Facial Aesthetic Ideals: A Literature Summary of Supporting Evidence.

BACKGROUND: To achieve the goal of enhancing facial beauty it is crucial for aesthetic physicians and plastic surgeons to have a deep understanding of aesthetic ideals. Although numerous aesthetic criteria have been proposed over the years, there is a lack of empirical analysis supporting many of these standards. OBJECTIVES: This aim of this review was to undertake the first exploration of the empirical evidence concerning the aesthetic ideals of the face in the existing literature. METHODS: A comprehensive search in MEDLINE, Embase, Scopus and CENTRAL databases was conducted for primary clinical studies reporting on the classification of the facial aesthetic units as per the Gonzales-Ulloa facial aesthetic unit classification from January 1962 to November 2022. RESULTS: A total of 36 articles were included in the final review: 12 case series, 14 cohort studies, and 10 comparative studies. These described the aesthetic ideals of the following areas: forehead (6 studies; mean level of evidence, 3.33); nose (9 studies; mean level of evidence, 3.6); orbit (6 studies; mean level of evidence, 3); cheek (4 studies; mean level of evidence, 4.07); lips (6 studies; mean level of evidence, 3.33); chin (4 studies; mean level of evidence, 3.75); ear (1 study; level of evidence, 4). CONCLUSIONS: The units that were most extensively studied were the nose, forehead, and lip, and these studies also appeared in journals with higher impact factors than other subunits. Conversely, the chin and ear subunits had the fewest studies conducted on them and had lower impact factors. To provide a useful resource for readers, it would be prudent to identify and discuss influential papers for each subunit.

Facial Beauty and the Correlation of Associated Attributes: An Empirical Aesthetic Database Study.

Background: The pursuit of understanding facial beauty has been the subject of scientific interest since time immemorial. How beauty is associated with other perceived attributes that affect human interaction remains elusive. This article aims to explore how facial attractiveness correlates with health, happiness, femininity, and perceived age. We review the existing literature and report an empirical study using expert raters. Methods: A peer-reviewed database of 2870 aesthetic female faces with a global ethnic distribution was created. Twenty-one raters were asked to score frontal images on the attributes of health, happiness, femininity, perceived age, and attractiveness, on a Likert scale of 0-100. Results: Pearson correlation coefficients ("r") were calculated to correlate attributes, with multiple regression analyses and P values calculated. Strong positive correlation was found between attractiveness and health (r = 0.61, P < 0.05), attractiveness and femininity (r = 0.7, P < 0.05), and health and femininity (r = 0.57, P < 0.05); medium positive correlation between health and happiness (r = 0.31, P < 0.05); and small positive correlation between happiness and femininity (r = 0.21, P < 0.05). A neutral relationship was observed between perceived age and happiness (0.01, P = 0.75), and medium negative correlation between perceived age and attractiveness (-0.32, P < 0.05), health (-0.36, P < 0.05), and femininity (-0.31, P < 0.05). Conclusions: Our study illustrates a positive correlation between the positive attributes of health, happiness, femininity and attractiveness, with a negative correlation of all characteristics with increasing perceived age. This provides insight into the complexity of human interaction and provides a holistic view of attraction as being a gateway to the reflexive perception of other attributes. The implications encourage an aesthetic focus on facial reconstruction.

Face Structure, Beauty, and Race: A Study of Population Databases Using Computer Modeling.

Background: Understanding the differences in facial shapes in individuals from different races is relevant across several fields, from cosmetic and reconstructive medicine to anthropometric studies. Objectives: To determine whether there are features shared by the faces of an aesthetic female face database and if they correlate to their racial demographics using novel computer modeling. Methods: The database was formed using the "top 100 most beautiful women" lists released by "For Him Magazine" for the last 15 years. Principal component analysis (PCA) of 158 parameters was carried out to check for clustering or racial correlation with these clusters. PCA is a machine-learning tool used to reduce the number of variables in a large data set, allowing for easier analysis of the data while retaining as much information as possible from the original data set. A review of the literature on craniofacial anthropometric differences across ethnicities was also undertaken to complement the computer data. Results: Two thousand eight hundred and seventy aesthetic faces formed the database in the same racial proportion as 10,000 faces from the general population as a baseline. PCA clustering illustrated grouping by latent space parameters for facial dimensions but showed no correlation with racial demographics. There was a commonality of facial features within the aesthetic cohort, which differed from the general population. Fourteen papers were included in the review which contained 8142 individuals. Conclusions: Aesthetic female faces have commonalities in facial features regardless of racial demographic, and the dimensions of these features vary from the baseline population. There may even be a common human aesthetic proportion that transcends racial boundaries, but this is yet to be elucidated.

Three-Dimensional Photography and Computer Modeling as a Reconstructive Surgical Training Tool.

Background: Reconstructive surgery operations are often complex, staged, and have a steep learning curve. As a vocational training requiring thorough three-dimensional (3D) understanding of reconstructive techniques, the use of 3D photography and computer modeling can accelerate this learning for surgical trainees. Objectives: The authors illustrate the benefits of introducing a streamlined reconstructive pathway that integrates 3D photography and computer modeling, to create a learning database for use by trainees and patients alike, to improve learning and comprehension. Methods: A computer database of 3D photographs and associated computer models was developed for 35 patients undergoing reconstructive facial surgery at the Royal Free Hospital, London, UK. This was used as a training and teaching tool for 20 surgical trainees, with an MCQ questionnaire assessing knowledge and a Likert scale questionnaire assessing satisfaction with the understanding of core reconstructive techniques, given before and after teaching sessions. Data were analyzed using the Mann-Whitney U test for trainee knowledge and Wilcoxon rank sum test for trainee satisfaction. Results: Trainee (n = 20) knowledge showed a statistically significant improvement, P < .01, as did trainee satisfaction, P < .05, after a teaching session using 3D photography and computer models for facial reconstruction. Conclusions: Three-dimensional photography and computer modeling are useful teaching and training tools for reconstructive facial surgery. The authors advocate the implementation of an integrated pathway for patients with facial defects to include 3D photography and computer modeling wherever possible, to develop internal databases for training trainees as well as patients. This algorithm can be extrapolated to other aspects of reconstructive surgery.

Patient-Reported Outcome Measures in a Facial Reconstruction Case Series Following the Implementation of an Integrated Craniofacial Multidisciplinary Team Clinic, Three-Dimensional Photography, and Computer Modeling.

Background: Facial reconstruction surgery is often a complex and staged process, leading to lengthy reconstructive journeys for patients. The integration of a clinical pathway can give patients a clearer understanding of what to expect at each stage of their reconstructive journey. Objectives: The authors demonstrate how the incorporation of multidisciplinary team clinics, three-dimensional (3D) photography, and 3D modeling into an integrated pathway can streamline the process for patients undergoing facial reconstructive surgeries and aid their understanding of their surgeries. Methods: A novel clinical pathway was developed for patients undergoing facial reconstructive surgery at a tertiary reconstructive unit in London. A case series was collated of 35 patients who had been through the integrated pathway. Patient-reported outcome measures (PROMs) were assessed using FACE-Q scales, Global Aesthetic Improvement Scale, Self-Perception of Age score, and Ordinal Rank change in facial aesthetic appearance, determined subjectively and objectively. Statistical analysis was performed to calculate mean averages for each scale and PROM. Results: High patient satisfaction with overall facial appearance, aging appearance, and the decision-making process was demonstrated. The average perceived improvement in age-related facial appearance was -7.7 years postreconstruction compared with prereconstruction. The Ordinal Rank improvement on facial aesthetic appearance showed considerable improvement, both subjectively and objectively. Conclusions: The authors advocate the implementation of an integrated clinical pathway for facial reconstruction, with positive impacts observed in terms of patient satisfaction and objective assessments of facial appearance. Similar principles can be extrapolated to other aspects of reconstructive surgery.

3D photography and computer modelling in nasal reconstruction.

Advances in high resolution 3D photography and computer modelling are revolutionising patient workup, surgical planning, patient satisfaction, clinical outcomes, and surgical training. We present a case in which this technology is utilised for a patient undergoing a forehead flap for reconstruction of a nasal defect, allowing us to develop a novel reconstructive algorithm. 3D photographs were taken pre-operatively, a computer model rendered and follow up photographs taken at each stage of the reconstruction using a Vectra XT camera. Patient satisfaction was measured qualitatively postoperatively. Prior to each stage we were able to use the 3D photographs to make thorough preoperative plans whilst minimising the number of outpatient appointments the patient required. With the images always at hand, we had much more time to make measurements and consider alterations. Utilising the 3D models in clinic and MDT allowed us to have more insightful outpatient appointments, in which we were able to discuss and illustrate each subsequent stage. The use of 3D photography and computer modelling allows for a greater level of care to patients by improving understanding and satisfaction and alleviating anxiety. It also reduced operative time, improves surgical planning, and acts as an excellent resource for surgical trainees and future patients.

Lower third chest wall reconstruction in a bilateral sequential lung transplant recipient.

Reconstruction of the sternum following deep sternal wound infection (DSWI) can be challenging, and despite advances in reconstructive surgery, DSWI remains a significant cause of morbidity and mortality in cardiothoracic patients. Transplantation patients present an additional, unique challenge for the reconstructive surgeon. These patients are often on immunosuppressant therapy, with multiple comorbidities, and cannot tolerate prolonged operations for reconstruction. They often have a prior extensive surgical history, which may limit donor options; and their wounds are often in the lower third of the sternum, which is a challenging location to reconstruct with locoregional tissues.We report a case of successful lower third chest wall reconstruction in a bilateral lung transplant recipient with a combination of bilateral pectoralis advancement flaps and omentoplasty.