One can objectively describe a youthful orbit. Figure 1 presents measurements of orbital structures found in young women.1-3 These measurements include the dimensions and cant of the palpebral fissure, the distance of the eyebrow from the midpupil, the height of the lower lid, and the projection of the cheek beyond the cornea. These dimensions and relations, which are characteristic of the youthful orbit, have been summarized as follows: brows with an apex lateral slant, eyes that are narrow, lower lids that are short, and cheeks that are full.4 These attributes should be the goal of orbital contour rejuvenation. As commonly performed, orbital rejuvenation surgery usually fails to restore youthful orbital contours; rather, it alters these contours, often exaggerating those of aging (Fig. 2).
In a recent article reviewing the 2001 meeting of the American Society for Aesthetic Plastic Surgery, Rohrich5 points out that the specialty of plastic surgery has evolved beyond just technique. The meetingâ€™s emphasis was placed on mastering shape and contour to restore and enhance. Rohrich asks, â€œDo we restore patients to appear younger and better or to look different?â€ He points out that youthful brows, upper and lower lids, cheeks, and midfaces are full. Defining the attributes of youth and those of aging is a critical first step in developing techniques for effective facial rejuvenation. Figure3 shows pre-operative and postoperative views of the left orbit of a woman whose rejuvenative orbital surgery attempted to restore the attributes of youth previously defined1,2 and demonstrated in Figure 1.
Although mathematical analysis can provide normative data that can objectively define changes that occur with aging, it is unlikely that curve analysis and recognition of particular curve forms on the human face can help understand the subjective attributes of human attractiveness or can guide the aesthetic surgeon6 in the creation of a beautiful face. Farkas et al.7 found little validity to the mathematically based neoclassical and Renaissance canons when those standards were applied to living, attractive faces.
Etcoff8 has pointed out that although the mathematÂical ratio phi, equal to 1.1618 and known as the divine proportion, may be seen in many biologic forms and its approximation may characterize certain relations of the normal human face,9 it does not distinguish beautiÂful from average or beautiful from plain. Etcoff summarizes her analysis of mathematÂical ideals of human beauty and, in effect, her entire book, which is subtitled The Science of Beauty, by saying that, â€œFor scientists in this century, the key to understanding human beauty is in our biology not in mathematics.â€