Thursday, July 21, 2011

Dark Eye Circles.. How to get rid of them..

NYC Cosmetic Surgeons Articles on Dark eye Circles~ Dark Circles Eyes ~ Eye Circles

Dark Circles around a panda bears eyes may be cute... but... not so much under your eyes..

                                   Courtesy of Womans

What causes them?

-Heredity: dark eye circles may run in families
-Atopic dermatitis (eczema)
-Lifestyle: stress, Alcohol abuse, lack of sleep
-Nasal congestion: this may cause engorgement of the veins around the eyes that drain the region creating a ---Bluish hue from chronic venous congestion
-Pigmentation irregularities: may be more common in people of color, especially blacks and Asians
-Rubbing or scratching the area
-Sun exposure which induces formation of melanin (substance that gives skin its color)
-Thinning skin and loss of fat and collagen: this occurs with age, making the underlying vasculature more visible

How do you treat them??

Stay tuned...

Skin Deep-Treating Dark Under-Eye Circles "Putting you tired look to rest". Katie Sezima; New York Times 2008. Accessed July 28, 2011

Wednesday, July 20, 2011

Breast Implants and Breast Feeding.

NYC Breast implant articles~Breast implants and breast feeding~Best breast implants and Breast feeding 

Is Breast Feeding after Breast Augmentation safe for your baby?

Several thousands of women undergo breast augmentation every year. Many of them in childbearing age. A frequent concern regarding silicone implants is whether or not the ability to breast feed is preserved, and if so, is it of any consequence to the baby. Fortunately, to date, there seems to be no major implication to the child in these circumstances. Studies analyzing the amount of silicone contained in the milk of lactating mothers when compared to commercial formulas have found little difference in the silicone content. The importance of breast feeding is undeniable. Medical literature has documented the nutritional and immune-stimulating properties of  of maternal milk when compared to commercial formulas. Maternal milk seems to be particularly protective against common childhood conditions such as Eczema, Iron deficiency anemia and Otitis media. Other less common and more serious diseases seem to be unequivocally mitigated by breast feeding; upper and lower respiratory infections and lymphoma amongst others.
For these reasons, it is recommendable to breast feed if the mother is able to do so. Approximately 50% of women are able to breast feed at baseline, and it is important for the physician to discuss this prior to undergoing breast augmentation with silicone or saline implants since it is unknown whether a patient is able to breast feed at baseline prior to the procedure.

                                                      Angelina Jolie Breastfeeding Courtesy of

A study published in PRS in 1998 undertook the arduous task of comparing the levels of silicone in breast milk from lactating women with and without silicone implants.
Two other sources were also included in the study consisting of cow's milk and infant formula for silicon content.
The samples were prepared in a special class one hundred "ultraclean" laboratory and analyzed via graphite furnace atomic absorption spectrophotometry. Silicon levels were analyzed in breast milk, whole blood, cow's milk, and 26 brands of infant formulas.
-Lactating women with implants were found to be comparable to control groups when measuring silicon levels:
(55.45 +/- 35 and 51.05 +/- 31 ng/ml, respectively) 
-In blood (79.29 +/- 87 and 103.76 +/- 112 ng/ml, respectively). 
-The mean silicon level measured in store-bought cow's milk was 708.94 ng/ml, and that for 26 brands of  commercially available infant formula was 4402.5 ng/ml (ng/ml = parts per billion)
-lactating women with silicone implants are similar to control women with respect to levels of silicon in their  breast milk and blood. 
-Silicon levels are 10 times higher in cow's milk and even higher in infant formulas.

In conclusion: there is no current evidence that would suggest that silicone implants have any undesirable effect on the child in the breast feeding period.

- Do silicone implants reduce the ability to breast feed?
The breast tissue that produces milk is in reality a modified sweat gland. It lies over the pectoralis major muscle and is composed of units known as lobes. Each lobe is composed of lobules. Small ducts emanate from the lobules where the milk is produced and then channeled toward the nipple where they coalesce into several lactiferus sinus which then empty into the nipple. Silicone implants are always placed behind the gland and does not divide the ducts or damage them. If the lobules and ducts are intact, the production of milk shouldn't change. Of the four procedures to insert implants, only one may divide the breast tissue containing the ducts, namely, the Trans-areolar approach. In general, even this approach usually does not affect breast feeding.

Breast implant approaches:

-Trans-Areolar: divides breast tissue, but usually does not affect lactation
-Inframammary incision: This incision is made under the breast crease and introduces the implant behind the breast tissue, avoiding the gland alltogether
-Trans-axillary Incision: In this method, the incision is in the axilla and the implant is once again introduced behind the breast tissue without damaging the glandular breast tissue
-TUBA Trans-umbilical Breast Augmentation: this procedure is only appropriate for saline implants and it uses a scope for dissection from the umbilicus to the retro-mammary space (behind the mammary gland) and does not affect the gland.

It has been documented that a women undergoing breast implant placement have a 2.6 to 3 times greater risk of not being able to breast feed than the rest of the population. This is in part attributable to the surgical approach which may be trans-areolar, and to the possible unwillingness of the mother to lactate after augmentation.
It should also be mentioned that if a woman is already lactating and wishes to have breast implants, it is advisable to wait for 6 months prior to undergoing augmentation. Milk accumulation has been documented in the peri-prosthetic space after surgery when augmentation is performed earlier.

Stay tuned.....


1.Breast Milk Contamination and Silicone Implants: Preliminary Results Using Silicon as a Proxy Measurement for Silicone Semple, John L.; Lugowski, Stan J.; Baines, Cornelia J.; Smith, Dennis C.; McHugh, Alana .  Plastic & Reconstructive Surgery. 102(2):528-533, August 1998.
2.Berlin, C. M. Silicone breast implants and breast-feeding. Pediatrics 1994; 94:546-49.
3. Silicone Breast Implants and Breastfeeding, Cheston M. Berlin, Jr. MD, Hershey Medical Center, Hershey, PA, from Breastfeeding Abstracts, February 1996, Volume 15, Number 3, pp. 17-18.
4. National Academy of Sciences Institute of Medicine, Safety of Silicone Breast Implants, National Academy Press, Washington, D.C., 1999, p. 197.

*Always consult with your plastic surgeon prior to undergoing any cosmetic procedure.Make sure your cosmetic surgeon is an ABPS (American Board Of Plastic Surgery) Board Certified or Board Eligible Plastic surgeon.

Rafael Magana MD

Sunday, July 17, 2011

Excess Armpit Sweat / Axillary Hyperhidrosis

NYC Plastic Surgeons Hyperhidrosis articles~NYC Cosmetic Surgeons Hyperhidrosis Articles~ NYC articles on  Hyperhidrosis

Yes.. sweaty armpits happen...

Axillary Hyperhidrosis (AH) is a condition characterized by excessive sweating in the armpit area. It is uncomfortable to patients who suffer it and can result in depression in some cases. It may exacerbated by different emotional states such as nervousness or anxiety. In the stricter sense, Hyperhidrosis is sweating in excess of the required amount normally needed for thermoregulation.
The ethiology (cause) of AH can be divided into primary and secondary. The primary has no recognizable cause for the excess activity of the Eccrine glands (Sweat Glands). Secondary Hyperhidrosis is caused by a concomitant illness or recognizable associated causes including certain medications.

What are the causes of secondary AH ?

-Diabetes Mellitus
-Carcinoid Syndrome
-Parkinson's syndrome
-Lung Disease
-Heart Disease
-Tricyclic antidepressants
Normal Physiologic States
-Emotional excitability
-Hot environment and/or exercise

Prior to treatment,  a thorough history and physical exam should be done to exclude any causes of secondary hyperhidrosis.
Diagnistic tests for this condition include:

-The Starch-iodine test. In this test, an iodine solution is applied to axillary area bilaterally. Once it has dried, starch is sprinkled on the site. The combination of excessive sweat and starch results in a dark blue color yielding a positive result in the presence of hyperhidrosis. This is often patchy in nature, revealing the most concentrated sites of sweat secretion

-In the Paper test. Special paper is placed on the affected area to absorb the sweat, it is then weighed to determine the amount of sweat contained in it.

-The most accurate to determine the presence of hyperhidrosis is with a device called a VapoMeter which provides an objective measurement for the amount of sweat. It measures the relative humidity in grams per meter square per hour and is quite accurate. Three measurements are done in the clinic and a control site such as the forearm is used as a control.

What are the treatment options?
Non Surgical treatments include:
-Antiperspirants: Usually in the form of aluminum chloride hexahydrate which will occlude the outlet of the gland decreasing the actual perspiration versus a deodorant which does not address the amount of sweat being perspired
-Iontophoresis: This method is FDA approved and uses a small electrical stimulus to reduce the amount of secretion in the affected area. It is most effective in the soles of the feet and the palms. The mechanism of action seems to be mild thickening of the regionally affected skin.
-Systemic Medications:Usually in the form of Anticholinergics such as Glycopyrrolate which decrease the amount of sweat being produced. These medications may have side effects such as a dry mouth, Dizzines and sometimes produce difficulties urinating.
-Botox: Type A botullinum type toxin is FDA approved for the treatment of Hyperhidrosis. It is generally effective in decreasing the symptoms associated to AH. It's mechanism of action consists in blocking the signal from the regulating nerve to the actual gland. Downsides to this treatment are that it is temporary and should be repeated every 3-6 months, may be locally painful and also produce a some local transitory weakness. It may be applied with a pre-fabricated grid shape, or with a more targeted  fashion by following the the "Minor's Starch Iodine test enhanced sites which are sometimes scattered.
Surgical Options:
-Endoscopic Thoracic Sympathectomy : This procedure is done via 2 incisions in the axilla. The sympathetic chain is localized next to the vertebral column anteriorly and then divided, thus cutting the nerve supply to the sweat glands. In the right hands, this procedure has a high success rate of 90-95%. There may be recurrence a small percentage of the time, or compensatory sweating in other parts of the body as a result of the sympathectomy.
-Suction assisted Arthroscopic Shaving*

*Definitive Diagnosis and Management of Axillary Hyperhidrosis: The VapoMeter and Suction-Assisted Arthroscopic Shaving.
This last procedure can be done in under an hour under general anesthesia and provides lasting effects by permanently excising the local sweat glands. It is done by marking the hair bearing area of the Axilla, after which 0.5% lidocaine is infiltrated for hemostasis (to reduce bleeding). A small incision is made in the crease area and the Arthroscopic Shaver is introduced and the eccrine glands (Sweat glands) are ablated by "Shaving" them off. This procedure does not damage the hair follicles.

There are support groups for this condition such as the International Hyperhidrosis Society

*Always consult with your plastic surgeon prior to undergoing any cosmetic procedure.Make sure your cosmetic surgeon is an ABPS (American Board Of Plastic Surgery) Board Certified or Board Eligible Plastic surgeon.

Rafael Magana MD

Stay tuned.....

1. : Accessed 7/20/2011 4:28pm
2.Endoscopic thoracic sympathectomy for primary hyperhidrosis of the upper limbs. A critical analysis and long-term results of 480 operations. F Herbst, E G Plas, R Függer, and A Fritsch, Annals of Surgery 1994 July; 220(1): 86–90.
3. The use of a grid to simplify Botulinum Toxin for Axillar Hyperhidrosis;Gina M. Kavanagh, M.R.C.P.
Department of Dermatology Royal Infirmary of Edinburgh Lauriston Clinic Lauriston Place Edinburgh EH3 9YW, Scotland ; Letter to the Editor~ Plastic and Reconstructive Surgery • January 2006
4.Definitive Diagnosis and Management of Axillary Hyperhidrosis;The VapoMeter and Suction-Assisted Arthroscopic Shaving David L. Larson, MD,Department of Plastic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin. Aesthetic Surgery Journal July 2011vol. 31 no. 5 552-559

Recommended Reading:
1. Kleyn, E., and Hepburn, N. C. The management of localised hyperhidrosis. Dermatology in Practice 10: 22, 2002.
2. Simonetta, M., Cauhepe, C., Magues, J., and Senard, J. A doubleblind, randomized, comparative study of Dysport vs. Botox in primary palmar hyperhidrosis. Br. J. Dermatol. 149: 1041, 2003.
3.To¨gel, B., Greve, B., and Raulin, C. Current therapeutic strategies for hyperhidrosis: A review. Eur. J. Dermatol. 12: 219, 2002.

Wednesday, June 1, 2011

Asian Eyelid Surgery NYC

Asian eyelid surgery Articles~NYC Cosmetic Surgeons~NYC Plastic Surgeons

Asian eye lid surgery (blepharoplasty) has become an increasingly popular cosmetic surgery all over the world. A common erroneous belief is that the goal of this type of procedure is to achieve  a  "westernized" appearance, which is rarely the case. Instead, the goal is most commonly a natural and younger appearance.
There are of course, exceptions to this as is shown in the linked report by CNN  below
Often patients will seek this surgery because they feel that a heavy upper lid will limit their expressive ability and thus limit their ability to interact socially. This concept is often misconstrued by American, European and non-Asian individuals as a desire to appear more Caucasian.

                                                           Courtesy of
                                                            Click on Image: Courtesy CNN

A deep understanding of the delicate regional anatomy is essential to performing any eyelid surgery. The nuances of the Asian blepharoplasty (Lid surgery) escape many surgeons.

Basic Asian eyelid anatomy

What are some of the characteristics of an Asian eyelid when compared to an occidental eye?
-The presence in varying degrees of an epicanthal fold. When prominent epicanthal folds are present medially (on the nasal side) they can give the undesirable illusion of esotropia (cross-eyed).
-An eyelid crease which is lower set and often not visible. When present, it differs from the non-Asian population in that is parallel to the lid margin and narrows as it reaches the nasal edge of the lid
-The angle of the brow tends to be higher medially (Close to the nose) in Asian eyelids
-Shallow orbits (eye bones)
-Minimally or non Cantilevered supraorbital ridges

The so called "double lid surgery" is the commonly requested surgery make the eyelid crease a more noticeable trait.  This procedure has been analyzed over the years and modified many times over the years.

Fast facts about the double eyelid procedure
-The prominence of the epicanthal fold is decreased by doing local flaps
-A lid fold is created by applying parallel sutures that create a new crease which is parallel to the edge of the eye lid
-In expert hands the procedure takes around an hour
-There is a "non-incisional" method for Durable Suture Technique (DST). Long term follow up results on this  technique are not yet available.

Potential complications:
One major single surgeon study quoting over 6000 patients in 18 years showed the following complications

During the perioperative period, the pateint may have eyelid swelling which may take weeks to months to return to a normal volume. This must be discussed in advance with the patient.

                                                           Courtesy of

Principles of the Asian "double lid surgery"
This varies greatly between individuals since the presence of an epicanthal fold or how noticeable the eyelid crease is or isn't to begin with differs from person to person. However the principle can be reduced to addressing two key issues:
-A decrease in the prominence of the epicanthal fold
-Creation of a more noticeable eyelid crease

In the right hands, this procedure yields fast and satisfying results to the patient. However it must be kept in mind that the immediate appearence postoperatively does not reflect the final outcome, which is true of so many other procedures in cosmetic plastic surgery.
Other issues should be recognized, acknowledged and addressed prior to undergoing a blepharoplasty. Amongst these are the presence of asymmetry, eyelid ptosis(droopy eyelid), disfunction or dehiscence of the levator muscle of the eyelid causing droopiness for reasons other than mere excess tissue.
Asian blepharoplasty (eyelid surgery) may be enhanced with a frontal lift.

*Always consult with your plastic surgeon prior to undergoing any cosmetic procedure.Make sure your cosmetic surgeon is an ABPS (American Board Of Plastic Surgery) Board Certified or Board Eligible Plastic surgeon.

Rafael Magana MD

1.Aesthetic Plastic Surgery;By Sherrell J Aston, Douglas S Steinbrech and Jennifer Walden  Chapter 33
2.Asian Blepharoplasty: An 18-Year Experience in 6215 Patients; Arthi Kruavit;Aesthetic Surgery Journal 2009 29: 272  DOI: 10.1016/j.asj.2009.04.004 
3.Anatomic Microstructure of the Upper Eyelid in the Oriental Double Eyelid,Jian Cheng, M.D., and Feng- Zhi Xu, M.D. Plastic & Reconstructive Surgery. 107(7):1665-1668, June 2001.
4.A New Crease Fixation Technique for Double Eyelidplasty Using Mini-Flaps Derived from Pretarsal Levator Tissues ;Choi, Yeop; Eo, SuRak;Plastic & Reconstructive Surgery. 126(3):1048-1057, September 2010. doi: 10.1097/PRS.0b013e3181e3b72a
5.The Concept of a Glide Zone as It Relates to Upper Lid Crease, Lid Fold, and Application in Upper Blepharoplasty Chen, William Pai-Dei Plastic & Reconstructive Surgery. 119(1):379-386, January 2007.
doi: 10.1097/01.prs.0000244908.04694.32

Monday, May 23, 2011

Younger Looking Hands

NYC Hand Rejuvenation Articles~NYC Cosmetic Surgeons ~ NYC Plastic Surgeons~ Hand Rejuvenation

Aside from the face and neck, hands are the most visible unclothed part of our bodies. Sophisticated techniques have allowed impressive changes in facial beauty, but often,  rejuvenation of the hands is overlooked.
A radiant smile and facial features must be harmonious with other physical traits.  La Gioconda (The Mona Lisa) is currently owned by the French Government and Sits in the Musee Du Louvre, In Paris. She sustains a mesmerizing and enigmatic stare. But what would she look like if her hands were not soft and Juvenile? It would certainly be inconsistent and detract from her overall beauty. 
It is the appreciation for beautiful hands that allows a plastic surgeon with an artistic vision to apply rejuvenating techniques to this all too under appreciated area of the body. The knowledge that the proper techniques for hand rejuvenation are available in the first place will allow it to become a part of a youthful and more befitting  appearance. After all,  "the eyes cannot see what the mind does not know" expresses this concept elegantly.
Beautiful Hands

A variety of techniques have been used over the years with limited results. Uniformity in the coloration of the skin can be obtained temporarily with topical agents, such as hydroquinone. Unfortunately, this may not apply to all skin tones, does not address the skin laxity that appears with age, nor does it address the fullness characteristic of younger hands.  Lasers and chemical peels, improve the overall appearence of the dorsum (back) of the hand by  increasing exfoliation, reducing lentigines (skin spots) and improving elasticity. However a youthful hand  has a subcutaneous (Under the skin) fullness that obscures veins and tendons. Dermal fillers have been used to replicate this appearence with varying and temporary results. 

Methods for rejuvenation of the hand
-Skin excision
-Chemical Peels
-Laser therapy
- Structural Fat Grafting
-Combination of the above techniques such as fat grafting and TCA peels
-Percutaneous Collagen induction (Experimental)

Fat Grafting
To date, fat grafting seems to give a more predictable and long lasting effect. It counters the visible effects of ageing and to some degree may improve skin quality by unknown mechanisms. 
Fat grafting allows correction of fat and muscular atrophy (Shrikage) with prominent veins. The technique involves injecting fat into the dorsum of the hand in a progressive manner at the sites where there is more notable depression, such as between the Metacarpals (Bones in the hand). The injection is done through inconspicuous access sites between the fingers in the web spaces. 

Indications for Fat Grafting
-Muscle wasting of the hands
-Lax skin on the dorsum of the hand
-Prominent veins
-Overall aged appearance of  the hands
                                                            Courtesy of

Stay tuned...

1.Rejuvenation of the Hand: Fat Injection Combined with TCA Peel, Bahman Teimourian and Mehdi N.  Adham Aesthetic Surgery Journal 2000 20: 70
2.Percutaneous Collagen Induction Therapy for Hand Rejuvenation : Matthias Aust, M.D.; Karsten Knobloch, M.D.; Ph.D.Andreas Gohritz, M.D; Peter M. Vogt, M.D., Ph.D.Plastic & Reconstructive Surgery. 126(4):203e-204e, October 2010.
3.Hand Rejuvenation with Structural Fat Grafting by Sydney R. Coleman, M.D Carraway, James H.
Plastic & Reconstructive Surgery. 110(7):1745-1747, December 2002. doi: 10.1097/PRS.0b013e3181ea92d1
4.Hand Rejuvenation by Denton D. Weiss, MD, Virginia Beach, VA, Aesthetic Surg J 2004;42:567-573.
5.The Erbium: YAG Laser: A Review and Preliminary Report on Resurfacing of the Face, Neck, and Hands
David H. McDaniel, Keith Ash, Jeff Lord, John Newman and Mark Zukowski;Aesthetic Surgery Journal 1997 17: 157 DOI: 10.1016/S1090-820X(97)80036-2

*Always consult with your plastic surgeon prior to undergoing any cosmetic procedure.
Make sure your cosmetic surgeon is an ABPS (American Board Of Plastic Surgery) Board Certified or Board Eligible Plastic surgeon.
Rafael Magana MD

The Ideal Eyebrow

Brow Surgery Articles ~ NYC Cosmetic Surgeons~NYC Plastic Surgeons

The ideal eyebrow frames and enhances an expressive eye.  A beautiful brow isn't simply a symmetric arch over the eye, it has a fluidity and symmetry to it. The head, body and tail compose a normal brow. It's shape is well depicted in Marquardt's Golden Mask as a line that progressively narrows laterally and peaks 2/3 of the way from mid to lateral points.
In the world of make up, a narrow well groomed and darkened eyebrow is attractive. It's position is key.
Here are the basic landmarks for the ideal female brow:

-The medial eyebrow should be at or below the level of the orbital rim.
-The medial border of the eyebrow should be above the medial canthus.
-The eyebrow should rise gently, with a gentle peak at least two thirds of the way to its lateral end, and with      this peak usually above the lateral limbus.
-The lateral tail of the brow should be higher than the medial end.

Here are some general proportions:

With age the brow begins to descend and droop over the brew bone and resting on the lid. The angle of the brow also changes, with the lateral higher portion slowly becoming horizontal in plane relative to the medial portion of the brow.
How can plastic surgery correct this?
There are several methods. Each one is tailored to specific needs. Some of the tools in the armamentarium of the plastic surgeon include:
-Botox to the lateral eye in the crows feet area. This helps reduce the crows feet and elevate the brow from   persistent tonicity of the forehead muscles
-Endoscopic browlift: This is a minimally invasive technique through small holes behind the hair line through which a scope is inserted for visualization and dissection down to the orbit of the brow. This "free's up" the overlying tissues, and allows a lift with the use of absorbable anchors under the scalp.
-Excision (Surgical removal) of excess skin above the brow itself or at the hairline. This is the least preferred method since there can be residual visible scars.

Combination techniques should be considered. In addition to that, problems with the eye lid, including ptosis (droopy lid) should be evaluated for correction and a natural appearance in conjunction with the brow lift

*Always consult with your plastic surgeon prior to undergoing any cosmetic procedure.
Make sure your cosmetic surgeon is an ABPS (American Board Of Plastic Surgery) Board Certified or Board Eligible Plastic surgeon.

Rafael Magana MD

Stay tuned....

Does Ф PHI make a beautiful face?

What are the most common traits of a beautiful face at a glance?

6 facial beauty traits 
-Facial Symmetry
-High youthful Cheekbones 
-Full Lips
-Lateral brow arch high point
-Large and Symmetric eyes
- Narrow nose

Adriana Lima. Victoria's Secret Model

A beautiful face is not difficult to recognize. It transcends cultural barriers and needs no translation. Beauty is what we intuitively imagine it to be since we are young, we recognize it at a mere glance and it is hardwired into our evolutionary mind. An Ideal of what constitutes a beautiful face differs from person to person. The proverbial “beauty is in the eye of the beholder” by Plato, is an aphorism that describes this subjective impression perfectly. There is however, in general, a consensus regarding what an attractive face looks like, whether or not it strikes an individual as a beautiful face.
This all too subjective, but symbolic mental image is known as archetype.
An Archetype, in the simplest of terms, refers to a pattern of behaviors, prototype from which others originate, or are emulated; a recognizable icon or stereotype.
Examples of this idea are the pictures found in a deck of Tarot Cards that symbolize universally understood characters , or the celestial beauty depicted in Sandro Botticelli’s painting “The Birth of Venus”.
Although the description in the field of psychology of this notion was described by Carl Jung in the early 20th century, its manifestation is evident in the late 18th and early 19th Century neoclassical paintings and sculpture.

Some of the first attempts to establish universal craniofacial measurements were in Egypt as far back as the third millenium B.C.
 Elaborate systems to estimate facial proportions were devised by Egyptian artists to allow bas-relief tomb carvings for the pharoahs and nobilty.

Description of Neoclassical Canons2 (Formula In Reference)
Formula No.
Forehead height nose length lower face height
Nose length ear length
Interocular distance nose width
Interocular distance right or left eye fissure width
Mouth width 1.nose width
Face width nose width

Cannon of fifths with endocanthal (inner eyelid)distance roughly
the width of the nose or a full eye.
Image courtesy of 

Neoclassical Ratios Dividing the face into proportionate segments and ratios on the right for facial proportions in  females
Victorias Secret Model Adriana Lima

What is Anthropometry?
In the mid 17th Century, anthropometry surged as a new method for elucidating craniofacial dimensions in a more accurate way.
Anthropometry is the measurement of human landmarks and proportions both directly from human subjects and indirectly from photographs. It is utilized in various fields of science and art, such as anthropology, forensic sciences, sculpture and illustration. In the context of cosmetic and reconstructive craniomaxillofacial surgery, this is an initial step toward understanding what can be corrected to establish a pleasing facial symmetry. It also establishes a clear language for communication of data with others

What is Phi?
Phi is  the ratio found in nature repeatedly. Greek sculptors, neoclassical painters and other artists have used it to portray a beautiful face. 
1:1.618 is the golden ratio. From it, you can derive a triangle as the base for several overlapping geometrical shapes. A blueprint of this rule was created by retired Oral Maxillofacial Surgeon. Dr Stephen Marquardt, and came to be known as Marquardt's mask or the "Golden Mask"

When superimposed on a beautiful face, you can see how they match almost flawlessly 

The Facial Beauty Mask is courtesy of, and copyright by, Dr. Stephen Marquadt. | Face image by Sean Armenta.

These shapes and ratios seem to repeat themselves over and over again in what is universally considered a beautiful face.
Marquardt's golden mask shows clear ratios throughout the beautiful face. For Example, the mouth is 1.618 time wider than the base of the nose; the nose base is 1.6 times wider than the tip of the nose; The triangle formed by a beautiful persons nose and lips is a perfect acute triangle... and so on...

The instrument used to measure this ratio in  a plastic surgeons office is called a "Golden Mean Gauge"

Golden Mean Gauge: Made in USA by Natural Pigments

Even the ratio of  a beautiful lower to upper lip follow this golden ratio by 1:1.680. This is especially important when considering a natural and beautiful appearance by using fillers or fat grafting for lip augmentation.
In the hands of a capable plastic surgeon with a good sense of aesthetics this can result in the "perfect pout" 
So... What are perfect lips, and what is the secret to natural full lips...                                          
Read  the "Perfect Pout" for more information on lip augmentation with fillers or surgery.
Beautiful cheek bones
High cheekbones are one of the findings in an attractive face. It is in fact, not the bone itself, but rather a fat pad which lays normally at the height of the orbital rim (the lower eye bone) and is at the level of the lower limbus of the Iris. With time, this fat pad descends due to gravity and contributes to the ageing appearance of the face. One of the objectives in maintaining a youthful appearance through cosmetic surgery, is to preserve the height and natural oval appearance of the "cheek bone".  Several methods have been described, including Fat grafting, Dermal Fillers and Polyethylene implants. My personal preference is the use of Fat grafting due to it's natural appearance and long lasting effect. The symmetry of the natural and youthful appearing cheek bone also follows the golden ratio.

*Always consult with your plastic surgeon prior to undergoing any cosmetic procedure.Make sure your cosmetic surgeon is an ABPS (American Board Of Plastic Surgery) Board Certified or Board Eligible Plastic surgeon.

Stay Tuned…….


1.; Accessed on 4/19/11.
2. L.G. Farkas, T.A. Hreczko, J.C. Kolar, I.R. Munro, Vertical and horizontal
proportions of the face in young adult North American Caucasians:
revision of neoclassical canons, Plast. Reconstr. Surg. 75 (1985)
3.John C. Kolar, Elizabeth M. Salter; Craniofacial Anthropometry: Practical Measurement of the Head and Face for Clinical, Surgical, and Research Use. Charles C Thomas Pub Ltd (March 1997)
4.Guyron. Plastic Surgery:Indications and Practice. Chapter 29 "Cephalometrics,Anthropometrics,Orthodontics"