What is it that makes a face or a body beautiful? This is a question that artists have asked themselves forever. There seems to be a universal beauty that exists across different races and is determined by a certain proportion. A proportion and harmony between the different constituents of the face and the body. Years ago when I started my practice, I was asking myself this same question. I had seen very capable plastic surgeons perform procedures that they thought were very successful, but the patient did not look good. For example, they would go to extreme measures to create a sharp angle between the chin and the neck, not realizing that it is always more aesthetic to achieve a gentle and smooth sub mental angle. In the late 80s I red the book, The Principalization of Plastic Surgery, written by one of the most respected plastic surgeons, Dr. Ralph Millard. There, I became familiar with the concept of the Golden Proportion, also called the Divine Proportion. It seems that people in antiquity were familiar with this concept and buildings like the Parthenon, by the Greeks, had been built using the golden proportion.
If one draws a line from point A to B and from B to C in such a way that the ratio of the longer segment AB to BC is equal to that of AC to AB, the ratio would be 1.618. This number is defined by the Greek alphabet (phi) and is the golden proportion. For example, a rectangle that has a length of 1.618 and a width of 1 has the golden proportion.
In this rectangle, the diagonal line in the second half of the yellow square is used to add length to the first full half. This creates a rectangle which has a length to width ratio of 1.618 to 1. One can also say the short side is .618 of the long side.
This proportion happens to exist everywhere from quasi-crystals to plants and animals, from mathematics and geometry to the structure of DNA, and from the Fibonacci numbers to the human anatomy. Kepler called it one of the great two treasures of geometry, but what interests me is it’s relationship to the human face and beauty. If you compare most beautiful faces from recent models and actresses to old Greek and Roman statues and even through racial lines there are common ratios and proportions between the various components of the face. These ratios follow the golden proportion. For example the ratio between the width of the eye to the width the mouth should be 1 to 1.618. Same goes for the width of the base of the nose to the width of the mouth.
Check out this drawing of the ear
See the various relations and proportions between the parts of the ear. These ratios exist between most parts of the face to the point that a mask has been drawn that would correspond to the ideal face this is called the golden mask or the mask of the golden ratio. Most beautiful faces that we know fit that mask. The mask follows the golden ratios. It is interesting to think that just like in biology, where everything follows the same rules from a simple organism to humans, there could be rules of beauty that exist universally.
The idea of harmony following a unique proportion is very appealing to the human mind. We look for simplicity. Most of us believe in a single god ruling the entire universe who happens to be the god of the humans.
The golden ratio was also called the divine ratio, divine proportion and divine section (sectio divino). These all associate the rules of beauty to the idea of divinity.
This is all very interesting but can we use these rules and ratios in our daily practice of creating a beautiful face and bodies? The answer is yes. In fact it is sometimes better to aim for beauty than rejuvenation. Because it happens in rare cases where I noticed that aging can make a face more beautiful. How could that happen? Well, if the changes that happen in an aging face goes in the direction of bringing the ratios in the face closer to the golden ratios then it is understandable that an aging face could in some cases appear more attractive and in those cases rejuvenation could change the proportion in an undesirable direction. What I am trying say is that we have to be mindful of the idea of creating harmony and beauty and not be obsessed with the idea of rejuvenation alone. The aim is not to go after every last wrinkle or to create a ninety degree angle between the neck and the chin but to consider the overall picture and the end results. Here is where art meets plastic surgery. Fortunately today we have a lot at our disposal. We can enhance facial features with fat grafting. We have powerful fillers like the Radiesse, Restylane and Juvederm. We can change some facial features with neuromodulators like Botox and Dysport. We can adjust skin tension with various face lifting procedures and even alter volumes in the face. Reshaping the nose (rhinoplasty), chin augmentation and lip modification are all procedures that allow us to beautify the face. We may not be able to easily change every facial feature but we can do more than we ever could before and a lot of what we do today could be done none surgically.
This is really where the artistic sense and experience is so important. One can not follow a recipe. Mastery of all plastic surgery procedures, improvisation and creativity is needed for success. One also needs great communication skills to find out if the patient really desires the proposed changes. And evaluate the changes that the patient is asking for to see if they make sense. The patient and the surgeon have to be in complete agreement. They both have to trust and fully respect each other.