Mr Ayad Harb discusses why he believes the term ‘aesthetic ideals’ is outdated
Human faces exhibit infinite variability and perceived physical beauty and are individual, variable, subjective and a mysterious phenomenon. Society has long sought to understand the concept of beauty – to contain it, control it and replicate it.
As a cohort of aesthetic practitioners and surgeons, we have developed our own set of aesthetic ideals, extracted partly from evidence-based science but mostly from tabloids, reality television and social media trends. These aesthetic ideals aim to predict facial features which would be judged as beautiful and to try and recreate them through the medium of scalpels, toxins and injectables.
The most fundamental aesthetic ideals described are those of facial proportions and symmetry. Concepts of horizontal thirds and vertical fifths, described by Leonardo Da Vinci1 have been adopted into contemporary aesthetic teaching to assess and redesign the distribution of facial features and volume, with the aim of creating harmonious, well balanced and ultimately more beautiful faces. Countless theories have been proposed, by those who all used their anatomical analysis and aesthetic genius to describe ‘ideal’ ratios, lines and planes that contribute to our perception of beauty.2-8
We have even sought to appropriate the golden ratio, Phi, into our system of facial assessment and treatment.9 This mysterious number, denoted by the symbol Φ (phi), an irrational number of the order of 1.618, is ubiquitous in nature and seems to continuously appear when measuring aesthetically pleasing objects, animate or inanimate. Marquardt even created a mathematical model10 – a mask – which could be superimposed onto any face and ‘prove’ that they were, in fact, ugly. The scientists, anatomists and artists of the past, present and undoubtedly, future, who give us these beautiful theories, have all had at their heart, the noble endeavour of making sense of what it is to be beautiful and to wrap it up in a simple formula or procedure.
Little did they know, I suspect, that their years of hard work, laborious experiments and facial analysis, would be usurped by a cynical aesthetic industry, trivialised, monetised and sold to the impressionable and insecure.
There are, of course, shortcomings in many of these rules, including Da Vinci’s ‘five-eyes wide’ theory,1 which we must be aware of in the context of our clinical practice. The first is that they were generally based on, and therefore can only reliably apply to, young, white, female faces. Any deviation in age, gender or ethnicity, makes these ‘ideals’ in my opinion, inaccurate, inappropriate and practically useless. The second, is that many of these rules are based on observations of averages.
Take 100 beautiful faces and measure the average lip ratio, nose size, eye shape or cheek projection and that number becomes the ‘ideal’ for a beautiful face. In actual fact, the number is an average and, when applied to a patient’s face, it will probably produce an averagely beautiful result, which is not necessarily a bad thing. That was precisely what happened with Marquardt’s Phi mask.10 It was technically perfect, based on the divine ratio. And yet, multiple studies have failed to show any correlation between a mathematically beautiful face and perceived facial attractiveness.11
Our patient population is incredibly diverse in age, ethnicity, lifestyle and personal preference. Each patient will have their own ideal – I would be uncomfortable and, not-to-mention, wrong, to try and dictate to a patient how her lips should ideally be or try to ‘mansplain’ the concept of cheek contour and ideal facial proportion. Each patient will have their own set of facial characteristics and quirks that make them individual and unique, and any treatment must be sympathetic to these features.
Attempting to dogmatically apply a template, or rule learned from a textbook is, in my opinion, a crude and inappropriate strategy which will, at best, produce average results. Furthermore, a colour-by-numbers approach to facial aesthetic treatments could lead to facial disharmony, disproportion and potential clinical risks. Ultimately, there is no mask, ratio, code or line that will fit all faces and there is no short-cut to producing a beautiful result from an aesthetic treatment. There is no ideal. I believe that nothing will replace the traditional skills of listening to your patients’ concerns in order to give them their own ideal result. There is no substitute for careful observation, a trained aesthetic eye and an experienced hand. Ultimately, our perception of facial beauty is a subjective measure and we must therefore trust our own subjective judgement, aesthetic eye or gut-feeling when delivering aesthetic treatments, as much or more than any objective measure or prescribed ratio.
There will always remain an element of mysteriousness to beauty, which science has not or perhaps cannot quantify. That, for me, is the beautiful thing about beauty.