16 Spiegel Beauty - UCSF CME · 1 The Evolution of Facial Attractiveness: A History of the Near Future Jeffrey H. Spiegel, MD, FACS Chief, Facial Plastic and Reconstructive Surgery

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The Evolution of Facial Attractiveness:

A History of the Near Future

Jeffrey H. Spiegel, MD, FACS

Chief, Facial Plastic and Reconstructive SurgeryDivision of Facial Plastic and Reconstructive Surgery

Department of Otolaryngology – Head and Neck SurgeryDepartment of Plastic Surgery

ProfessorBoston University School of Medicine

www.DrSpiegel.com

Thank You!

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A few questions…

• Is Beauty Real?

• What is Beauty?• How is this analyzed?

• What is the role oflooking “feminine” inlooking beautiful?

Information Conveyed By Faces

• Age

• Emotion

• Attractiveness

• Race / Ethnicity

• Health Status

• Identity / Familiarity

• Gender Can you explain how you know?

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What I hope to prove

• Current approaches to facial analysis are incorrect

• To put it less confrontationally: The existing paradigm is inadequate and based upon the wrong premise.

Goal: Appreciate Beauty Differently

But should you listen to me?

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How we learned Beauty

Is this beauty? What do we know about this person?

• Figure from Minas Constantanides, MD in Advanced Therapy in Facial Plastic and Reconstructive Surgery, Regan Thomas, 2010

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In other words

• Beauty is mathematical and based on the appropriate ratios, angles, and proportions.• With the added caveat of being healthy

and blemish free.• Oh yes, and young.

Where did this all come from?

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Albrecht Durer

• 1471-1528

• Engraver, printmaker, mathematician

• Vier Bucher von Menschlicher Proportion• Four Books on Human Proportion.

• Fourth book appendix, Durer’s theories concerning “ideal beauty”.

• Rejected relativist notion of beauty (Alberti, 1404-1472).

• Believed that nature created rules that ordered beauty.

What is Beauty?

• Averageness

• Symmetry

• What about racial differences?

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A universal ideal of beauty?

• How do species knowwho to mate with?• Biocompatibility• Physics• Geography• Attraction

• Why do we have a concept of beauty?

• Attractiveness is oneway to control mating.

Averageness and Attractiveness

Where did you grow up? New York or Utah?Why does this matter?

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Best Looking in a Group

Phi

• (1+sq.r5)/2 = 1.618

• Divides a line into two parts: 61.8 and 38.2.

• Bigger is to smaller as sum is to bigger.

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In Nature

Pentagram

• Most adherent shape

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No wonder this is a popular theory

Problem is, it’s not real

• Aesthetic judgement of triangular shape: compactness and not the golden ratio determines perceived attractiveness• Friedenberg J, i-Perception (2012)

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The Golden RatioDr. Steven Marquardt

Or is it?

• Easy Facial Analysis Using the Facial Golden Mask• YH Kim. Journal of Craniofacial

Surgery (2007)

• Identification of Facial Shape by Applying Golden Ratio to the Facial Measurements• V Packiriswamy, P Kumar, M R. N Am J

Med Sci (2012)

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Cosmetics

• Enhance luminence

• “create supernormal facial stimuli…by exaggerating cues to sexual dimorphism”

Marquardt’s Phi Mask: Pitfalls of Relying on Fashion Models and the Golden Ratio to

Describe a Beautiful Face

• Holland E. Aesthetic Plastic Surgery (2008)• “women seeking aesthetic facial

surgery would be ill-advised to aim towards a better fit with Marquardt’s mask”

• Mask fits northwestern European masculinized faces.

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Symmetry

Why does this matter?Which face (left or right) looks most like center? Why?

Preference for symmetry in human faces in two cultures: data from the UK and the Hadza, an isolated group of hunter-gathers. Little AC, Apicella CL,

Marlowe FW. Proc. R. Soc. B (2007)

Beauty = Good Mate

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Attractiveness Survey

• 2007

• N=4000

• Woman B (19 yo)

• Man A (29 yo)

Why are men attracted to young women?

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Is this cultural or hard-wired?Is beauty real?

• A beautiful woman's face is like chocolate, cash or cocaine to a young man's brain, according to Harvard University researchers.

• Their brain-imaging study revealed that while young heterosexual males are indeed capable of finding beauty in another man's face, only a lovely female visage can set off the "reward centers" (in the nucleus accumbens) their brains.

• When men in the study were shown pictures of various faces, only the female faces deemed beautiful triggered activity in brain regions previously associated with food, drugs and money.

• Aharon I, Etcoff N, Ariely D, Chabris CF, O’conner E, Breiter HC. Beautiful faces have variable reward value: fMRI and behavioral evidence. Neuron. 2001 Nov 8;32(3):537-51.

Why would men be attracted to younger women?

Conclusion: Young = Attractive

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Monthly variations

• Rating women on effort they placed on beauty

• Women’s attractiveness changes with fertility, monthly and over years.• Women’s attractiveness changes with

estradiol and progesterone across the ovulatory cycle. Puts DA, Bailey DH, et al. Hormones and Behavior (2012)

Some Math

• Young = Attractive

• Attractive implies having beauty

• Beauty = good mate

• Thus…

• Youthfulness = Beauty

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Which is more Attractive?Which is more Masculine?

Which is more Attractive?Which is more Feminine?

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Femininity and Attractiveness

• In reproductive competition, certainly the more feminine one looked the more attractive she would be to potential mates. These findings appear to be independent of ethnicity. When evaluating femininity and attractiveness for female faces in both Chinese and Caucasian faces, it was found that enhanced feminizing of the face resulted in increased attractiveness for faces of both races.

• Rhodes G, Hickford C, Jeffery L. Sex-typicality and attractiveness: Are supermale and superfemale faces super-attractive? Br J Pschol (2000) 91:125-140.

Femininity Preferred

• Males prefer feminized females

• Females prefer feminized males

• Why?

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Feminine = Attractive

• Muscularity and facial masculinity require large amounts of testosterone, which is hard on the immune system

• Masculine men are higher risks as stable long-term partners

• Women seek stability thus tend to be more attracted to more “caring” men with somewhat feminine faces

• Femininity suggests Fertility

Conclusion

Femininity = Beauty

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Femininity goes away

• Why?

• Does masculinity go away?

Shocking Observation

• Women’s faces get more masculine as they get older; i.e. – women lose femininity.

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Age – Femininity - Beauty

Age and Femininity

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Q.E.D.

• Youthfulness = Beauty• Femininity = Beauty• Attractiveness = Beauty• Thus:

• Youthfulness = femininity• Attractiveness = femininity

• Now, how would you do a facial analysis?

How to determine facial gender?

• Isn’t this obvious?• As an academic facial plastic

surgeon, shouldn’t you be focusing more on nasal tip graftingor new types of injectablefillers?

• How does understandingthis help you?

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Facial Gender Identity:We don’t know how we do it!

• It’s being worked on…• Computer Scientists

• Forensic Scientists

• Law Enforcement

• Security Experts

• Psychologists

• Neurologists (prosopagnosia)

The problem is…

We don’t know what makes a face feminine!

Let’s consider some possibilities…

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Sugar and Spice and Everything Nice: What are the key facial features of a woman?

• Hair? (On head or on face)

• Skin quality?

• Nose shape?

• Clothing?

• Makeup?

Fundamental Elements of Identity

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What is Feminine?

• What are the most important genderdefining facialfeatures?

Opposite Features!

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Eyebrows

Luminance

• Eyes and mouth of females have a greater luminance difference from the rest of the face in women than men.

• Role of Cosmetics

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Facial Shape

What about nose shape?

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Man or Woman?

The Nose Knows

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So, what do we actually do?

• How can we use the information about femininity and beauty?

• How would you do a facial analysis now?

Is this beauty? What do we know about this person?

• Figure from Minas Constantanides, MD in Advanced Therapy in Facial Plastic and Reconstructive Surgery, Regan Thomas, 2010

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Can we convert unattractive (masculine) to attractive (feminine)?

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Forehead Cranioplasty / Brow

• Goal: smooth out the forehead, less sloping – less protuberant.

Gender BasedCranial

Variations

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What about the scar / hairline?

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Lip Lift

• Women have fuller lips.

• Upper lip projects beyond lower.

• Lower lip projects beyond chin.

• Red part of lip (vermillion border) is closer to nose in women.

Tracheal Shave

• Women have a less prominent “adam’s apple”.

• The larynx is a different shape and dimensions.

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How do we do this safely?

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Tracheal Shave / Laryngeal Cartilage Shaping

Immediate Results /

Safe Voice

Cheek Surgery

• Augmentation

• Why do we do this?

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Mandible Surgery (Jaw)

• Angle of Mandible:thick muscle / flaredbone

• Chin: Too square / cleft

• Options: Bone ResectionMuscle ResectionGenioplastyChin implant

• New: Botox® , steroids – in the office.• New – contouring of chin soft tissue.

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Rhinoplasty

• Bone and Cartilage

• Goal:

RefineReduce size /

protuberance

Fit the Forehead

Rhinoplasty / Feminine Aesthetic / “Fitting the Face”

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Face, Forehead, Chin, Nose

6 days later

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Conclusion

• Think “why” not just “what”

• Think “problem” not “tools”

• Think of the next great thing.

Thank you!

[email protected]

[email protected]