Ethnic differences

AND WHAT WE CAN DO ABOUT THEM

The earliest records of facial proportional analysis date back to ancient Greek times. The sculptor Polycleitus (480-520 B.C.) was one of the first to use artwork to exhibit “ideal” facial proportions, while Aristotle (384-322 B.C.) was unconvinced of the subjectivity of beauty, using math to contemplate the specific measurements of the “ideal” facial proportions (Fang et al., 2011). Fast forwarding to the European Renaissance, artists such as Leonardo da Vinci (1452-1519 A.D.) took  the concepts of the Greeks and developed them into a system known as the “neoclassical canons,” which are still used by most plastic surgeons and aestheticians today to define ideal standards of beauty (Fang et al., 2011). But are these millenia old analyses still relevant in today’s world in definition of caucasian beauty – let alone our 21st century, ethnically diverse society? 

‘West’ is not Best.

In our growingly interconnected global society, it would stand to reason that beauty ideals as defined by ancient Caucasian analysts can no longer be exclusively used by cosmetological and aesthetic professionals. A Systematic Review of Interethnic Variability in Facial Dimensions conducted at The University of Michigan concluded that “previously defined tenets of facial proportion based upon the stereotypical Caucasian features are no longer adequate” (Fang et al., 2011). Their methods involved calculating coefficients of variation (CVs), as the comparison of numerous different facial features and dimensions necessitated a unit-free index of variability. Using this index to compare the relative inter-ethnic variability among 27 different ethnic groups for each of the neoclassical facial proportions has found that “the greatest inter-ethnic variability in facial proportions exists in the height of the forehead. More pronounced difference among the ethnic groups is also present in the measurements of the eyes, nose, and mouth” (Fang et al., 2011), specifically interocular distance, and nasal width. The least amount of variability was found in the ear height, and upper, middle, and lower facial widths.

The method of this study classified five levels of variability – least variable, less variable intermediate, intermediate, more variable intermediate, and most variable; “significant difference (with 95% confidence) exists between any two non-adjacent groups (e.g. least variable compared to middle intermediate or less variable intermediate compared to more variable intermediate” (Fang et al., 2011). This provides a useful framework for practitioners to reference the specific ethnic differences of each facial feature and tailor the patient’s procedure to their ethnic group, allowing them to enter reconstructive or aesthetic work with a more conscientious approach, and hopefully a more desirable outcome. Studies confirm that the maintenance of desirable ethnic-specific features is preferable. For example, the ideal Asian female nose tip is more round that their Caucasian counterparts; a “more conservative nasal tip augmentation can achieve the desired Asian features while maintaining a more ethnically appropriate look that could look otherwise too artificial and unharmonious if the distinct tip points are created, which are desirable in Caucasian women” (Gao et al., 2018). But with the permeation of Western beauty ideals globally, as discussed in our article on Beauty Ideals? A small incision into beauty ideals – ever changing throughout time and place, are ethnic differentiations becoming less desirable, or conforming to one standard, cross-cultural ideal? 

How Do Things Differ?

In A Comparison of aesthetic facial criteria between Caucasian and East Asian female populations: An esthetic surgeon’s perspective, it was found that certain commonalities exist between attractive Caucasian and East Asian faces, namely neonate features such as large eyes, smaller noses, and a relatively large facial upper third of the and smaller lower third (Gao et al., 2018). One could hypothesize that this is true across many ethnicities, as from the perspective of evolutionary psychology, neoteny is generally desired and preserved as sexual attractiveness and the presence of vibrant secondary sexual characteristics in females are intertwined (Gao et al., 2018). To get into more distinctive preferences, “compared with White women, East Asian women prefer a small, delicate, and less robust face, lower position of double eyelid, more obtuse nasofrontal angle, rounder nose tip, smaller tip projection, and slightly more retruded mandibular profile” (Gao et al., 2018). In an Easter Asian comparison, both Chinese and Japanese female faces are found to ideally have flatter cheekbones, obtuse mandible angles, and sharp chins; “many Asian women seek the reduction of malarplasty and genioplasty to get a more smooth overall face” (Gao et al., 2018). However, Chinese women prefer a slim and thin face and Japanese women prefer slightly chubby cheeks.

Focusing on key facial features that can be manipulated by injection contouring and fillers – facial shape, eyebrow shape, nose, and lips – among those, the midface and lips have been found to be the regions with the highest degree of inter-ethnic variability (Oranges et al., 2016). Considering this, a few key differences should be considered in procedures when dealing with certain ethnicities, in difference to their caucasian counterparts. For example;

• Due to underlying skeletal and morphological features, Asians tend to present a shorter face, with wider bitemporal, bizygomatic, and bigonial width and structural low projection of the central third of the face; “therefore, in distinct contrast with patients of European descent, who commonly seek augmentation of lateral maxilla and zygoma, adequate treatment of Asian patients should be limited to medial maxilla volumization to enhance central projection and avoid the creation of facial disharmony by further widening the midface” (Oranges et al., 2016). 
• For Asians of South-Eastern origin, lip augmentation is normally not indicated as they present greater lip fullness, already in good balance with the lower third of the face. 
• Due to the nature of black skin, namely less thinning of collagen bundles and elastic tissue, women of African descent are less likely to seek out facial soft-tissue augmentation. However, aging may reduce upper-lip volume and restoration of youthful fullness via injectable filler may be more sought after (Gao et al., 2018). 
• Hispanic people are largely of intermingled European and Native American ethnicities. Depending on their presenting characteristics, both white and Native American/Asian aesthetic standards apply, and practitioners should use their judgment and knowledge to best assess and provide the desired outcomes (Gao et al., 2018). 

Understanding the unique facial proportions of various ethnic groups is critical in preserving the ethnic identity of the individual while pursuing the ideal facial proportion. As the number of aesthetic treatments undergone globally is rising, surgical technique has evolved to such a degree that the manipulation of ethnically characteristic features is routinely performed (Fang et al., 2011). Following neoclassical canons in our mutli-ethnic society is no longer an adequate standard, nor a desirable one. Maintaining the specific ethnic harmony of the face is essential in achieving desirable patient outcomes. 

References

9584. Gao, J. Niddam, W. Noel, B. Hersant, J.P. Meningaud. Comparison of aesthetic facial criteria between Caucasian and East Asian female populations: An esthetic surgeon’s perspective. Asian Journal of Surgery. Volume 41, Issue 1, 2018, Pages 4-11, ISSN 1015-9584. https://doi.org/10.1016/j.asjsur.2016.07.007

Oranges, Carlo M. MD*; Gohritz, Andreas MD*; Haug, Martin MD*; Harder, Yves MD†; Schaefer, Dirk J. MD*. Universal and Ethnic-specific Considerations on Facial Rejuvenation: Where Do You Inject Your Fillers?. Plastic and Reconstructive Surgery – Global Open 4(8):p e842, August 2016. | DOI: 10.1097/GOX.0000000000001010

Fang F, Clapham PJ, Chung KC. A systematic review of interethnic variability in facial dimensions. Plast Reconstr Surg. 2011 Feb;127(2):874-881. doi: 10.1097/PRS.0b013e318200afdb. PMID: 21285791; PMCID: PMC3074358.