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Exploring The Validity Of Neoclassical Facial Canons Across Various Ethnicities
Wilmina N. Landford, MD1, Ledibabari M. Ngaage, MA Cantab MB BChir2, Alvaro Reategui, BA3, Joseph Lopez, MD1, Adekunle Elegbede, MD, PHD1, Robin Yang, MD, DDS1.
1Johns Hopkins University School of Medicine, Baltimore, MD, USA, 2University of Maryland Medical Center, Baltimore, MD, USA, 3University of Puerto Rico School of Medicine, San Juan, PR, USA.

PURPOSE: Facial proportional analysis for pre-operative planning in aesthetic and reconstructive surgery stems from the neoclassical facial canons used to describe ideal beauty. Earlier studies defined ideal measurements of the face and developed two-dimensional (2D) anthropometric analyses that have served as an excellent tool for the evaluation of craniofacial morphology; however, 2D analysis has inherent methodologic limitations. Alternatively, 3D imaging technology has been shown to provide more accurate and reproducible measurements as well as reliable landmarks. The advantages of a 3D imaging modality are well established but normative 3D anthropometric data that factors in age-, gender-, and race/ethnicity-dependent factors for treatment planning in aesthetic surgery are nonexistent. The aim of this study was to establish a baseline for selected 2D and 3D facial anthropometric measurements across various ethnicities in the literature, test the validity of neoclassical facial canons, and determine differences among ethnicities presented in the literature.
METHODS: A systematic review of the literature was performed using a MEDLINE search following PRISMA guidelines. Keywords related to anthropometric landmarks, 2D photometric analysis, three-dimensional imaging, and various broad ethnicities were included. Two independent reviewers identified articles describing facial measurements using 2D and 3D imaging. Inclusion criteria included articles that had bony and soft tissue linear and angular anthropometric landmarks, described a 2D and 3D imaging modality, and identified a particular ethnic group.
RESULTS: Twenty-seven studies met the inclusion/exclusion criteria and were included in this meta-analysis. A total of 3578 patients were extracted, with the majority (52%) consisting of female patients. The ethnic distribution represented as follows: East Asian (26%), Middle Eastern (21%), Caucasian (15%), South Asian (13%), Latino (10%), and African (10%). Facial measurements varied across ethnicities. Intercanthal distance was greatest in East Asian populations (Mean = Male 36.9mm, Female 35.0mm), followed by Latino (Mean = Male 34.3mm, Female 33.4mm), Middle Eastern (Mean = Male 33.1mm, Female 33.1mm), and South Asian (Mean = Male 32.3mm, Female 31.5mm). Middle Eastern women had a larger nasal height, on average, than East Asian women (Mean = 51.9mm vs 45.6mm). Contrary to the common belief, intercanthal distance was less than nasal width in East Asian males, Latino males, and Middle eastern males. Interestingly, compared to the neoclassical canons of the face, East Asian males, on average, had a smaller facial width whereas East Asian female had a wider facial width.
CONCLUSION: Collectively, we present multi-level data that quantifies differences in facial measurements across various ethnicities in both 2D and 3D anthropometric analyses. Additionally, our review demonstrates the need to restructure our current conceptions of ideal measurements and develop a more accurate methodology for facial analysis across ethnicities.


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