Research in Facial Plastic Surgery – Aesthetic Facial Units: What are they and why are they important?

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Research in Facial Plastic Surgery – Aesthetic Facial Units: What are they and why are they important?

One of the most common questions facial plastic surgeons as well as cosmetic surgeons get asked is, “will I have a scar?” If there is going to be a cut in the skin, the answer is 100% of the time yes. However, how the plastic surgeon deals with this scar makes the difference between a good scar and a bad scar.  When we design our incisions we often have to have these scars line up in what we call, aesthetic subunits of the face. You can think of this as boundaries of the face. For example, there is a clear boundary between the side of your nose and your check. There is a clear boundary between your lip and the skin between your lip and your nose.  It is in this boundaries that we try to orient scars as they are less noticeable.

Here is a link to common facial aesthetic subunits we use in Facial Plastic and Reconstructive Surgery so you get an idea what I am talking about. When you look at the image, the lines represent the boundaries between these aesthetic subunits of the face.  These are the areas we are focusing on in this paper.

One question that arises is whether these boundaries are also important in aging. Do these boundaries become more defined and thus more noticeable with age? What if we were to smooth these boundaries in older people, will this give the appearance of a more youthful face?

This is the question proposed by the authors of the first article I will review in my first installment of my literature review series. It will involve a discussion of a recently published article by Dr Tan et al (2015) published in JAMA – Facial Plastic Surgery Journal ( .  Dr Tan is a Head and Neck Surgeon who is also an individual completing a fellowship in Facial Plastic and Reconstructive Surgery in Toronto, Ontario, Canada.

The primary objective of her article was to evaluate the effect of aesthetic subunits of the face on facial aging and if blending the boundaries of these areas will create a more youthful appearance. The authors of this paper propose that doing this has the potential to create smoother contours of the face and thus more youthful appearance.

In order to assess this, the researchers presented a series of photographs to people. Each time, 2 photographs were presented, one with smooth aesthetic subunits and one with more defined and obvious boundaries between the subunits of the face. The face was the same in both images, but they were altered digitally to make the subunits of the face look smooth or more defined. Those who are viewing the photographs are then asked to pick which of the two photographs appear more youthful.

Well, what did the researchers find? They found that when judging photographs, those people with smooth boundaries between the subunits were far more likely to be judged to be more youthful than those with more defined subunits.

So, what does this all mean for the Facial Plastic Surgeon as well as the patient or client who is interested in having a more youthful appearance of their face.

For one, when using treatments such as laser for facial wrinkles if we can smooth out the lines between these subunits, we may get a better anti-aging result than if we did not. Also, when using fillers we can inject fillers into these subunits and thus help people look younger. In fact, we do this. When we see someone who has deep nasolabial folds (those are the folds that run from the side of your nose down towards the corners of your mouth), we often inject dermal fillers into these areas (ie Juvederm, Radiesse, Estalis, etc).  This is what these fillers are doing, they are blunting or softening the boundaries between the aesthetic subunits of the face.

In the end, this research helps confirm some of the principles that many of us in the Plastic Surgery as well as Cosmetic Surgery world have been using. Nurses and doctors who inject fillers and use lasers to treat facial wrinkles rely on these principles and now we have a better understanding as to the effect of this.

James Bonaparte, MD, MSc, FRCSC
Assistant Professor, Department of Otolaryngology –Head and Neck Surgery
Practicing in Facial Plastic and Reconstructive Surgery
Ottawa, Ontario, Canada