Throughout history mankind has tried to define beauty. Poets, philosophers, and artists have pondered its elusive quality while attempting to quantify that which is evident to all of us. As surgeons, however, we are required to have a more scientific approach to beauty to formulate operative plans with successful surgical outcomes. Common reference points are essential in communicating with colleagues and medical record keeping. Furthermore, we must be able to accurately define specific characteristics that deviate from the norm so that we may identify congenital anomalies and facial deformities.

As early as ancient Egypt, aesthetic facial proportions have been idealized in art. However, it was not until the Greek philosophers that the study of beauty became a formal discipline. To Plato and Aristotle beauty meant symmetry, harmony, and geometry. In the fifth century BC, the Greek sculptor Polyclitus defined perfect beauty as the mutual harmony of all parts, such that nothing could be added or subtracted. Such harmonic proportions were held to be beautiful in themselves, independent of any observer.

These ideas were later revisited by the Renaissance artists, who began to define ideal proportions for the human form. This example is nowhere more evident than in the drawings of Leonardo da Vinci and his Vitruvian man ( Figure 21-1 ). It was da Vinci, who, through the study of anatomy, formulated ideal facial proportions and divided the profile into equal thirds ( Figure 21-2 ). Leonardo’s scientific accuracy rivaled that of Vesalius, whereas his artistic beauty remains unchallenged. Another Renaissance artist inspired by the Vitruvian notion of perfect proportions was the German printmaker Albrecht Durer. Durer used his own finger as a unit of measurement to construct a proportional system for the entire body, and in 1528 he published a four-book treatise on human proportions. Durer divided the facial profile into four equal parts and recognized that the length of the nose equals that of the ear.

Figure 21-1  Leonardo da Vinci. The proportions of the body according to Vitruvius, ca. 1490. Pen and ink with touches of wash, over stylus 34.4 × 24.5 cm.  (Courtesy of the Galleria dell’ Accademia, inv.228, Venice.)

Figure 21-2  Leonardo da Vinci. The proportions of the head, ca.1490. Pen and ink over black chalk, 28.0 × 22.2 cm.  (Courtesy of the Galleria dell’ Academia, inv.236v, Venice.)

The artistic cannons set forth in antiquity and during the Renaissance dominated Western art for centuries. In the twentieth century, anthropometrist Leslie Farkas[3] challenged the classical cannons by measuring the facial proportions of 200 women, including 50 models. His results concluded that some of the cannons are nothing more than artistic idealizations. Nevertheless, although social and cultural factors influence every generation’s concept of beauty, the aesthetic cannons have withstood the test of time. Currently, the parameters established in the facial plastic surgery literature are based predominately on the works of Powell and Humphreys, who in 1984 crystallized this topic into a single text Proportions of the Aesthetic Face.[7]



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