Measuring Facial Landmarks of Attractive People Around the World: A Scoping Review

Abstract

PURPOSE: The ideal outcome of any craniofacial surgery requires consideration of balance with the patient’s whole face. Detailed cephalometric measurement of the face plays an essential role in planning these surgical procedures. “Attractive” facial measurements and proportions vary widely across different racial groups.1,2 To our knowledge, the variation in facial beauty standards around the world has not yet been reviewed. This scoping review aims to summarize how racial groups are delineated, identify methodologies used for cephalometric analysis of attractive adults, and summarize findings in the existing literature. METHODS: A scoping review was conducted using the Arksey and O’Malley methodological framework. Five bibliographic databases were queried for studies using keywords relevant to cephalometric analysis, photogrammetry, and race or ethnicity. Two independent reviewers completed abstract and full-text screening to identify original studies with measurements soft tissue facial landmarks in attractive adults of a specified race. Differences were resolved by consensus. Data on subject characteristics, cephalometric analysis methodology, and linear and angular craniofacial measurements were collected. RESULTS: The search yielded 1,058 unique articles, of which 186 were selected for full-text screening and 19 were included. Overall, cephalometric analysis was conducted on 1,107 attractive adults. One thousand two (90.5%) of these subjects were female and 105 (9.5%) were male. Six hundred twenty-four (56.4%) were white, 462 (41.7%) were Asian, and 21 (1.9%) were black. Among Asian groups, racial categories tended to be more granular; frequently both countries of descent and nationality were specified (eg, Korean-American), whereas often only the region or country were specified for white and black groups. Methodologies either utilized 3-dimensional scanners (n = 4), 2-dimensional cameras (n = 8), or photos from the internet (n = 6). While studies tracked similar facial landmarks, calculated linear and angular measurements varied. Studies comparing attractive women from different racial groups did not yield significant differences,1 although Asian models had more acute angles compared to white models at the alar curvature point and labiale inferius. Studies comparing attractive white models to normal white women concluded that attractive women have more “juvenile” characteristics, including a wider soft tissue orbital area.2 CONCLUSIONS: These aesthetic facial measurements should be taken into consideration during preoperative planning to accommodate patients’ cultural backgrounds. Although existing studies adequately characterize attractiveness in European and Asian countries, it remains challenging to evaluate transcultural beauty standards for people of mixed race and people in ethnically diverse countries, where perceptions of attractiveness are shaped both by their own racial features as well as prevailing norms. There is also a paucity of studies examining attractive males, as well as attractive people from non-white and Asian backgrounds. Cephalometric analyses of attractive adults have been performed mostly using 2-dimensional scanning systems or photographs; future analyses should be conducted using 3-dimensional scanning systems now that this technology is available. REFERENCES: 1. Rhee SC, Kang SR, Park HS. Balanced angular profile analysis. Plast Reconstr Surg. 2004;114:535–544. 2. Sforza C, Dolci C, Grandi G, et al. Comparison of soft-tissue orbital morphometry in attractive and normal Italian subjects. Angle Orthod. 2015;85:127–133.