The first step in facelift surgery is acceptance that everyone has a truly unique face. Once this concept is accepted, Dr. Durkin begins your process by specifically identifying what comprises the inherent strengths and weaknesses of a your face. Everyone is born with natural strengths in their personal facial aesthetics. Some people have perfect brow position, others are born with a perfect, aquiline nose. There are things about our faces that work, and things that do not work.
We dedicate time to analyzing and discussing the inherent strengths and weaknesses of your facial appearance during our plastic surgery consultation. Our goals with any intervention is simply to:
There are a number of ways to analyze the human face. The most commonly utilized technique is application of the neoclassical tenets of facial beauty.
If you think about the concept of beauty, it is truly unique because while it lies in the eye of the beholder, there are some universal aspects to beauty that we all can identify. For example, not everyone listens to classical music on a regular basis but, most people can recognize a classical masterpiece when they hear it as compared to generic classical music. Whether or not you enjoy orchestral performance, almost everyone can tell the difference between Mozart and the elevator ensemble.
But how can people universally discern beautiful music from pedantic music? There is a natural beauty to Mozart that is universally appealing. It may be in its layered complex organization, or it may lie in the exactitude of each note. Whatever it is, almost everyone recognizes it as beautiful, and because of this beauty, Mozart creates a feeling inside of us whenever we hear his music throughout the centuries. This effervescent feeling is what beauty evokes in us, and we are lucky to be in a world with so many examples. They can be found in nature, in sports, in medicine, and most commonly in peoples’ actions and appearance.
This same concept holds true in facial aesthetics. While there are many different shades of beauty in both men and women, there are some universally accepted traits of facial aesthetics. These traits are present regardless or gender or race.
Did you know that the angles of the human face are similar across races and genders? The anatomical features of the human face creates aesthetic angles that are well documented in plastic surgery. Facial analysis reveals that the proportions and angles between men and women are strikingly similar (Diagram A). For example, the nasofacial angle (NF) is 34 degrees in females, 36 degrees in males. Just 2 degrees separates the sexes! The nasolabial angle (NL) is 100 to 103 degrees in men and 105 to 108 degrees in women.The difference in nasal angles occurs because the female’s nose is tipped slightly upward whereas men’s noses are slightly flatter. Flatter by just 2 degrees. While only a slight difference occurs, the angle of the nose is a desirable trait. Our female patients often say that they wish that their nose were “more feminine” and turned up just a little.
Diagram A. Dr. Alan Durkin describes the subtle differences between the aesthetic facial angles between men and women. In Caucasians, the nasofacial angle (NF) is regarded as ideal at 36 degrees in men and 34 degrees in women whereas the nasolabial angle (NL) is desirable at 100-103 degrees in men and 105-108 degrees in women. The man pictured on the left of diagram A has an NF of 40 degrees and an NL of 103.9 degrees. The woman shown on the right has an NF measured at 34 degrees and an NL of 110 degrees.
3 Vertical Proportions of an Ideal Face
Your aesthetic face is divided into three vertical regions of nearly equal length. The regions are (1) the trichion to nasion, (2) nasion to subnasale, and (3) the subnasale to a gnathion. The face can also be divided into 5 proportions of equal size horizontally. This is based on the distance between the medial canthus and lateral canthus. The medial canthus is where the upper eyelid and lower eyelid meet on the nasal side.
The lateral canthus is where the upper eyelid and lower eyelid meet on the ear side. The horizontal distance between the inside and outside of the eye can be transposed to the entire ideal face in equal proportions. Furthermore, the width of the mouth is 1.5x the width of the base of the nasal ala.
The eyebrows shape your eyes.
We know that well groomed eyebrows change a person’s appearance. You undoubtedly have heard of the “unibrow” an undesirable effect of having your eyebrows grow towards each other. You have also likely seen women who “over pluck” their eyebrows or lack a desirable eyebrow arch. But, the position of the eyebrow is also an important facial feature that is well respected in plastic surgery.
The eyebrow itself should be above the level of the superior orbital rim. If at or below the rim, the brow is considered apoptotic, or low. Brow position is a strong contributor towards the tired look, and must be evaluated. There should be a peaked brow between the lateral limbus (where the color meets the white of the eye), and the lateral canthus (where the upper and lower eyelids meet).
The eyes describe our environment to us through visual data, but they also portray us to the world. Appropriate periorbital aesthetics are crucial to facial harmony.
The lower eyelid is, in my opinion, the foundation of facial aesthetics. The lower lid is a dynamic balance of positive canthal tilt, appropriate soft tissue volume, with limited excess skin
The upper eyelid should have an almond type shape with an acute upper eyelid angle medially, followed by a softer gentle angle as you travel laterally. There should be minimal overlap of skin over the upper eyelid.
Men should have appropriate eyelashes. With women, long, dark, and full eyelashes will make your eyes appear more vibrant and youthful.
The concept of canthal tilt is crucial, as it serves as a subtle indicator of youth and vitality. As you proceed from the nasal side to the ear side of the eye, the lower eyelid should lightly tip upwards. This is called positive canthal tilt. If there is no tilt, it is considered neutral, and if the angle proceeds downwards, it is called negative canthal tilt.
As we age, we commonly form a line between the lower eyelid and the cheek. This line is called the lid-cheek junction, and medially, it can form what we call a tear trough deformity. This line is caused by a multitude of factors, including loss of subcutaneous volume, and descent of the cheek fat pad (aka malar fat pad, aka McGregor’s Patch)
The periorbital area should not appear hollow. This is not a youthful appearance, and can unfortunately give a sense of sickness or age. There should be a comfortable degree of subcutaneous volume surrounding the ocular structures.
The lower 1/3 of the face has a crucial set of retaining ligaments. These ligaments allow for a predictable pattern of skin sag along the jawline and along the lateral cheek.
The degree of skin sag is paralleled by the degree of laxity to the SMAS layer of the face and the Platysmal muscle of the neck. Excess skin and loose SMAS can blunt the jawline, reduce the definition of the cheek, and minimize the appearance of the neck muscles. Chin projection. Not all chins are created equal. Chin projection directly impacts upon the draping of the neck skin, and the chin profile must be taken into account in both men and women.
In summary, these are some of the concepts evaluated during initial consultation when Dr. Durkin examine your natural facial aesthetics. Each of these areas are examined, and the strengths and weaknesses of the face are catalogued. The goal of any intervention is to enhance the natural, inherent facial beauty that we all have in the safest possible fashion with the safest possible procedure. Correction of any facial weaknesses/deficiencies may or may not involve surgery, but intervention to ANY facial patient is always individualized.
Again, the foundation of facial aesthetic medicine and surgery is the realization that each face is completely different. Because of this belief, each intervention must be customized to that particular patient.
At Ocean Drive Plastic Surgery in Vero Beach, Dr. Alan Durkin, Dr. Jimmy Chim and their team of providers deliver incredible results tailored to your needs in a relaxing and uplifting atmosphere. Learn more about the Ocean Drive difference by scheduling your one-on-one diagnostic consultation with Dr. Durkin or Dr. Chim today.