This article discusses the various factors that contribute to facial beauty and the different contexts in which they are significant. The authors examine the roles of the golden ratio, ideal proportions, symmetry, and specific facial features in what constitutes an attractive face. They also investigate the influence of cultural and evolutionary perspectives on facial beauty and the impact of social media on our perception of beauty. The article provides a comprehensive overview of the topic and emphasises the significance of facial beauty and its impact on our lives. The authors acknowledge that the concept of beauty is difficult to define with absolute precision, and that the objective-subjective argument regarding facial beauty remains unsolved. However, they argue that physical attributes undoubtedly influence perceptions of attractiveness, but beauty extends beyond surface-level features. They also suggest that embracing diversity in beauty standards fosters a more inclusive society that celebrates the unique qualities of every person.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

BACKGROUND: The increasing number of esthetic procedures emphasizes the need for effective evaluation methods of outcomes. Current practices include the individual practitioners\' judgment in conjunction with standardized scales, often relying on the comparison of before and after photographs. This study investigates whether comparative evaluations influence the perception of beauty and aims to enhance the accuracy of esthetic assessments in clinical and research settings.
OBJECTIVE: To compare the evaluation of attractiveness and gender characteristics of faces in group-based versus individual ratings.
METHODS: A sample of 727 volunteers (average age of 29.5 years) assessed 40 facial photographs (20 male, 20 female) for attractiveness, masculinity, and femininity using a 5-point Likert scale. Each face was digitally edited to display varying ratios in four lip-related proportions: vertical lip position, lip width, upper lip esthetics, and lower lip esthetics. Participants rated these images both in an image series (group-based) and individually.
RESULTS: Differences in the perception of the most attractive/masculine/feminine ratios for each lip proportion were found in both the group-based and individual ratings. Group ratings exhibited a significant central tendency bias, with a preference for more average outcomes compared with individual ratings, with an average difference of 0.50 versus 1.00. (p = 0.033) CONCLUSION: A central tendency bias was noted in evaluations of attractiveness, masculinity, and femininity in group-based image presentation, indicating a bias toward more \"average\" features. Conversely, individual assessments displayed a preference for more pronounced, \"non-average\" appearances, thereby possibly pointing toward a malleable \"intrinsic esthetic blueprint\" shaped by comparative context.

BACKGROUND: Ears are an important aesthetic feature that is vital to the overall attractiveness of the face. Although there have been many studies on the aesthetics of the auricle, there is currently a lack of consensus on the ideal proportion of auricle exposure for Asian women in frontal view.
OBJECTIVE: This study aimed to investigate ideal proportion of auricle exposure in Asian women.
METHODS: An observational study was carried out on the photographs of 84 women on the list of the 100 most beautiful faces in Asia (published by TCC Asia in 2020). The proportion of the distance between the outer canthus and the outermost point of auricle to the distance between the inner canthus and the outermost point of auricle was calculated as the auricle exposure proportion. Evaluators were asked to rank a set of photographs of the volunteer with varying auricle exposure proportions from most attractive to least attractive.
RESULTS: Measurements of the photographs of the 84 women showed a mean ear exposure proportion of 0.600. With 487 questionnaire responses received, the proportion of auricle exposure that the evaluators considered most attractive was 0.600. People with aesthetic experience considered 0.625 the most attractive proportion, while the general group considered 0.600 the most attractive.
CONCLUSIONS: The ideal proportion of the auricle exposure for Asian women is in the range of 0.60-0.625, which may help surgeons reconstruct aesthetically pleasing ears.
METHODS: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Empirical evidence shows that the often-made positive correlation between human physical and moral beauty is tenuous. In this study, we aimed to learn whether facial and moral beauty can be psychophysically separated. Participants (n = 95) provided beauty and goodness (i.e., trustworthiness) ratings for pictures of faces, after which they were presented with a fictitious peer rating for the same face and asked to re-rate the face. We used the difference between the initial and final ratings to quantify the degree of resistance to external influence. We found that judgments of facial beauty were more resistant to external influence than judgments of facial \"goodness\"; in addition, there was significantly higher agreement within beauty ratings than within goodness ratings. These findings are discussed in light of our Bayesian-Laplacian classification of priors, from which we conclude that moral beauty relies more upon acquired \"artifactual\" priors and facial beauty more on inherited biological priors.

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The aging process affects skin, muscle and fat of the eyes in a different manner. Their individual rejuvenation would require specific surgical treatment according to their particular demands during lower eyelid blepharoplasty. This would require the separate management of the skin and the muscle by separating them into two different flaps. Basing on the anatomy, during sub-ciliary myocutaneous incision in conventional lower eyelid transcutaneous blepharoplasty most of innervations of the lower orbicularis oculi muscle are transected and denervation sequelae at the pretarsal orbicularis oculi muscle would be expected. However, sub/ciliary approach is still popular. The absence of signs or symptom of denervation of in our large case series even though injury to the motor innervation of the orbicularis oculi muscle during the operation led the authors to investigate the discrepancy between the anatomical concept and clinical outcomes. The study aimed to investigate the residual functionality of the orbicularis oculi muscle after lower eyelid transcutaneous blepharoplasty according to Reidy Adamson-s flap.
Ten patients were enrolled in the study. Orbicularis oculi muscle functionality was investigated with electroneurography before and at least 6 months after the surgical procedure. Investigated parameters are: Compound Muscle Action Potential (CMAP) as expressions of quantity of activated muscular fibers by the electrical stimulation of the facial nerve. Pre- and post-op collected data were compared and statistically analyzed.
The mean age was 52.9; minimum follow-up 6 months; twenty eyes were investigated; 1 patient was excluded. Postoperative data did not show any significant reduction in the CMAP at all.
The study suggests that the buccal branch and medial branch of the zygomatic nerve of the facial nerve supplies efficiently to the orbicularis oculi innervation.
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Beauty is difficult to define. The US population becomes more diverse by the day. Thus, traditional stereotypes of beauty in various ethnic groups become less applicable as diversity increases. Often, new and uniquely beautiful facial features and proportions emerge as different ethnicities converge. With the increased diversity in facial appearance comes increased variability in patients\' goals. A successful cosmetic surgeon will cultivate an understanding of aesthetic ideals in different ethnic groups, nurture discussions with patients to determine their aesthetic goals, devise a surgical plan for each patient, and develop and refine the necessary surgical skills to perform the procedure.

Human physical characteristics and their perception by the brain are under pressure by natural selection to optimize reproductive success. Men and women have different strategies to appear attractive and have different interests in identifying beauty in people. Nevertheless, men and women from all cultures agree on who is and who is not attractive, and throughout the world attractive people show greater acquisition of resources and greater reproductive success than others. The brain employs at least three modules, composed of interconnected brain regions, to judge facial attractiveness: one for identification, one for interpretation and one for valuing. Key elements that go into the judgment are age and health, as well as symmetry, averageness, face and body proportions, facial color and texture. These elements are all Costly Signals of reproductive fitness because they are difficult to fake. However, people deceive others using tricks such as coloring hair, cosmetics and clothing styles, while at the same time they also focus on detecting fakes. People may also deceive themselves, especially about their own attractiveness, and use self-signally actions to demonstrate to themselves their own true value. The neuroscience of beauty is best understood by considering the evolutionary pressures to maximize reproductive fitness.

BACKGROUND: Correction of tear trough (TT) deformity is a crucial aspect of facial rejuvenation. Because the anatomical origins of TT deformity lie in the TT ligaments, which firmly attach the dermis to the periosteum, the release of TT ligaments should be considered when performing an etiological correction. The aim of this paper is to propose an alternative method for TT deformity correction, comprising use of filler together with the release of TT ligaments. This technique was compared to the procedure of only percutaneous filler.
METHODS: From January 2014 to December 2015, 10 patients were enrolled in the study for recurrence of TT deformity. All the patients underwent TT ligament release and filler injections; all had been previously treated with percutaneous hyaluronic acid injection without ligament release. Under local anesthesia, the TT ligaments were detached using a blunt cannula introduced directly in the supra periosteal plane through an intraoral access. Once the ligament was released, the TT depression was evenly recontoured with a very small amount of filler. The clinical data, digital images, evaluations of outcomes, including patient satisfaction rates were collected and compared.
RESULTS: Adding the procedure of TT ligament release to filler injections showed satisfactory results, avoiding an unnatural puffy appearance. The comparison between the two different methods showed improved outcomes and increased patient satisfaction with minor patient discomfort among those who underwent TT ligament release.
CONCLUSIONS: Because TT ligaments are among the etiologic factors of TT deformity, they have a strong impact on procedures that are designed to improve TT deformity; therefore, TT ligament release should always be considered to obtain satisfactory, natural results.
METHODS: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

BACKGROUND: The aim of this study was to assess whether scores assigned to the eyes, nose, mouth, and chin regions work as predictors of full smiling face scores.
METHODS: In this cross-sectional study, the authors used the facial photographs of 86 smiling men. Photographs yielded 5 components: 1 of the face itself and 4 subcomponents (eyes, nose, mouth, and chin region). Raters assigned the photographs beauty scores that the authors measured morphometrically. The authors analyzed the predictive ability of the subcomponents against that of the full face.
RESULTS: The subcomponents were statistically significant predictors of facial beauty (mouth: r2 = 0.38, P < .0001; eyes: r2 = 0.14, P < .0001; chin region: r2 = 0.09, P < .0001; nose: r2 = 0.02, P = .05). The more beautiful people had several statistically significant characteristics, such as narrower faces.
CONCLUSIONS: Facial subcomponents are predictive factors of the male smiling face and contribute in the following descending order of importance: mouth, eyes, chin region, and nose.
CONCLUSIONS: The results suggest that for many people improvement in smile esthetics also likely will exert a more positive effect on facial beauty than will other procedures (for example, rhinoplasty).