Aesthetic physicians performing procedures aimed at improving facial appearance can reliably use the orbital oval balance principle to achieve optimal results in white middle-aged women, according to a study published in October in Plastic and Reconstructive Surgery.
U.S. plastic surgeon and study author Timothy J. Marten, M.D., popularized the orbital oval balance method of analysis, which suggests a key feature in periorbital attractiveness is when the eye is centered in an oval defined by the lid-cheek junction and the eyebrow.
The study’s lead author Haydar Aslan Gülbitti, M.D., Ph.D. candidate at the University Medical Centre of Groningen, and senior supervisor Prof. Berend van der Lei, M.D., Ph.D., professor for Aesthetic Plastic Surgery at the University Medical Centre of Groningen, The Netherlands, tell The Aesthetic Channel that they agreed with the principle as advocated by Dr. Marten.
“So we decided to prove this theory by a clinical morphometric study,” Dr. Gülbitti writes in an email. “It is possible that many plastic surgeons overcompensated the eyebrow position in the past. When you read scientific articles, you will see that many eyebrows were positioned too high.”
Dr. Gülbitti and colleagues analyzed responses from 100 doctors and nondoctors who ranked digital morphed images of four females with four periorbital proportions: higher or lower lid-cheek junctions versus higher or lower eyebrow levels. Participants also quantified seven emotions on the images, which were of Caucasian women who had previously undergone a midface lift along with either upper blepharoplasty or forehead lift. The group of images of each patient included two photos with neutral expressions, one preoperatively with a low lid-cheek junction and one 6 to 12 months postoperatively with a high lid-cheek junction. Researchers used a computer program to adjust the eyebrows in both images.
Emotions of surprise, anger, sadness, disgust, fear, happiness and tiredness were reviewed.
Balance Wins
The researchers found that participants were significantly more likely to rank images with the high lid-cheek junction as more attractive than those with the low lid-cheek junction, especially when the high lid-cheek junction was combined with a lower eyebrow position. Conversely, a lower lid-cheek junction was more attractive when combined with a higher eyebrow, versus a lower eyebrow, position.
Participants perceived the high lid-cheek junction as more attractive and youthful, and less tired and sad.
The lower lid-cheek junction was associated more with tiredness and elevating the lid-cheek junction in images reduced the perception of tiredness by nearly 50%. Participants were more likely to associate the low lid-cheek junction with sadness and the high lid-cheek junction with happiness.
The position of the lid-cheek junction didn’t seem to impact participants’ perceptions of fear, anger, surprise or disgust in the images.
Not a Fixed Formula
The findings suggest the focus of the orbital oval balance principle on combining a relatively high lid-cheek junction with a relatively low eyebrow position makes it a useful guideline when planning and performing surgery of the upper face of Caucasian women.
“Surgeons should pay close attention to restoring the lid-cheek junction with performing facelift procedures to create a more youthful face and not target only the lower cheek, jowl and jawline,” the authors write. “Furthermore, close attention should be paid to the condition of the midface and the relationship between the lid-cheek junction, eyebrow upper eyelid and eyebrow position with performing forehead lift procedures.”
Surgeons using traditional fixed guidelines for positioning the eyebrows of younger patients might over-lift brows in those with a low lid-cheek junction.
The findings also have implications for those performing nonsurgical procedures, as some patients don’t want surgery on the lid-cheek junction. In these cases, doctors should focus on using nonsurgical solutions to restore the orbital oval balance by heightening the eyebrows according to the aesthetic relationship set forth by the orbital oval balance principle. Dr. Gülbitti recommends rejuvenating the lid-cheek junction with fillers or autologous fat, for example, when the lid-cheek junction is too low.
The ideal eyebrow position, the authors write, strives to achieve proportion and balance with other facial features. It’s not a fixed formula.
Aesthetic physicians should keep this saying in mind, according to Dr. Gülbitti: “Beauty is around the eyes of the beheld.”
“Rejuvenating the periorbital area is very important to achieve optimal results in facial rejuvenation,” he says. “Young and elderly patients want to look young or younger. Young faces are associated with a high lid-cheek junction and a low eyebrow position.”
Among the study’s limitations is that the study used only images of middle-aged Caucasian women.
Whether these results would apply to women of different ages and races or men requires more research.
