The old saying, “beauty is in the eye of the beholder,” has scientifically been proven true. A study in a recent issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS), found that variations in eyebrow shape, eyelid position, and wrinkles significantly impact how your facial expressions, and subsequent mood, are perceived by others.“A key complaint of those seeking facial plastic surgery is that people always tell them they look tired, even though they do not feel tired,” said John Persing, MD, ASPS member and study co-author. “We found that variations in eyebrow contour, drooping of the upper eyelid, and wrinkles may be conveying facial expressions that don’t necessarily match how patients are feeling.”

In the study, a standardized photo of a youthful face was digitally altered to change a number of variables, including eyebrow shape and position; upper and lower eyelid position; upper eyelid drooping and removal of excess skin; and facial wrinkles. Twenty health care workers were given 16 photos and asked to rate, on a scale of 0 to 5, the presence of seven expressions or emotions: tiredness, happiness, surprise, anger, sadness, disgust, and fear. The results for each altered photo were compared with scores from the original unaltered photo. Overall, eyebrow shape had a greater influence than absolute position on perceived mood.

Tiredness

Drooping of the upper eyelid was the biggest indicator of tiredness, according to the study. Simulating skin removal of the upper eyelid, as performed in some eyelid procedures, but not correcting accompanying eyelid ptosis (drooping), resulted in an increase in the perception of tiredness (and sadness). Photos that included an overall elevation of the eyebrows or an increase in the distance between the eyebrow and upper eyelid also increased the perception of tiredness.

Anger & Disgust

Lowering or slanting the inner corner of the eyebrows towards the nose, as well as adding forehead winkles significantly increased the perceived facial expressions of anger and disgust.

Fear & Surprise

Raising the upper eyelids produced an increase in the perception of surprise and fear. Also, raising the outer corner of the eyebrows produced an increase in the perception of surprise.

Sadness

Raising the inner corner of the eyebrows away from the nose was perceived as a sad facial expression.

Happiness

Happiness was perceived by raising the lower eyelid and the presence of crow’s feet, which, according to the study, seem to simulate the cheek elevation that occurs with smiling.

“The eyes and their related structures nonverbally communicate a wide range of expressions that are universal to all people,” said Dr. Persing. “Therefore facial expression should be a factor in how patients and their plastic surgeons select various rejuvenation procedures. As our findings show, even the slightest modification can elicit profound changes in how others perceive us.”

Not only are cheeks central to your face – they are central to the American concept of beauty. A study in June’s Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS), found that a deep fat compartment located within the cheek is vital to a youthful-looking face. Not only does rejuvenating or returning volume to this fat compartment make the cheek more youthful, it also improves volume loss under the eyes, helps eliminate “parentheses” lines around the nose and mouth and gives more curve to the upper lip – essentially restoring a youthful appearance to the overall face.“From the irresistible urge to pinch the cheeks of adorable infants to our admiration of Hollywood stars like Audrey Hepburn and Angelina Jolie, we’ve known for a long time that cheeks are vital to what we consider beautiful,” said Joel Pessa, MD, ASPS Member Surgeon and study co-author. “Adding volume rather than lifting is not a revolutionary concept in plastic surgery. But the idea that restoring volume to deep cheek fat will affect so many areas of the face is a breakthrough in our understanding of how to better treat facial aging.”

In the study, 14 cadavers were injected with dye to identify the deep cheek fat compartment, which is located underneath the fat beneath the skin. After latex was injected into the compartment, which then set overnight, the study authors located the boundaries of the fat compartment, as well as the compartment’s relationship with adjacent muscles. Three additional fat compartments in the face were also identified in this study.

According to the study, volume loss to the deep cheek fat compartment leads to “hollowing” of the face. It further noted that volume loss of the deep cheek fat compartment could be the determining factor in much of what a person observes as aging in the midface. When volume was restored deep within the cheek, either by using fat, tissue fillers or an implant, improvement in the hollowing of the face became apparent immediately. Finally, when the injection was done correctly into the fat compartment, a smaller volume of fat or filler was needed, the study noted.

The study authors concluded that many other compartments of fat remain to be identified in the face and human body. But the finding that adding volume to particular facial compartments results in highly specific, predictable and immediate results, brings plastic surgeons closer to fighting facial aging in an algorithmic or step-by-step way.

According to ASPS statistics, nearly 8,000 cheek implants were performed in 2007. In addition, nearly 47,000 fat injections and 1.1 million injections with hyaluronic acid fillers were performed last year.