Facial analysis: maintaining ethnic balance

Abstract

Achieving balance and harmony are the goal of most facial plastic surgical procedures. The ideal balance is unclear for the patient of non-Caucasian background. This article reviews the current literature on analysis of the face for African American, Latino, and Asian populations. ‘‘Caucasianization’’ and future directions are also discussed. Facial analysis is an integral aspect of the patient consultation prior to performing a plastic surgery procedure. A comprehensive understanding of facial proportions is requisite to identifying deviations from the aesthetic ideal and achieving facial harmony and balance. These aesthetic ideals dictate the techniques and guide the approach to surgery to achieve an aesthetically proportioned face. The focus of the preoperative discussion with the patient is often based on achieving this ideal, tempered by the patient’s individual preferences and the surgeon’s aesthetic sense. In addition, it is important to recognize that these ideals are merely guidelines, and that subjective analysis and patient individuality continue to remain vital aspects of the patient consultation. Traditionally, the aesthetic ideal was based on neoclassical facial canons developed by artists and anatomists in the seventeenth and eighteenth centuries. Since then, modern anthropometric measurements of the ideal face, based on actual measurements, have been well described. This aesthetic ideal, however, is based on the Caucasian patient [1,2]. Ethnic variability from these established canons has only recently been reported [3–6]. Differences between ethnic groups are readily apparent on casual observation to both the layperson and the clinician. There is tremendous diversity even within ethnic groups due to geographic origin and inter-racial marriages. Nevertheless, the aesthetic ideal for the non-Caucasian ethnic patient has not been well defined and, therefore, presents a challenge for the astute surgeon. Frequently, the ethnic patient is made to fit the Caucasian ideal, due to either patient desire or surgeon preference, yielding an incongruent appearance. The resultant face is disharmonious and appears obviously operated, even to the untrained eye. More recently, the focus has been on maintenance of a refined ethnocentric appearance, with natural-appearing balanced facial proportions [7]. This article reviews the classical canons that provide the foundation for facial analysis and focuses on the analysis of the face based on ethnic background. Historical perspective