Helen Witherow, a consultant maxillofacial surgeon, discusses the ins and outs of facial aesthetics for gender differences.
I became interested in facial aesthetics and surgery through art, dentistry, plastics and maxillofacial surgery. I work as a consultant maxillofacial surgeon at St George’s and Ashford and St Peter’s hospital and continue to love the work I do.
Facial appearance is very important. People often make up their mind about a person in the first few seconds that they meet the person based on their appearance.
Facial surgery can make an enormous difference to someone and can increase their confidence and self-esteem. I became interested in aesthetics, facial proportions and the differences between the faces of men and women in my aesthetic and orthognathic practice.
We can all recognise a male or female face. But if asked to describe the specific differences how many of us would be able to describe those specific characteristics that define a man or a woman?
It is crucial for anyone involved in facial surgery, dental, aesthetic, transgender or orthognathic surgery to understand these differences.
It is possible to inadvertently make someone’s face more or less female or male. And whilst this may be what the treatment the patient wishes, sometimes it is not the right treatment to carry out. Additionally, it is important to be aware of maintaining correct facial proportions and the optical illusion that can occur when changing one part of the face or another.
For example, moving the chin point either forward or back can cause an optical illusion. The nose appears to change size. By advancing the chin point the nose appears to reduce in size. Patients with a normal sized nose and a small retrognathic mandible may complain of a large nose and ask for a reduction rhinoplasty. Whereas the best aesthetic result is more likely to be achieved by advancing the mandible and chin.
Removing bone from the lateral aspect of the bone orbit makes the eyes look larger. Whereas adding to the orbit makes the eyes look smaller.
Most of the physical contrasts between men and women are as a result of the male and female sex hormones, testosterone and oestrogen. These differences are most apparent at and after puberty.
There are general distinctions, men tend to be larger, their skulls are larger and squarer in shape whereas women tend to be smaller in stature and have a smaller and more rounded oval skulls.
Males have thicker darker skin compared to women who have paler delicate skin. Muscles are larger in men and fat distribution is different in women. Men have different patterns of hair distribution.
There are also similarities between men and women in that the ideal facial proportions are the same. Ideally the upper middle and lower facial thirds are equal and the vertical facial thirds and the horizontal facial fifths are the same.
The differences can be better understood if we look at the upper, middle and lower thirds individually.
The upper third extends from the hairline to the glabella region. The female hairline tends to be lower and more curved whereas the male hairline is M shaped and higher. The male skull is more angular, squarer with prominent supraorbital ridges.
The larger temporal muscle produces a sharp temporal crest. The larger supraorbital ridges have the effect of making the eyes look smaller and deeper set. The female skull is smoother and rounder. The supraorbital margins are less prominent and results in the appearance of larger eyes.
Female eyebrows tend to be lower medially and arch laterally whereas male eyebrows are usually thicker and horizontal. The nose tends to project from the base of the frontal bone leading to a lower frontonasal angle. The female nose projects less sharply resulting in a larger frontonasal angle.
Moving to the middle third the nose tends to be larger and straighter in a man and smaller in a woman.
The female nose tends to have a slight slope upwards and a more prominent supratip break, (the slight depression above the nasal tip). The male cheekbones are wider and stronger, but the female cheeks are more prominent and are higher. This is due to the distribution of fat in that region rather than the prominence of the bone.
Increasing volume in the middle part of the face usually feminises and rejuvenates the face. The female lips are generally fuller with a greater display of vermillion. The male lips are longer, thinner and less full. The cupids bow is less defined in a man and tooth show at rest is less in a man when compared to women. Men generally have squarer teeth while women’s teeth are slightly rounder at the corners.
With respect to the lower third of the face. The male jaw is larger. The angles of the jaw are squarer whilst the female jaw is smaller with more sloping obtuse mandibular angles. The male chin is more prominent and squarer in shape. Whilst a feminine chin is smaller, and more heart shaped and slightly set back.
Helpful during consultation
Techniques learned in maxillofacial, plastics and skull base surgery can enable many features of a person’s face to be changed. It is the responsibility of the clinician to ensure they are aware of the facial changes that their surgery will cause.
Orthognathic surgery moves the facial bones to correct a malocclusion. However, a number of different surgical moves will correct the occlusion but will have a very different facial appearance.
A good knowledge of the features that are male and female can avoid unwanted changes to the patient. This knowledge can be very helpful during the consultation period with a patient who has fixed views of what they want. Education and explanation during the consultation with the patient is more likely to result is a satisfactory outcome.
For more information visit www.womendentistsnetwork.com.
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