Optimizing Facial Structure to Maximize Beauty

You’ve been told over and over again since you were a child that beauty is not skin deep. While this is certainly true from a social standpoint, it is also true from an aesthetic standpoint. While the importance of radiant skin and situation-appropriate makeup cannot be overstated in achieving a stunning look, it is useful to understand how the foundation of the facial skeleton itself can be manipulated (often noninvasively!) to propel a face to the ranks of astonishing beauty. I like to think of facial structure in terms of three categories that can influence facial appearance. First, overall facial shape: is the face a youthful heart-shape or is there descent and deflation of soft tissues giving more weight to the lower facial third? Second, the facial features: are they optimal as individual entities, and are they balanced with one another to lend a well-proportioned look to the face as a whole? Finally, I assess facial symmetry: a symmetrical face has been innately associated with beauty for as long as written records of the concept have been available.

Lets begin with facial shape. One of the most classic facial shapes associated with youth and beauty is that of a heart. High, well-supported cheekbones that gently give way to a defined jawline below and support wide, bright eyes above are a staple of this look. Two factors contribute to prominent cheeks: strong cheekbones (called the “zygoma”) and a full, high malar fat pad. If these elements are not present, they can both be addressed with either filler or fat grafting. A tight jawline can be defined with high-definition liposuction (a 45-minute office procedure). The jawline can also be enhanced with filler or fat grafting where appropriate. If there is minor skin laxity, this can be addressed with radiofrequency energy. More significant laxity can be treated with more invasive procedures like a facelift. A week chin can be made stronger noninvasively with filler or fat grafting. More severe weakness can be addressed with an osseous genioplasty, a procedure in which the bone of the chin is moved down and forward as necessary and plated into its new position. If a chin is too prominent, a genioplasty can be performed to move it further back. Major imbalances in facial shape can be addressed with jaw surgery (“orthognathic” surgery) designed to completely rebalance facial proportions.

Moving on to facial features, there is a defined range of “normal” distance between the eyes. If the eyes are too close together, this is called “hypotelorism.” Too far apart? “Hypertelorism.” It is possible to surgically move entire eye sockets (“orbits”) with a procedure called a “box osteotomy,” in which the orbit is cut free from surrounding bone and moved to its new position. This is major surgery and reserved for reconstructive procedures only. Some degree of hypertelorism is actually considered attractive by many observers, and can be observed in many celebrities. In extreme cases, the distance between the eyes can be made to look smaller by building up the nasal dorsum (top of the nose) – a very effective optical illusion. Speaking of noses, the aesthetically pleasing nose is an entire topic unto itself. For now let us say that a well-proportioned nose that fits the face is a critical element of facial beauty, and a skilled aesthetic surgeon has many tricks up his or her sleeve to achieve this goal. Some fixes (including camouflaging a big bump) can be made instantaneously with filler (think “liquid rhinoplasty”), while more extensive work requires rhinoplasty (nose job) surgery.

Finally, all of the above elements must come together in the form of a symmetrical face. Symmetry in nature is a sign of health and vitality, and human beings have evolved to be attracted to this attribute in potential mates. We can use all of the tools discussed here to achieve improved symmetry. Filler or fat grafting can be employed asymmetrically to compensate for an underlying skeletal asymmetry, or in more severe scenarios, the facial skeleton can actually be reshaped with controlled bone cuts called “osteotomies” and plated back together in an improved position. This latter option is again usually reserved for reconstructive cases given the invasiveness of the procedure.

Hopefully this overview gives you a glimpse of what is going on beneath the face’s surface. With this toolkit at our disposal, we can work together with your aesthetician or makeup artist to achieve an amazing look that you may have never thought possible.

Office of Darren M. Smith, MD

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