Surgical Facial Harmonization: Cat-eye Brow Lift, Forehead Reduction, Using Facial Thirds in Surgery

When I was younger, I was taught how to draw a perfect face and I apply similar principles to surgery. I commonly discuss how important subtle changes are, and how I strive to avoid “obvious” changes. At the same time, beautification is important, and both goals can be met by adhering to basic principles of facial beauty. This is what surgical facial harmonization is all about.

Beauty is a challenge to define, as intangible cultural and psychological influences play as significant a role as measurable physical features. Attempts at quantifying beauty include prototype masks and analyzing adherence to divine proportions. Beauty and attractiveness are parameters of interpersonal perception that are related but distinct; beauty holds a more objective connotation while attraction is subject to motivational forces. Symmetric, smooth features, large eyes, and facial harmony enhance objective beauty.

There is a growing literature describing methods to quantify beauty. I’ve personally written on the topic. Modern theories of averageness and group prototype imply humans are capable of recognizing incongruities from regional or global standards. Evaluation of static photographs neglects the important influence of facial dynamism. Still, beauty may be sufficiently measurable to allow us to compare various surgical techniques and interventions. In 2006, Bashour endorsed Masquelet’s phi mask theory but implicated the importance of additional cues and exposed flaws in its design. He compared the theory to subjective evaluations using visual analog scale (VAS) based scoring system. This was the first time a virtual, internet-based medium was used for facial analysis.

If we perceive beauty instantaneously on the basis of digital images, the potential of online focus groups becomes relevant. Online resources promise high volume data across demographics at little cost, compared to traditional focus groups. However, subjecting protected information to virtual focus groups has legal implications, and may be weakened by rater anonymity and bias.

We can only contemplate myriad reasons people seek plastic surgery. We respect Sir Francis Galton’s unintended discovery that a composite average face is more attractive than individual faces, but we imagine clients seek more than averageness. This conundrum is the focus of my own surgical practice and the interwoven elements (wellness, surgery, and skincare) of the Zelken Institute.