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Beauty is a complex phenomenon intrinsic to interactions between individuals. It is generally agreed that facial beauty is related to vertical and horizontal proportions of various facial features. Universal beauty, however, is almost impossible to define because of differences in time, culture, ethnicity, and age. The surgeon, however, relies on certain facial proportions and relationships to provide a basis for diagnosis and planning in facial plastic surgery. Previous studies have addressed ideal vertical and horizontal proportions of facial features. Few of these have addressed the location of the malar or zygomatic prominence, as it is a less distinct landmark than other facial features and its position is difficult to define. The cheekbone, however, “is the second most frequently fractured bone on the craniofacial skeleton” (Donald PJ, quoted in Czerwinski et al1), and accurate localization is important for surgical reconstruction. Although vertical positioning of the malar prominence is in common usage during facial reconstruction, no extensive studies have actually reported the vertical location of this feature. Various previous studies have related ideal vertical and horizontal facial proportions to the Golden Ratio, or “phi” φ.2–7 [The Golden Ratio, also known as the Divine Proportion, is that which is obtained when one divides any length into two parts in which the ratio of the larger part to the smaller is the same as that of the whole to the larger part. This ratio, φ, is an irrational number whose value is (√5 + 1)/2 ≈ 1.618]. The presumption is that certain proportions, described using φ, are aesthetically pleasing and that attractive facial features correspond to these aesthetic proportions. Ricketts2–4 identifies the “golden relations” between various facial proportions using 10 frontal-view photographs of male and female models taken from magazine advertisements and “allegedly selected for outstanding beauty.”2 He claims that vertical facial proportions are accurate to within 95–99% of the predicted values based on the Golden Ratio. Measurements of the location of the zygomatic prominence were not determined in these analyses2,3 despite the fact that this feature is included in his figures. By extracting from 2 of the figures presented in Ricketts’ articles,2–4 an overall proportion for vertical cheek height (malar prominence) can be found, with respect to chin (menton) and eye (lateral canthus) locations (Fig. (Fig.1).1). The ratio of the height of the malar prominence from the chin compared with the height of the eyes from the chin is given by: (φ + 0.5)/(φ + 1) ≈ 0.809. Fig. 1. Predicted location of the malar prominence based on the Golden Ratio. Lines demonstrate localization of the malar prominence based on Golden Ratio relationships to other facial features.2–4 The position of all lines drawn is those shown in Ricketts. ... Other studies have divided the face into thirds to determine ideal facial proportions. Richardson8 reproduces Dr. Gottfried Schadow’s work on The Proportions of the Human Body of Figures of Both Sexes and Various Ages, 1886. Similarly, Prendergast9 also describes division of the face into thirds. In these, the face is divided roughly into thirds—upper third from hairline to glabella, middle third from glabella to subnasal, and lower third from subnasal to menton. The lower two thirds can each be further divided into 3 parts—in essence dividing the face roughly into ninths. In both of these, the malar prominence appears within the middle third, at about four ninths from the chin, and the eye canthus appears at about five ninths from the chin. The malar prominence is thus found at approximately four fifths of the distance from chin to eye canthus. This value, 0.8, is almost identical to the value of 0.809, which is based on the Golden Ratio. Prendergast and Schoenrock10 measured the location of several facial landmarks, including the horizontal and vertical position of the malar eminence in a small group of subjects. Twenty models were used, all of whom were white women except 1 black and 1 Asian model who were “judged to have white faces.”10 The location of the malar eminence was found to be similar to the values obtained using either the Golden Ratio or the trisection of the face. Our purpose was to evaluate the vertical location of the malar prominence with respect to facial landmarks (chin and eye) in a large group of subjects and to determine whether the location of this feature was consistent among individuals. We also assessed whether any measured differences were associated with gender, age, or ethnicity. The value we obtained for the vertical position—that is, ratio of cheek height to eye height—was then compared with the values based on the Golden Ratio or used in artistry as a proxy for attractiveness. Our study comprises a larger cohort than any of the previous articles. Moreover, we have a mixed population with respect to age, gender, and ethnicity, and subjects were not selected based on attractiveness. No previous studies have examined the location of the malar prominence with respect to gender, age, or ethnicity in a population that was not selected for attractiveness. These results may be more applicable to the population in general. |
