The differences in facial structure, as well as differences in photoaging not discussed here, may be useful in the way we approach different aesthetic procedures sought by patients in different ethnic groups. Understanding these structural differences also may help us avoid a cookie-cutter approach and instead use aesthetic procedures to enhance each individual’s inherent beauty and what their ideals of beauty may be.
Beauty is subjective, but many have tried to measure beauty objectively by using anthropometry. Anthropometry is the quantitative measurement and ratio of facial features based on proportional relationships of the face known as the neoclassical canons. As proposed by Leonardo da Vinci, the ideal face can be divided into equal horizontal thirds: the distance from the frontal hairline to the top of the brow, from the brow to the base of the nose, and from the base of the nose to the inferior aspect of the chin. These mathematical facial proportions translate to a symmetrical oval or heart-shaped face, with prominent cheekbones, a tapered jaw line, a narrow nasal base, and thin lips.
Another method used to calculate beauty with mathematical proportions is the concept of "phi," the golden ratio. The ratio of 1:1.618 was described by ancient Greeks as a mathematical method to calculate optimal proportions for all structures in nature. Phi is the unique point on a line that divides the line into two lines in such a manner that the ratio of the smaller portion to the larger portion is the same as the ratio of the larger portion to the whole line.
Plastic surgeon Dr. Stephen Marquardt trademarked the "Phi mask," a facial mask of proportions that incorporates the 1:1.618 ratio to describe the mathematical ideal of an attractive face. The original Phi mask has been applied to persons of all races and ethnicities. However, Marquardt has modified it in recent years to apply to three different ethnic groups – Caucasian, Asian, and African – and he has noted the likelihood of more variations to come.
While phi proportions may be applied all ethnicities, baseline facial anatomic structural differences among different ethnicities exist. A study of facial analysis by Farkas et al. compared facial structure in African Americans with Caucasians (Aesthetic Plast. Surg. 2000;24:179-84). African Americans had a broader nasal base, decreased nasal projection, bimaxillary protrusion, orbital proptosis, increased soft tissue of the midface, prominent lips, and increased facial convexity. Given the interethnic variability in facial structure, other studies have identified two types of African-American nasal structure, one with a high dorsum and one with a low dorsum (Arch. Facial Plastic Surg. 2001;3:191-7).
Latino individuals reflect a range of ethnic backgrounds, but studies of Latina female facial structure generally have shown an increased bizygomatic distance, bimaxillary protrusion, a higher convexity angle, a broader nose, a broad rounded face, and a receding chin (Aesthetics and Cosmetic Surgery for Darker Skin Types, Lippincott Williams & Wilkins, 2007:10).
In persons of Mexican descent, studies show that the face is broader, with a prominent malar eminence, broad nose, widened alar base, short columella, horizontally oriented nostrils, and thick nasal skin (Clin. Plast. Surg. 1977;4:89-102; Aesthetic Plast. Surg. 1980;4:169-77). In Caribbean women, the anthropometric measurements are more similar to those of African American women than to those of Central and South American women, whose anthropometric measurements are closer to those of Caucasian women (Arch. Otolaryngol. Head Neck Surg. 1996;122:1079-86; Laryngoscope 1988;98:202-8).
Shirakabe et al. described the facial structure and soft tissue of persons of Asian descent as including a wider and rounder face, higher eyebrow, fuller upper lid, lower nasal bridge with horizontally placed flared ala, flatter malar prominence and midface, more protuberant lips, and more receded chin (Aesthetic Plast. Surg. 2003;27:397-402). The distance from the eyebrow to the upper-lid margin in Asians is much greater than in Caucasians due to the fuller upper eyelid and to the narrower palpebral fissure (Aesthetic Surg. J. 2003;23:170-76). There is also more malar fat in the midface of Asians, moderate premaxillary deficiency, and more prominent soft tissue in the lips compared with the thinner lips and more prominent chin often seen in Caucasians (Cosmetic Surgery of the Asian Face, Thieme Medical Publishers, New York, 1990).
Of course, such studies are limited by the use of one term to describe a large group of people encompassing many different countries and cultures that have different facial features and structures that distinguish them, but these are the data available thus far.
A recent study by Biller and Kim characterizing the ideal nasolabial angle, nasal tip width, and location of eyebrow apex for Asian and white women showed that neither the ethnicity of the model nor the ethnicity of the volunteer evaluating the model played a significant role in determining the ideal angle or position of the above parameters. The researchers found that, in general, a more lateral brow apex was preferable in younger faces, whereas a more medial apex was preferred in older faces. In addition, moderate nasolabial angles of 104 and 108 degrees and a nasal tip width of 35% of the alar base was most attractive in both ethnicities. The study supports some claims that beauty is considered to be innate and independent of ethnicity (Arch. Facial Plast. Surg. 2009;11:91-7). However, the study is limited by the small number of models (four), representing only two ethnicities. In addition, all of the volunteers evaluating the models were from the United States, which may represent a more "Westernized" ideal of beauty.