Facial Beauty and the Central Role of Volume

Introduction

The quest for beauty is eternal, a phenomenon as old as time itself. It is universal, it knows no limits, it transcends all boundaries and borders, and it is essential to our existence, both as individuals and as a species. Since time immemorial, humans have relentlessly cultivated beauty in their physical surroundings, coveted it in their partners, sought it in their peers, and strived for it within themselves. Although certain beauty ideals have gone in and out of style over time, and some may have shown variations across cultures, the fundamentals have remained constant. Facial beauty is defined by certain tenets: symmetry, balance, harmony, synchrony of elements, homogeneity of color and texture, and smooth contours. An extremely important feature of restoration, enhancement or maintenance of facial beauty is judicious and strategic placement of volume, as it is responsible for achieving many of the desirable attributes. With a multitude of soft-tissue fillers, the clinician has an extensive armamentarium to address age-related changes in facial volume and hence modify patients’ self-perception, self-esteem, and overall interaction with their external world. Central to this role is a deep understanding of beauty, as there is little doubt that it is beauty that we are ultimately seeking. To successfully manage patients and their aesthetic concerns, we must start by establishing why beauty exists, why its attainment is so important to our patients, how it evolves over time, and how best to address those predictable changes.

The very existence of beauty

The pursuit of beauty is an innate drive linked to survival itself. Connection is one of the most primal of human needs. We are programmed to communicate with one another and to bond from birth, and these tendencies are honed as life proceeds. We learn to modify our appearance and behavior very early in life to enhance positive human engagements, thus maximizing our survival tendencies. A child, at its youngest, understands that charm and attractiveness will beget nurturing connections, ones that are rewarded with love, food, protection, safety, and security. By recognizing what is good and bad around us in terms of beauty or ugliness, we are likely to choose good (or beautiful) and avoid bad or harmful (ugly). Many different professions have studied attractiveness and beauty—psychologists, neuroscientists, biologists, human behaviorists, anthropologists, dentists and orthodontists, dermatologists and surgeons, as well as other specialties—all approaching this topic from their unique perspectives. With the prospect for a more fulfilling life, enhanced purely by its presence or absence, beauty clearly has an important function.

Given that our visual sense is such a dominant force, it is no surprise that our appreciation of facial appearance is rapid and efficient. Humans have profound needs to connect with one another and to belong and conform within a larger group. These needs manifest throughout all of life’s stages, from early infancy to the playground days of childhood, from our romantic choices in adolescence and beyond, to the quest for social and professional circles in adulthood. The most direct and effective way to achieve this coveted interpersonal connection is through our faces and our facial expressions; therefore, maximizing facial attractiveness is of utmost importance to humans. Although facial movement and surface-related issues are undoubtedly important aspects to a beautiful face, volume and the resultant shape remain key components to the perception of a beautiful face ( Fig. 3.1 ).Volume is central to rejuvenation of the aging face, or facial improvement at any age, and plays a pivotal role in our visual clues when assessing facial beauty.

What are the principles that underpin our understanding of beauty?

The total attractiveness of an individual is not quite the same as facial beauty. Attractiveness is multifactorial, more of the total package; it may relate to how a person moves, one’s appearance of fitness, the manner of expression, or how one sounds or even thinks. It may relate to one’s power or success, to reputation, how a person relates to others, and many other facets that go into the making of an individual. Mere physical beauty, combined with attractiveness, can lead to success and wealth in life. As it becomes clear, success begets beauty, which in turn begets more success. As such, reasonable dedication to one’s physical appearance is a sound investment in one’s future stability and financial security.

The introduction of photography and its rapid evolution and integration into our quotidian lives through smartphones and “selfies” have undoubtedly shaped our modern perception and understanding of beauty. Until almost 100 years ago, humans were not accustomed to seeing themselves represented in images. Self-portraits hung on the walls of mansions, palaces, and castles of the upper-class for centuries, but the average humans depended on their social interactions with their peers for self-validation and self-definition. After the invention of photography, the idea of seeing one’s image in print became possible. Later, with the advent and worldwide distribution of smartphones, photography became ubiquitous, with most individuals capable of access within seconds to a device to photograph themselves, to check on their appearance, comparing themselves to the beauty ideals blasted on social platforms online, and to filter, modify, and modulate their appearance at will. The tsunami of selfies, filters-effects, editing options, and virtual, video-based meetings has led to a unique storm for distortion in self-perception, as these images alter one’s external sense of self. The synchrony between inner and outer beauty is essential for a harmonious sense of self, and the omnipresence of self-imagery has created an imbalance in this relationship. This has resulted in an increase in displeasure with one’s appearance, greater anxiety, and a surge in the desire to undergo cosmetic procedures in an attempt to rectify this perceived disparity. It should also be noted that the camera and lens with which one photographs significantly affect the resultant image, thus impacting one’s self-perception. The choice of photographic hardware, further magnified by the software options, in conjunction with varying lighting conditions, can render a huge range in resultant images, altering facial angles and curves, shifting balance and shape, often creating fictitious issues, and false impressions for the viewer. These factors play significantly and regularly into the information received by the human psyche, as the barrage of sensory input rarely lets up.

These are important, game-changing considerations in the modern aesthetic arena, and patient expectations must be filtered through this new lens.

Attractiveness in humans is certainly not limited to the face. A determinant of female attractiveness and beauty is termed the “ogee curve.” This curve is simply a convexity, followed by a concavity, which is best appreciated by the example of the classic 1950s pin-up, in which there is a convexity on either side of a concavity at the waistline. The waist–hip ratio (WHR) is one of the most alluring aspects of body attractiveness. The thrust, however, of this chapter is more specifically facial beauty and the role of volume in that beauty, and here, we witness volume-expanded ogee curves ( Fig. 3.2 ) as clues to sexual maturity in the curve of the high cheekbones, eyelid–cheek junction, lips, and eyebrow.