in everyday aesthetic practice.

METHODS

A Medline, Embase search for beauty, facial features and quantitative analysis was undertaken.

SELECTION CRITERIA

Inclusion criteria were studies on adults, and exclusions included studies undertaken for dental, cleft lip, oncology, burns or reconstructive surgeries. The abstracts and papers were appraised, and further studies excluded that were considered inappropriate. The data were extracted using a standardised table. The final dataset was appraised in accordance with the PRISMA checklist and Holland and Rees' critique tools.

RESULTS

Of the 1253 studies screened, 1139 were excluded from abstracts and a further 70 excluded from full text articles. The remaining 44 were assessed qualitatively and quantitatively. It became evident that the datasets were not comparable. Nevertheless, common themes were obvious, and these were summarised.

CONCLUSION

Despite measures of the beauty of individual components to the sum of all the parts, such as symmetry and the golden ratio, we are yet far from establishing what truly constitutes quantitative beauty. Perhaps beauty is truly in the 'eyes of the beholder' (and perhaps in the eyes of the subject too).

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Differences between Caucasian and Asian attractive faces

INTRODUCTION

There are discrepancies between the public's current beauty desires and conventional theories and historical rules regarding facial beauty. This photogrammetric study aims to describe in detail mathematical differences in facial configuration between attractive Caucasian and attractive Asian faces.

METHODS

To analyse the structural differences between attractive Caucasian and attractive Asian faces, frontal face and lateral face views for each race were morphed; facial landmarks were defined, and the relative photographic pixel distances and angles were measured. Absolute values were acquired by arithmetic conversion for comparison.

RESULTS

The data indicate that some conventional beliefs of facial attractiveness can be applied but others are no longer valid in explaining perspectives of beauty between Caucasians and Asians. Racial differences in the perceptions of attractive faces were evident. Common features as a phenomenon of global fusion in the perspectives on facial beauty were revealed.

CONCLUSIONS

Beauty standards differ with race and ethnicity, and some conventional rules for ideal facial attractiveness were found to be inappropriate. We must reexamine old principles of facial beauty and continue to fundamentally question it according to its racial, cultural, and neuropsychological aspects.

Association of overjet and overbite with esthetic impairments of oral health-related quality of life

OBJECTIVE

Esthetics is an important part of quality of life and a frequent reason for orthodontic treatment demand. It was the aim of this study to investigate whether esthetic impairments, related to overjet and overbite, can be assessed with an established oral health-related quality of life instrument.

MATERIALS AND METHODS

Data from 1968 participants (age: 16-90 years; 69.8% female) from three German surveys were analyzed. Esthetic impairments of oral health-related quality of life were measured with four questions of the Oral Health Impact profile (OHIP), which comprise esthetic aspects of oral health-related quality of life. Higher values represent greater esthetic impairment (sum score: 0-16). Overbite and overjet values were categorized (≤ - 1 mm, 0-1 mm, 2-3 mm, 4-5 mm, ≥ 6 mm). The specific impact of each category on esthetic impairment, in relation to the reference category (2-3 mm), was calculated in linear regression analyses. The type of relationship and the specific impact of overbite and overjet were evaluated in regression analyses with fractional polynomials.

RESULTS

Overbite ranged from - 5 to 15 mm (mean: 3.2 mm) and overjet from - 7 to 19 mm (mean: 3.1 mm). Both an increase and a decrease in overjet, in relation to the reference category, resulted in more esthetic-related oral health-related quality of life impairments. However, in this model, only the effect for increased overjet was statistically significant (4-5 mm: + 0.4 OHIP points; ≥ 6 mm: + 0.9 OHIP points). In the regression analysis with fractional polynomials, both an increase and a decrease in overjet resulted in more esthetic impairments, characterized by a U-shaped relationship. No association could be verified for overbite.

CONCLUSION

A substantial increase or decrease of overjet from the reference values is associated with esthetic impairments of oral health-related quality of life, whereas the extent of overbite seems to have no impact on esthetics.

Brain responses to facial attractiveness induced by facial proportions: evidence from an fMRI study

Brain responses to facial attractiveness induced by facial proportions are investigated by using functional magnetic resonance imaging (fMRI), in 41 young adults (22 males and 19 females). The subjects underwent fMRI while they were presented with computer-generated, yet realistic face images, which had varying facial proportions, but the same neutral facial expression, baldhead and skin tone, as stimuli. Statistical parametric mapping with parametric modulation was used to explore the brain regions with the response modulated by facial attractiveness ratings (ARs). The results showed significant linear effects of the ARs in the caudate nucleus and the orbitofrontal cortex for all of the subjects, and a non-linear response profile in the right amygdala for only the male subjects. Furthermore, canonical correlation analysis was used to learn the most relevant facial ratios that were best correlated with facial attractiveness. A regression model on the fMRI-derived facial ratio components demonstrated a strong linear relationship between the visually assessed mean ARs and the predictive ARs. Overall, this study provided, for the first time, direct neurophysiologic evidence of the effects of facial ratios on facial attractiveness and suggested that there are notable gender differences in perceiving facial attractiveness as induced by facial proportions.

Chen's Double Eyelid Fold Ratio

BACKGROUND

Double eyelidplasty can construct palpebral folds and enhance beauty perception for Asians with single eyelids. A new palpebral parameter for the quantitative interpretation of surgical outcomes is proposed on the basis of a photometric study of the altered proportions of Asian eyes after double eyelid operation.

METHODS

A total of 100 Asian adults with single upper eyelids who were satisfied with the enlarged eyes by operation were included in the study. A retrospective measurement of palpebral parameters in the frontal profile both preoperatively and 6 months postoperatively was performed. The proportions of various parameters in the eyebrow-eye aesthetic unit were calculated and analyzed.

RESULTS

Double eyelidplasty can augment the vertical dimension of palpebral fissure by 27.9% increase on average. The vertical ratio of palpebral fissure to the eyebrow-eye unit is augmented by 34.4% increase. The vertical ratio of the subunit below double eyelid fold peak to the unit is augmented by 82.6% increase.

CONCLUSIONS

Double eyelidplasty can substantially enlarge the vertical dimensions of the eyes of Asians with single eyelids. The eyes are perceived to be larger because of the visually assimilated illusion of the superimposed eyelid fold and the relative proportions of the eyebrow-eye unit. The authors propose using a vertical ratio of the subunit below double eyelid fold peak in the eyebrow-eye unit to measure the visually perceived proportion of the eye in the unit. This ratio can be applied clinically for a quantitative evaluation of the surgical outcome after double eyelidplasty.

Anthropometric comparison of painting portraits of beautiful women, femme fatales, and artists' mothers

The aim of this study was to compare the painting portraits of beautiful women, femme fatales, and artists' mothers using anthropometry.Portraits of each theme were selected in modern novels, essays and picture books, and categorized portraits. A total of 52 samples were collected, including 20 beautiful women, 20 femme fatales, and 12 artists' mothers. In 5 persons, 17 anthropometric ratios including the alae-alae/zygion-zygion ratio were compared in a 15-degree oblique view and in anteroposterior view photographs, and they were proved to not differ significantly. To distinguish oblique portraits less than 15 degrees, we measured the exocanthion-stomion-exocanthion (ESE) angle in photographs of 5 volunteers. The mean ± SD of the ESE angle was 64.52 ± 4.87 in the 15-degree angle view and 57.68 ± 54.09 in the 30-degree angle view. Thereafter, if the ESE angle was greater than 65 degrees, we considered the portrait to have less than a 15-degree angle and included it in the samples.The ratio did not differ significantly in 11 anthropometric proportions. However, the remaining 5 proportions were statistically significant. Beautiful women had wider noses (85% of the endocanthion-endocanthion width) than those of the femme fatale group (77%). Lips in the beautiful woman group are nicer and thicker (36% of lip's width) compared with the artists' mother group (27%). Femme fatales were relatively similar to beautiful women such as those women with nice and thick lips. However, the femme fatale group had an attractive midface ratio (36% of the total face height) that has been mentioned in the older literature, and the noses of the femme fatale group were narrower and sharper (77% of the endocanthion-endocanthion width) than those of the beautiful women (85%). The artists' mother group has a relatively narrower upper face (29% of the total face height) and thinner lips (27% of the lip width) compared with the other 2 groups (36%).Proportions from works of art are more ideal and attractive than clinically measured proportions. The ideal ratios measured from historical portraits might be useful in planning facial surgeries.

Centralization or decentralization of facial structures in Korean young adults

It is well known that facial beauty is dictated by facial type, and harmony between the eyes, nose, and mouth. Furthermore, facial impression is judged according to the overall facial contour and the relationship between the facial structures. The aims of the present study were to determine the optimal criteria for the assessment of gathering or separation of the facial structures and to define standardized ratios for centralization or decentralization of the facial structures.Four different lengths were measured, and 2 indexes were calculated from standardized photographs of 551 volunteers. Centralization and decentralization were assessed using the width index (interpupillary distance / facial width) and height index (eyes-mouth distance / facial height). The mean ranges of the width index and height index were 42.0 to 45.0 and 36.0 to 39.0, respectively. The width index did not differ with sex, but males had more decentralized faces, and females had more centralized faces, vertically. The incidence rate of decentralized faces among the men was 30.3%, and that of centralized faces among the women was 25.2%.The mean ranges in width and height indexes have been determined in a Korean population. Faces with width and height index scores under and over the median ranges are determined to be "centralized" and "decentralized," respectively.

Beauty in a multicultural world

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.

Neural responses to cartoon facial attractiveness: An event-related potential study

Animation creates a vivid, virtual world and expands the scope of human imagination. In this study, we investigated the time-courses of brain responses related to the evaluation of the attractiveness of cartoon faces using the event-related potential (ERP) technique. The results demonstrated that N170 amplitude was higher for attractive than for unattractive cartoon faces in males, while the opposite was found in females. Facial attractiveness notably modulated the late positive component (LPC), which might reflect the task-related process of aesthetic appraisal of beauty. The mean LPC amplitude in males was significantly higher for attractive cartoon faces than for unattractive faces, while the LPC amplitude in females did not significantly differ between attractive and unattractive cartoon faces. Moreover, the paint mode (computer graphics, gouache, and stick figure) modulated the early encoding of facial structures and the late evaluative process. The early modulation effect by paint mode may be related to the spatial frequency of the pictures. The processing speed and intensity in females were both higher than those in males. In conclusion, our study, for the first time, reported ERP modulation based on the assessment of cartoon facial attractiveness, suggesting the facilitated selection of attractiveness information at the early stage, and that the attentional enhancement of attractive faces at the late stage only exists in males. This suggests that men's brains are hard-wired to be sensitive to facial beauty, even in cartoons.

Evaluation of facial attractiveness for patients with malocclusion: a machine-learning technique employing Procrustes

OBJECTIVE

To establish an objective method for evaluating facial attractiveness from a set of orthodontic photographs.

MATERIALS AND METHODS

One hundred eight malocclusion patients randomly selected from six universities in China were randomly divided into nine groups, with each group containing an equal number of patients with Class I, II, and III malocclusions. Sixty-nine expert Chinese orthodontists ranked photographs of the patients (frontal, lateral, and frontal smiling photos) before and after orthodontic treatment from "most attractive" to "least attractive" in each group. A weighted mean ranking was then calculated for each patient, based on which a three-point scale was created. Procrustes superimposition was conducted on 101 landmarks identified on the photographs. A support vector regression (SVR) function was set up according to the coordinate values of identified landmarks of each photographic set and its corresponding grading. Its predictive ability was tested for each group in turn.

RESULTS

The average coincidence rate obtained for comparisons of the subjective ratings with the SVR evaluation was 71.8% according to 18 verification tests.

CONCLUSIONS

Geometric morphometrics combined with SVR may be a prospective method for objective comprehensive evaluation of facial attractiveness in the near future.

Children and adults use attractiveness as a social cue in real people and avatars

Observing social interactions between children and adults is a major method in the toolkit of psychologists who examine social development and social relationships. Although this method has revealed many interesting phenomena, it cannot determine the effect of behavior independent of other traits. Research on the role of attractiveness in social development provides an example of this conundrum: Are attractive and unattractive children/adults treated differently because of their attractiveness (independent of their behavior), do they behave differently and thus elicit differential treatment, or both? Virtual world and avatar-based technologies allow researchers to control the social behaviors of targets; however, whether children and adults use the facial attractiveness of avatars as a social cue in the same way as they do with real peers is currently unknown. Using Mii avatars from the popular Nintendo Wii video game console, Study 1 found that the facial attractiveness ratings of real people strongly predicted the attractiveness ratings of avatar faces based on the former group. Study 2 revealed that adults (n=46) and children (n=42) prefer attractive avatars as social partners. The results of this set of methodological studies may help to clarify future research on the relationship between attractiveness and behavior throughout the lifespan. Furthermore, the use of avatars may allow studies to experimentally examine the effects of attractiveness in situations where such research is not ethical (e.g., peer victimization).

Stimulus requirements for face perception: an analysis based on "totem poles"

The stimulus requirements for perceiving a face are not well defined but are presumably simple, for vivid faces can often by seen in random or natural images such as cloud or rock formations. To characterize these requirements, we measured where observers reported the impression of faces in images defined by symmetric 1/f noise. This allowed us to examine the prominence and properties of different features and their necessary configurations. In these stimuli many faces can be perceived along the vertical midline, and appear stacked at multiple scales, reminiscent of "totem poles." In addition to symmetry, the faces in noise are invariably upright and thus reveal the inversion effects that are thought to be a defining property of configural face processing. To a large extent, seeing a face required seeing eyes, and these were largely restricted to dark regions in the images. Other features were more subordinate and showed relatively little bias in polarity. Moreover, the prominence of eyes depended primarily on their luminance contrast and showed little influence of chromatic contrast. Notably, most faces were rated as clearly defined with highly distinctive attributes, suggesting that once an image area is coded as a face it is perceptually completed consistent with this interpretation. This suggests that the requisite trigger features are sufficient to holistically "capture" the surrounding noise structure to form the facial representation. Yet despite these well articulated percepts, we show in further experiments that while a pair of dark spots added to noise images appears face-like, these impressions fail to elicit other signatures of face processing, and in particular, fail to elicit an N170 or fixation patterns typical for images of actual faces. These results suggest that very simple stimulus configurations are sufficient to invoke many aspects of holistic and configural face perception while nevertheless failing to fully engage the neural machinery of face coding, implying that that different signatures of face processing may have different stimulus requirements.