It could be said that cosmetic surgery is where science meets art. In some ways, plastic surgeons have become 21st-century portrait artists or sculptors working with real bodies.
Clients arrive with a view of what they want to look like, perhaps seeking rejuvenation in a consumerist spirit of “you’re only young twice”. As surgeons work from photographs, sketches and markings on skin, there is a blurring of the distinction between portraiture and medical procedure.
But to achieve perceived beauty, a surgeon has to be more than an accomplished technician. The surgeon has to know the answer to what is beauty?
Of course, the concept of “beauty” is problematic and open to subjective judgments. What is considered beautiful may change with time and fashion, and there are also significant cultural differences.
However, let’s focus on modern Western perceptions and observations by leading cosmetic surgeons, notably consultant Rajiv Grover, president of the British Association of Aesthetic Plastic Surgeons.
The leading Harley Street practitioner recognises that the interaction of art and surgical aesthetics is essential to achieve a natural and pleasing result from cosmetic surgery.
According to Mr Grover, pop artist Andy Warhol knew the importance of the central facial triangle, consisting of the two eyes and mouth, as a key feature of the face.
“The central facial triangle is the first area to draw the gaze of an observer,” says Mr Grover, who has lectured at the Louvre in Paris, and London’s Royal College of Art and Central Saint Martins.
Research conducted at New York’s Metropolitan Museum of Art, when a camera was used to identify where a person’s eyes look when they first see a face, showed people focus initially on the subject’s eyes, then down to the mouth and then back to the eyes, before looking around the outline of the face.
“Even very young children look at faces this way, long before they have learnt about facial beauty or perception,” says Mr Grover.
Leonardo da Vinci talked about the shape being more important than features and wrinkles as signs of ageing nearly 500 years before its value was appreciated by science
Warhol’s striking silk screen prints of Hollywood film stars Marilyn Monroe and Elizabeth Taylor, for example, emphasised the central facial triangle to great effect by creating prominence of the eyes and lips.
“Any feature which could distract from the central facial triangle, such as the nose, was minimised,” says Mr Grover. “This way he emphasised the youth and beauty of his subjects.”
In the world of photographic art, the Vogue cover which was voted the most iconic of the 20th century was the January 1950 edition featuring Erwin Blumenfeld’s distillation of the female face down to just an eye and mouth, and yet we can still perceive the image as a face.
“This illustrates the powerful impact which the features of the central facial triangle have on perception,” says Mr Grover.
“Understanding this allows us to look at beauty in an analytical way. A face where the central facial triangle is emphasised may be perceived as more attractive.
“Wide bright eyes and proportionate lips, without features that could distract attention, such as a large nose, prominent nose-to-mouth lines or jowls, mean that you can focus on the key features of the central triangle.”
The face of a young Brigitte Bardot illustrates this well. The smooth junction between eyelid and cheek means the eyes are emphasised, as is the mouth. The shape of her midface and cheeks also acts as a pedestal to enhance the eyes.
“The fact that her central facial triangle is so clear makes her very beautiful,” says Mr Grover.
As we age, it can be loss of volume from the face, particularly over the cheeks, which changes the prominence of the facial triangle, so important for youth and beauty. And, according to research by Mr Grover with the Qmed Institute, this occurs about seven years before there is evidence of gravity causing facial tissues to drop.
“Leonardo da Vinci talked about the shape being more important than features and wrinkles as signs of ageing nearly 500 years before its value was appreciated by science,” says Mr Grover.
“As the face ages, the loss of midface volume detracts from the eyes and the presence of nose-to-mouth lines distracts from the mouth, as does the development of jowls. The appearance of the central facial triangle therefore seems to reverse.
“Modern rejuvenation should address these changes in order to rejuvenate in a natural way and one that respects what is known from the work of the great artists.”
Early approaches to facial surgery focused on the fact that ageing led to loose skin and, therefore, tightening of the face and neck was the main aim. But the effects of tightening the skin alone, rather than the underlying soft tissues, resulted in surgery which caused pulling and flattening of the cheeks. Tension in the skin distorted facial appearance, including the ears which were often pulled forward.
“Surgery has changed a lot in the last two or three decades and appreciation that the soft tissues also require support, rather than just pulling the skin, has led to the so-called ‘deep plane’ lifts where the underlying muscle of the face is pulled in addition to the skin,” says Mr Grover.
“The true appreciation that cheek volume is the key to beauty and also to a natural, artistic rejuvenation has only reached prominence in recent years.”
Understanding that the face ages first by volume loss and then by gravity, he concludes, means both these parameters must be addressed.
“Science has helped us understand the mechanism of ageing and that volume loss is the precursor of gravitational change,” says Mr Grover. “Focusing attention on adding volume to the cheek and midface enhances the perception of the central facial triangle, which creates a beautiful and youthful face.”