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The Golden Ratio—Just How Important is Facial Symmetry in Medical Esthetics?

Contact Author Robert Manzo April 2015 issue of Skin Inc. magazine
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Facial symmetry is important, but there are many aspects about facial proportion, condition and appearance that are equally important—sometimes even more important—when it comes to perceived beauty.

The golden ratio

Facial symmetry with respect to perceived beauty is a highly controversial and deeply investigated field. There is a well-known “golden ratio,” also called the “golden rule” or “divine proportion,” that is extensively written about and researched. The basic idea is that if certain measurements of facial features conform to this ratio, the face will look more aesthetically pleasing.

The concept goes back a long way in history to the ancient Greeks and also to the mathematician who created the mathematical sequence Fibonacci numbers, Leonardo Fibonacci. The well-known idea is that a ratio observed in aesthetically pleasing nature is mathematically calculated that leads to an optimal aesthetic ration of 1.61.

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For many years, medical esthetic professionals have measured skin quantitatively, attempting to get the best aesthetic for the patient by utilizing noninvasive techniques.

A few points to keep in mind relative to facial symmetry and beauty are as follows.

  1. Perfectly symmetrical faces are rare.
  2. Symmetry does not exclusively define beauty in a face. A face can be symmetrical, but with poor proportionality relative to individual facial features.
  3. There is a static symmetry and a dynamic symmetry to deal with in a face. What happens when a smile, a frown or confused expression occurs? Is the face symmetrical in motion?
  4. Many times a particular asymmetry in a face leads to the very uniqueness and beauty aesthetic of the individual, and attempting to generate perfect symmetry loses that person’s uniqueness.

A slightly different approach to improving facial symmetry relative to perceived beauty of a face in the field of medical esthetics, referred to as eye distraction reduction (EDR).

Eye distraction reduction

When first consulting with a prospective client who wants to improve their looks, spend time evaluating them in the following ways.

  1. Evaluate symmetry in the face by eye or preferable by diagnostic imaging.
  2. Evaluate the key beauty aesthetic in the face—what makes the face aesthetically pleasing to the eye? This could be face shape, or sectional areas of the face that stand out, such as the cheek bones or eye shape.
  3. Then—this is important and is often missed in evaluations—determine what aspects in the face are distracting the eye from focusing on the beauty aesthetic in the face.

So many skin care professionals just aim to target winkles, volume loss, pigmentation or other obvious issues in the face, and just work on those issue without looking at the whole face aesthetic. Often times beautiful eye shape and symmetry can be completely distracted by undereye darkness or the presence of milia. Facial symmetry can be masked by distractions on the face.

Case study 1

When this client in Image 1 and Image 2 was evaluated initially, she reported that she was aging and wanted to turn back the signs of aging without surgery. Following the above method, her consultation was as follows.

  1. This face is asymmetrical vertically, particularly in the eye and brow area. The client has relatively good proportionality within key features, such as nose, lip and eye distances and ratios.
  2. The key aesthetics areas are two-fold. The horizontal eye area and the lower facial structure.
  3. What distracts from key aesthetics? Skin tonality, undereye texture and forehead wrinkles.

Approach. One could use neuromuscular blocking agents and fillers to improve symmetry in the upper face area. Clearly, improving symmetry in these areas would provide an aesthetic benefit. The goal for overall aesthetic improvement is to do so with as little invasiveness or side effects as possible. In this case, while symmetry is important, removing the EDR will generate a significant improvement in perceived beauty.

This client experienced in a long-term treatment that lasted three years and improved the aspects listed above with topical cosmeceuticals. There were no neuromuscular blocking agents or fillers used, no lasers and no surgery. The improvement is visible from Image 1 to Image 2 over the three-year period.

The asymmetry is still there, but the distractions are gone. Is there an improvement in perceived beauty? Yes. Can further improvement be achieved in improving the symmetry through slightly more invasive techniques? Of course.

Note: The images are not altered in any way, so the face is at a slightly upward angle in Image 1 and there is some weight loss in Image 2. These are factors that occur in long-term studies, but the facial improvement is apparent.

Case study 2

The patient in this case presented with significant epidermal melasma. (See Image 3 and Image 4.) This patient also has significant asymmetry in the vertical aspect of the face. Which issue would you treat first, melasma or asymmetry?

Approach Melasma should be treated first. Look at the results in Image 5 and Image 6. This was achieved by a series of customized chemical peels with home-care cosmeceuticals over a period of about four months.

A significant improvement in perceived beauty was achieved due to EDR. Could she benefit from treatments to improve symmetry? Of course. But the practioner must learn to prioritize not only what features can be improved, but what aspects of the face are distracting from the beauty aesthetics in the face.

“Beauty is in the eye of the beholder” could not be a more true statement. While facial symmetry is important to facial aesthetics, pay attention to the obvious and not so obvious aspects of facial features that distract from clients’ natural facial features, providing their individual beauty aesthetic.

Look at well-known esthetics issues—including tonal problems, textural issues, wrinkles, dullness and dark spots—in light of how they affect the unique and individual natural assets clients’ have and how they distract from those aspects. Then treat them in order of priority to achieve better aesthetic results more quickly.

Robert Manzo, president of Skinprint, has more than 30 years experience in creating efficacious health and beauty products.

Note: treatments that a licensed esthetician may perform in a medical spa space vary by state. Please consult with your state board before adopting or performing any unfamiliar treatment.

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