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In modern culture, beauty reigns supreme. Everywhere we look-whether it's magazines, TV shows or movies-beautiful people dominate. We aspire to be beautiful and if we're not, we are intrigued by the possibility of becoming so. Witness the popularity of shows such as "Extreme Makeover" and "Dr. 90210."
Our quest for beauty isn't a modern obsession. Philosophers and poets chronicle the importance of beauty-and the virtues that accompany it. In Timaeus, Plato states that "The good, of course, is always beautiful."1In "Ode on a Grecian Urn," Keats writes that "Beauty is truth, truth beauty-that is all." And Emerson describes beauty as "The mark God sets upon virtue."2
While many continue to revere beauty and pursue it, others condemn it and consider its pursuit a waste of time and energy. Feminists argue that emphasizing beauty reinforces the idea of sexual inferiority. It's not uncommon for protests to accompany beauty pageants and runway shows. Popular children's stories, such as "The Ugly Duckling" and "Beauty and the Beast," advise us against placing too much emphasis on beauty. And proverbs, such as "Beauty is only skin deep," and "Don't judge a book by its cover," reinforce this.
What is Beauty?
But what is beauty and how do we define its characteristics? This question is critical to sound cosmetic medicine practice. Beginning with the ancient Greek philosophers, people have attempted to define beauty.
Since 1970, more than 2,000 published articles have examined theories of beauty and attractiveness. Although no clear agreement exists as to what defines beauty, several fundamental ideas about facial attractiveness guide us in our efforts in cosmetic medicine. They are symmetry, proportion, neoteny and sexual dimorphism.
Symmetry. This is an easily perceived characteristic and one of the strongest components of attractiveness. This is why we see beauty in objects such as flowers, butterfly wings and coral fish. In human faces, we look for right and left symmetry. Obvious distortions in symmetry are universally considered less attractive.
Slight facial asymmetry, however, is extremely common. In fact, it's rare to find a person with a perfectly symmetrical face. The most common areas of asymmetry include the eyebrows (shape and position), eyes (shape) and nose (curvatures). When evaluating a patient, I commonly point out facial asymmetries. Most of the time, the patient doesn't notice the asymmetry. Recreating symmetry, however, has a powerful impact on improving her facial aesthetics.
Slight facial asymmetry can be demonstrated using chimeric images. A chimeric image is made by replacing one half of the face with an exact mirror image of the other half of the face. The result is a perfectly symmetric image composed of two left halves or two right halves. (See Figure 1.) When looking at an original image and comparing it to chimeric images, we see slight facial asymmetries.
The fact that we perceive symmetry as attractive illustrates that the human face is judged as a whole, rather than on its individual parts.
Proportion. The ancient Greeks thought the secret to beauty lay in harmonious proportions. They found that the ideal face can be divided into three sections: from hairline to eyes, from eyes to upper lip and from upper lip to chin. The ideal face is also two-thirds wide as it is high. Mathematicians from the 17thand 18thcenturies expounded on this idea and determined the ideal size of eyes, the space between them, and the relationship between the mouth and the nose.
Neoclassical canons were developed that defined beauty based on rules of proportions. These canons are still used in painting and sculpting and serve as a guideline for training cosmetic surgeons. (See Table 1.)
This proportional relationship is extremely important in my practice, particularly the relationship between the middle and lower "thirds" of the face. It's common for someone to request rhinoplasty to correct a "large" nose. A proportional evaluation of the face, however, may reveal that the issue is not a large nose, but rather a small chin. The real problem can be found in the discrepancy between the middle and lower third of the face. Enlarging the lower third of the face through chin augmentation can correct this perceived "large" nose, thus rebalancing the face without nasal surgery. (See Figure 2.)
Neoteny. Neoteny or "babyness" refers to having characteristics of newborns. Youthful faces are not necessarily more attractive. Rather, it's the characteristics of youth that are considered attractive: round cheeks, large eyes, small nose and smooth skin.
Adults with "baby" features are judged more attractive. This can be demonstrated when facial images are digitally manipulated to have larger eyes and rounder cheeks. The results are consistent among different races, cultures and ethnicities. So when patients request that I make their faces look "younger," they're actually requesting that I create facial features found in the very young.
In women, there's a trend for higher and fuller cheeks, which are characteristic of a newborn. The advent of injectable fillers now allows us to achieve this look without surgery.
Sexual Dimorphism. This notion of sexual dimorphism refers to the difference between male and female facial features. Male and female facial characteristics occur from different hormonal influences during puberty. It's what makes a face masculine or feminine.
For instance, the testosterone in men causes increased growth of facial bones. Wider cheeks, increased eyebrow ridges and a larger jaw are the result. A wide face, heavy brow and square jawline are considered classically "male."
Estrogen encourages fat deposition in the cheeks and lips and decreases facial bone growth. This gives women a classically "female" face, with plump cheeks and lips, a narrow face and softer features. (See Table 2.)
In judging male faces, women consider those with strong "male" features as more attractive. Similarly, men find women with "female" features more attractive. This is important to understand when considering cosmetic surgery so we don't "feminize" a male face or "masculinize" a female face.
Looks Do Matter
In nature, beauty among animals helps encourage mating and survival of the species. Take note of the bright colors of male birds. Evolutionary psychologists believe this is true in humans as well, thus providing a survival benefit to attractive people.
Our society places great importance on beauty, and scientific studies confirm an advantage to people who are beautiful. Studies have shown that the "halo effect" causes strangers to attribute positive qualities to more attractive people. Attractive children tend to be more popular in school, as well as receive higher grades and more positive personality evaluations.
In simulated court appearances, attractive people were more likely to receive lesser sentences. Additionally, attractive people are more likely to receive help from strangers in public places, such as subways, hospitals and highways.3
Economic implications exist as well. A Canadian study examining the effect of attractiveness in the workplace found that 81 percent of attractive people were judged by evaluators to be "sincere," as compared to only 59 percent of less attractive people. Financial implications also exist, with attractive people earning higher wages than unattractive people. This is most likely a result of the "sincerity" perception, rather than because of looks alone.4
Whether right or wrong, looks do matter. It's na•ve to say they don't.
The difficulty in defining beauty is that it's ever-changing, and what is judged to be beautiful today may not be so tomorrow. Many claim that the media dictates what society considers beautiful through popular magazine features, such as People's "100 Most Beautiful People" and Maxim's "Hot 100." Does the media influence our perception of beauty? Or is the media merely reacting to our evolving vision of what is beautiful?
We have endless data, from psychologists and philosophers to neuroscientists and cosmetic surgeons, about what defines attractiveness. The fact remains, though, that we may never to able to define beauty. This is because beauty is more perception than reality. It's best defined by the reaction of the observer. Beauty evokes feelings of pleasure, joy and delight. Attractiveness is only one small part of beauty.
Without sounding too cliché, science has failed to show us that beauty isn't in the eye of the beholder.
For a list of references, go to www.advanceweb.com/healthyaging and click on the references toolbar.
Matthew R. Schulman, MD, is a plastic surgeon in private practice at Madison Avenue Plastic Surgery in New York City. He is assistant professor of plastic surgery at The Mount Sinai School of Medicine in New York, as well as attending plastic surgeon at The Mount Sinai Medical Center in New York. He is board-certified by the American Board of Plastic Surgery and a member of the American Society of Plastic Surgeons. In addition, he is medical director of Euphoria Spa in New York City.
Disclosure: Dr. Schulman indicates that he has no affiliations with any commercial entities, directly or indirectly referenced in this article. <% footer %>
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