Facial proportions refer to the relationship in size and placement between features, while symmetry pertains to how similar the left and right side of the face appear, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
Just like artists who need to an in-depth knowledge of facial proportions to create their masterpiece, facial plastic surgeons must also possess such critical but nonetheless hard-to-grasp concept of beauty and balance.
But what constitute a face that is deemed attractive? And what are the features that distinguish it from plain and not-so-pleasant ones? Or does the axiom “beauty is in the eye of the beholder” have merit despite claims made by scientists and researchers suggesting that there are indeed mathematical ratios that can quantify objectively the level of attractiveness or lack thereof?
On top of these conundrums surrounding physical attractiveness, some research studies have pointed out that the perception of beauty is affected by variables that include culture, media, and socio-economic background.
Nonetheless, Dr. Smiley believes that beauty does possess certain hallmarks that transcend culture and milieu; these hallmarks, he suggests, can help plastic surgeons deliver natural and pleasant results from rhinoplasty (nose reshaping), facial implants, fat injection, chin reduction, etc.
Chin and Jawline
When the face is divided into three horizontal segments—from the forehead hairline to the outside corner of the eyes, from the eyes to the base of the nose, and from the base of the nose to the chin margin—and their distances are all equal, the face is considered more attractive.
The aforementioned ratio can help guide surgeons during chin reduction/augmentation and jawline enhancement.
Rhinoplasty, aka nose job
A nose deemed attractive has a breadth that is similar to the distance between the eyes; however, it does not strictly apply to ethnic noses, which can even tolerate a slight nostril flare that may even contribute to facial attractiveness.
Furthermore, the length of the nose is ideally equal to the chin’s vertical height in order to increase the attractiveness of the face. It should be noted that the chin and the nose play a critical role in facial proportion and harmony and thus it is not uncommon to combine rhinoplasty and chin augmentation.
Typically, the length of attractive faces is roughly one-and-a-half times longer than their width. This hallmark of beauty and youth may guide plastic surgeons during cheek augmentation (via implants or fat injection) and buccal fat reduction.
Furthermore, the lower two-thirds of a youthful face has an inverted triangle shape thanks to fullness of the upper cheek (or prominent cheekbone), which gently tapers toward the lower cheek and jaw.
Forehead and hairline
The ancient Greeks believed that the Golden Ratio, now more commonly referred as the Divine Proportion or phi (1.618), was the key to beauty and was seen in nature. When applied to facial proportions plastic surgery, it states that the ideal distance between the forehead hairline and the upper eyelid is 1.6 times the distance between the top of the upper eyebrow and the lower lid.
Hence, the concept of phi might be applied during brow and forehead lift surgeries.
It may come as a surprise that rhinoplasty, or nose job in layman’s term, could make someone look younger, an effect more commonly attributed to neck lift and facelift surgery.
An aging nose has some archetypal traits: more prominent hump along the dorsum or bridge, and drooping tip, which contributes to the elongated appearance.
When these before-and-after photos were posted on Dr. Smiley’s Instagram account, some followers pointed out the youthful effects of the surgery on her face.
Aging causes the skin to lose its elasticity and the cartilaginous framework of the nose to weaken, leading to the drooping nasal tip, which could create an illusion of a more acute nasolabial angle and a longer looking nose.
Sometimes, the aged-related drooping of the tip causes breathing difficulty and abnormal airflow, which are considered medical conditions and thus some insurance may agree to cover the cost of rhinoplasty surgery.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley, who has performed over 3,000 rhinoplasties as of this writing, says the “inadvertent rejuvenating effects” of the surgery can be achieved when the drooping tip is de-rotated.
However, the amount of de-rotation should take into account the patient’s ethnicity, gender, nasal anatomies, and cosmetic goals, he says.
For instance, women of short stature in general can have more angle of tip rotation (i.e., angle between the tip and upper lip) with studies suggesting that they can tolerate up to 110 degrees angle.
The ideal angle of rotation of the nasal tip for men, meanwhile, is close to 90 degrees giving it a stronger, straighter profile. The upturned appearance is avoided like a plague during male rhinoplasty due to its feminizing effects.
De-rotating the tip entails improving its structural integrity; hence, Dr. Smiley often uses the patient’s own cartilage derived from the nose itself or the back of the ear to raise it a bit. The use of “living tissue” eliminates the myriad of risks associated with artificial implants.
Shaving down the prominent dorsal hump can also result in a younger, more feminine appearance. Nonetheless, it might be ideal to preserve some minimal fullness along the bridge when dealing with male patients to ensure a more natural and masculine result.
A 2012 study published by Archives of Facial Plastic Surgery has shown that patients who have had rhinoplasty looked 1.5 years younger on average compared with their “before” photos.
The researchers enlisted 53 rhinoplastic patients aged between 15 and 61 (35 was the average age) who were photographed before and one year after surgery; 50 “ordinary observers” were then asked to rate their appearance based on the perceived youthfulness.
The study noted that the rejuvenating effects were more evident for older patients than younger ones, although regardless of age, individuals who had dorsal hump reduction and greater nasal tip de-rotation appeared to lose more years than other patients.
Nose reshaping recovery may differ from patient to patient, although most can go out in public after 8-14 days without having to worry about the “outward signs” of surgery such as bruising and swelling.
Many patients are surprised that the recovery following a nose reshaping surgery (which is medically referred to as rhinoplasty, or in layman’s term nose job) is not as painful as they have been expecting it to be. Nonetheless, most describe the experience as rather “uncomfortable” since they have to breathe through their mouth due to temporary nasal congestion.
Leading Inland Empire plastic surgeon Dr. Tarick Smiley has provided a list of activities to avoid or at least limit during the nose reshaping recovery.
* Running, jogging, dancing, and other similar aerobics exercises are best postponed for two weeks, or sometimes even longer depending on the individual healing. It is important to note that the pressure and nasal congestion also makes it difficult to perform rigorous workouts.
* Contact sports are best avoided for a minimum of 2-3 months to give the underlying framework of the nose the opportunity to heal completely.
* Avoid wearing eyeglasses. How long should one wait depend on many things, although patients who have had osteotomies (breaking of the nasal bone) are typically instructed to avoid wearing eyeglasses for a minimum of six weeks.
* Making extreme facial expressions. Anything that causes discomfort or results in excessive manipulation of the upper lid (which affects the nose itself) is best avoided in the meantime.
* Avoid showers to prevent bandages and splint from getting wet. Typically, they are removed about a week postop.
* Avoid blowing one’s nose. By two weeks postop, most patients can blow their nose as long as they do this with care. However, others are required to wait up to three months particularly if they have had septal perforation repair or other similar types of complex or reconstructive surgery.
* Avoid hard-bristle toothbrush in the first few weeks following a nose reshaping surgery. The goal is to prevent excessive manipulation of the upper lip to keep the nose at rest and prevent inadvertent injury or disturbance.
* Avoid accidental bumps with proper attire. Button down shirts and wrap-around dresses are particularly ideal in the first few weeks of recovery.
Septoplasty insurance coverage might be possible provided that the patient and his doctor are able to prove that this type of nose surgery aims to improve breathing functions. For this reason, proper medical documentation is of critical importance.
While septoplasty is commonly combined with rhinoplasty, or more commonly referred to as nose job, its only aim is to improve the function of the nose—not its outside appearance or “aesthetics.”
Septoplasty primarily “aligns” the deviated septum, which is the strip or wall of tissue between the nostrils, ultimately eliminating the “obstruction” of airflow. In general, it has no or very little effect on the outside appearance of the nose, according to California Surgical Institute website.
Should the patient and his doctor are able to demonstrate that septoplasty is a medically warranted procedure, health insurance is possible. Many surgeons these days have well-trained staff who can verify insurance coverage and possibly help individuals secure proper medical documentations.
Nonetheless, septoplasty insurance coverage typically means that the patient will still pay for the deductibles, copays, etc.
It is not uncommon to combine septoplasty and rhinoplasty in one surgery. Should the insurance agree to cover the cost of the “reconstructive part” of the operation, the patient will still have to pay for the anesthesia “time” associated with the cosmetic aspect of the procedure.
It is almost always ideal to combine septoplasty and rhinoplasty (should the patient wish for cosmetic improvements as well) instead of performing them separately. With combo procedure, he will only experience recovery once and possibly lower the overall cost of the surgery.
Doing them together also gives the surgeon more “options” and better control over the aesthetic aspect of the nose. For instance, instead of throwing away the removed [excess] septal cartilage, which contributes to the abnormal airflow, he is able to re-use it to refine the tip and/or create a stronger structural support.
As of this writing, the average cost of septoplasty combined with rhinoplasty varies from $5,000 to $8,000.
Facial plastic surgery and smoking do not mix. First and foremost, smokers have compromised healing due to the effects of nicotine and the hundreds of cancer-causing chemicals found in a single cigarette stick.
While instructions about complete cessation of tobacco products may differ from surgeon to surgeon, the consensus is that three weeks is enough to flush out most of their detrimental effects.
Tobacco products contain nicotine, which is a strong vasoconstrictor, i.e., it causes blood vessels to constrict therefore the nutrient- and oxygen-rich blood flows less efficiently. Ultimately, it takes a longer time for the patients to heal and they become more susceptible to infection and skin necrosis in which the tissue turns black and dies due to lack of oxygen.
Facelift for smokers is particularly risky. In this procedure doctors create skin flaps, which are healthy tissue that is partly detached and moved to create a tighter, more youthful appearance.
But with constricted blood vessels these skin flaps may not receive enough oxygen and nutrients and ultimately “die.” For this reason smokers are more likely to have revisions than non-smokers after facial plastic surgery to address poor scarring.
Also, smoking defeats the inherent purpose of facelift, i.e., to achieve a more youthful appearance, because it significantly accelerates the skin’s aging rate.
Smoking also has detrimental effects on patients having rhinoplasty, or more commonly referred to as nose job. According to California Surgical Institute website, because of the delay healing the grafts and the underlying anatomies of the nose are susceptible to injuries for a longer period of time.
After about two weeks, the grafts and the new contour created by rhinoplasty are more “stable.” But in smokers, the healing process occurs at a much slower pace that they are at an increased risk of inadvertent shifting of the bones due to trauma.
Coughing episode is another common issue with smokers since tobacco disturbs the lining of the lungs and bronchi.
It is important to note that coughing episodes could lead to hematoma (internal bleeding) and persistent swelling, further complicating the patient’s recovery.
Furthermore, a 2005 study has suggested that smokers require 23 percent more pain medications after an operation, and 33 percent more anesthesia during surgery than non-smokers.