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Facial symmetry


March 2016

illustration ©

Thereís a math equation called the golden ratio, which is a number found by dividing a line into two parts so that the longer part divided by the smaller part is equal to the whole length divided by the longer part. If you find it confusing and youíre wondering why an article about cosmetic procedures would begin with a mathematic formula, read on. During the European Renaissance, artists and architects used this golden ratio to map out their

masterpieces. They determined that the resulting number, roughly 1.62, was the key to beauty. The theory is that in nature, art and architecture, the closer an object comes to that number the more attractive it is.

The same is true of the human face. When measuring the symmetry of a face, the closer the final numbers are to 1.62, the more beautiful that person will be. The simplest measurement is the length of the face divided by the widest part of the face, but to get the overall figure and find out just how good looking you are, there are countless measurements you need to take; the top of head to chin, the pupil to tip of nose, tip of the nose to the chin, size of the ear compared to length of the nose, and so on.

According to Dr. Mark Blake of the Clinic of Cosmetic Surgery, symmetry is a key component to be considered in all cosmetic procedures ó both surgical and nonsurgical. "Oftentimes, the primary goal of surgery is to achieve symmetry," he says.

Dr. Andrew Campbell of Quintessa Medical Spa agrees. "I think all procedures are affected by facial symmetry, whether itís a brow lift where I want to correct different brow heights or a filler injection where we try to maintain or create symmetry. In essence, if there is natural symmetry, we want to maintain it. If there is facial asymmetry, we want to try and create symmetry," he explains.

How does a surgeon calculate facial symmetry? Blake says that apart from the golden ratio of 1.62 for facial length to width, there are many calculations doctors use. "Often we divide the height of the face into thirds ó from the hairline to a spot between the eyes, from that spot to the bottom of the nose and from the bottom of the nose to the bottom of the chin. Ideally they should all be equal," he says.

"Some surgeons will split a facial photo in half, duplicate and reverse each side to create a new left-left face and a new right-right face," adds Campbell. "Oftentimes those two faces look quite different, proving facial asymmetry. Sometimes the asymmetry can be very obvious; other times, itís very subtle, but overall I would say that 85 percent of my patients lack facial symmetry."

Asymmetry is something that normally increases with age. Dr. Alex Colque of Skiin in Waukesha says that many fillers and procedures aim to restore lost symmetry. "Most of our patients have asymmetry in how their eyelids and eyebrows age," he says. "The face and the neck can also age asymmetrically, and we restore that symmetry during a face-lift. Oftentimes when we use fillers we need to use a different amount on each side of the face to help provide more facial symmetry."

A few years back, actor Denzel Washington was hailed as someone who had near perfect facial symmetry. "If you look at photos of most models and Hollywood stars who we think are beautiful, they most likely have good facial symmetry. Charlize Theron, for example, is considered gorgeous by many people and certainly has nice symmetry," says Campbell.

Colque points to Angelina Jolie, Michelle Pfeiffer and Halle Berry as examples. "They all have great facial symmetry, which is why their faces are considered attractive and aesthetically pleasing," he explains. Put that way, itís hard to argue with the math.

Keep it Natural

By Guy Fiorita

Successful cosmetic procedures are all about keeping things natural looking. You want to turn back the hands of time, not give the patient a permanent look of shock ó a role-limiting expression weíve seen on a few Hollywood stars. But how can you ensure your procedure leaves you looking natural? "When a celebrity has a procedure that does not look natural, typically it is because the procedure is overdone or not performed using the latest techniques. Unfortunately, when someone has a procedure that makes them look unnatural, it leads to a lot of bad press, and then we have to do our best to educate our patients that those are not typical results," says Dr. Alex Colque of Skiin.

Dr. Andrew Campbell of Quintessa Medical Spa says that most of the time

the unnatural look is due to either over aggressive surgery or from using the wrong technique. "Sometimes they are lifting in the wrong direction for face-lifts, using surgical techniques for females on men like upper eyelifts (think Kenny Rogers), or simply they have not had the correct procedure for the problem," he explains. "This is often because the evaluation or diagnosis is wrong, and therefore the treatment is going to be wrong. An example would be placing cheek implants in someone that really doesnít need them, or more commonly, performing a brow lift on someone that really doesnít need their brows lifted. That is where you get the unnatural, surprised look we have all seen."

"Oftentimes patients choose a procedure based on the fact that there is less recovery time or that it is less invasive or has a trendy name. Itís like fitting a square peg in a round hole. In addition, poor results may result from trying to turn back the clock too far. A 70-year-old trying to look 20 will yield an unnatural appearance," adds Dr. Mark Blake of the Clinic of Cosmetic Surgery.

Once the right procedure is done, the problem becomes follow-up. Campbell says the most common mistake many patients make is to come in and get a facelift or other rejuvenating procedure, heal, then never do anything to maintain their appearance. "They should really be seeing us regularly to help keep the look they desire," he says.

"The best way to prolong surgical and nonsurgical results and to keep them looking natural is to have a comprehensive maintenance program, including sun protection, skin care, facials and various noninvasive procedures. Nothing lasts, meaning nothing is permanent. We continue to age the second a procedure is done. The goal of surgery is to set back the clock, and from that point we continue to age accordingly," says Blake.

Campbell says that daily skin care is like brushing your teeth. "It helps prevent certain skin problems and therefore makes the skin look better longer. We recommend two broad band light (BBL) treatments per year," he explains. "One recent study looked at patients who had received at least two BBLs per year over a 10-year period. They compared their photos today to ones taken 10 years ago, and independent evaluators determined that the skin in the current photo looked one year younger than the original photos, even though they were taken 10 years earlier."

One problem all cosmetic surgeons face is unrealistic expectations. "Fortunately itís not very common, but occasionally someone will have unrealistic expectations regarding a surgery or filler," says Campbell. "Sometimes they want a look that is not going to be natural, or they expect the procedure to bring with it an external change like a new job or a new relationship. If we pick up on this, we will discuss it with the patient. If they truly have unrealistic expectations, we simply will not treat them. I usually use the words, ĎI donít think I can make you happy.í"



This story ran in the March 2016 issue of: