Facial Surgery
https://doi.org/10.1093/asj/sjab339
www.aestheticsurgeryjournal.com
From the Department of Plastic Surgery, University of California,
Irvine, Orange, CA, USA.
Corresponding Author:
Dr Nima Khoshab, UC Irvine Manchester Pavilion, 200 S Manchester
Ave #650, Orange, CA 92868, USA.
E-mail: nkhoshab@hs.uci.edu; Instagram: @nima_khoshab
Presented at: Plastic Surgery The Meeting 2020 (virtual).
Historical Tools of Anthropometric Facial
Assessment: A Systematic Raw Data Analysis
on the Applicability of the Neoclassical
Canons and Golden Ratio
Nima Khoshab, MD, MS; Megan R. Donnelly, BS ; Lohrasb R. Sayadi, MD;
Raj M. Vyas, MD; and Derek A. Banyard, MD, MBA, MS
Abstract
Background: The fundamental tenets of facial aesthetic surgery education have not changed in centuries. Research is
beginning to demonstrate that the Neoclassical Canons and the Golden Ratio, Phi, have limited utilization in populations
other than those of White European extraction.
Objectives: The purpose of this study was to analyze comparable raw data in the literature to determine (1) if there is
interethnic variability in Neoclassical Canon and Phi measurements, and (2) if the measurements in these representative
samples difer from the “ideal.”
Methods: A PubMed/Scopus search was performed. Manuscripts with raw data and individuals aged ≥16 were included.
Measurements were extracted and employed to calculate the Neoclassical Canons and Phi. One-way analysis of variance
(ANOVA) tests were conducted to compare mean measurements across 6 ethnic groups (P < 0.05).
Results: Twenty-seven articles were included. Every continent was represented except Antarctica and Australia. Men
were less commonly studied than women. Participant ages ranged from 16 to 56. Averaged Canons 2, 6-8 measurements
had signifcant interethnic diferences in males, whereas Canons 5-8 had signifcant diferences across ethnicities in fe-
males. For men, there was signifcant interethnic variability in measurements of Phi 2, 5, 8, 10, and 17. For women, Phi 1, 2,
5, 8, 10, and 17 varied across ethnicities. No ethnic/gender group showed consistent approximation of the “ideal” for both
the Neoclassical Canons and Phi.
Conclusions: Today, the utility of the Neoclassical Canons and Phi is limited. It is incumbent on our feld to systematically
study and defne the anthropometric measures that defne the “ideal.”
Editorial Decision date: August 31, 2021; online publish-ahead-of-print September 13, 2021.
When attempting to defne “beauty,” the line between art
and science is seldom more blurred.
1
In fact, it was the an-
cient Greeks who frst ventured to describe “beauty” as a
state of harmony or observed symmetry often found in na-
ture.
2
Circa 450 to 420 BC, sculptor Polycleitus took these
Grecian concepts one step further, combining them with
Egyptian principles to derive 11 facial proportions meant
to capture the aesthetic “ideal.”
3
Later, in 90 to 20 BC,
Marcus Vitruvius Pollio, a Roman architect and engineer,
© The Author(s) 2021. Published
by Oxford University Press on behalf
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Aesthetic Surgery Journal
2022, Vol 42(1) NP1–NP10
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