Facial Characteristics in Korean-American vs. North Am. Caucasian Women

Facial beauty arises from symmetric, balanced, and harmonious proportions. Achieving that standard requires restoration of proportional facial structures and elimination of disproportionate relationships. Surgical specialists use the optimal relationships between facial structures to assess the face during aesthetic and reconstructive consultations.

Although Caucasians and African-Americans facial analysis and proportions have been researched, only a limited number of studies exist for Asians, and none exist for Asian-Americans. The consequence is that aesthetic surgery on Asian-American patients relying on Caucasian norms may result in dissonant facial proportions. Furthermore, many Asian-Americans seek to maintain their ethnicity through cosmetic procedures making the challenge for surgeons to maintain appropriate ethnic facial features and correct only the features that are disproportionate to the rest of the face.

The concepts of beauty and "normal" facial proportions have changed with time. As the population becomes more heterogeneous, new facial proportions have emerged from interracial mixing. It is now apparent that what has been considered beautiful and acceptable as the norm for one specific culture may be different for another. Inherently, the notion of a single aesthetic standard and beauty is grossly inadequate and naïve. Consequently, many believe that new model of aesthetic standards and beauty unique to different ethnic groups are needed to better fit their facial skeletal and skin profile and culture.

A team of facial plastic surgeons set out to assess the differences in facial proportions between Korean- American (KOREAN-AMERICAN) and North American Caucasian (NAC) women as well as to clarify aesthetic facial features in the Korean-American female. The authors of the study, "The Korean-American Women's Face: Anthropometric Measurements & Quantitative Analysis of Facial Aesthetics," are Kyle S. Choe MD, Anthony P. Sclafani MD, Jason A. Litner MD, Guo-Pei Yu MD, MPH, and Thomas Romo, III MD. all with The New York Eye and Ear Infirmary, New York, NY, and affiliations with the New York Medical College, Valhalla, and Lenox Hill Hospital, New York, NY. They will present their findings at the annual meeting of the American Academy of Facial Plastic and Reconstructive Surgery http://www.facial-plastic-surgery.org/index.asp being held May 2-4, 2003, at the Gaylord Opryland Hotel, Nashville, TN.

The quantitative determinations will be useful in pre-and postoperative facial assessment for both cosmetic and reconstructive purposes.

Methodology: Seventy two Korean-American female volunteer subjects (and models) and an additional ten (five males and five females) Korean-American volunteer judges participated in this two part study. All participants were ages 18-35 years, without previous facial trauma or cosmetic surgery. All subjects were of full Korean descent. Demographic data obtained included age, place of birth, length of stay in the United States, and parental heritage.

Digital photographs of the face were obtained (of models) in frontal, left lateral, and basal views. A ruler was included in each image for calibration. Photographs were analyzed with Mirror Image software and anthropometric (the study of comparative measures in the human body) measurements were obtained based on facial soft tissue landmarks. Twenty six standard anthropometric measurements were obtained, including special forehead height, special face height, forehead height I, forehead height II, total nasal length, tip protrusion, lower face height, calva height, special upper face height, ear length, interocular distance, eye fissure width, mouth width, facial width, lip thickness lower, lip thickness total, nasal root, nasal width, alar thickness, columella length, alar length, ear incline angle, nasofrontal angle, nasofacial angle, and nasolabial angle.

In Part 1 of the study, the results were compared with previously published standards for the North-American Caucasians. Data was analyzed using unpaired t-test if the variables of two samples were equal or unpaired t test with Welch's correction if the variables of two samples were unequal due to unequal population size. The researchers assessed the differences between their results to those of others.

In Part 2 of the study, the frontal views of the subjects (models) were judged for facial aesthetics using visual analogue scale by the ten judges. The aesthetic scores were correlated with anthropometric measurement data. Facial features between high aesthetic score group's with other Korean-American and North American Caucasian women were quantitatively analyzed and compared. Results were further analyzed using both bivariate correlation and multiple regression.

Results: Seventy-two KOREAN-AMERICAN women were enrolled for the part one of the study. The subjects had an average age of 25 (range, 18-35). Most subjects were born in South Korea (90 percent) and not in the United States (10 percent). The average length of stay in the United States was 10 years (range one month to 28 years). Ten Korean-American subjects (five females & five males) participated as judges for Part 2 of the study. The judges were pooled from different communities and had an average age of 30. Most judges were born in South Korea (87 percent) and not in the United States (13 percent). The average length of residence in the United States was 17 years (range, one month to 28 years).

A statistically significant difference existed between the Korean-American women and the NAC norms in 25 of the 26 measures taken. The study revealed that the traditional template for horizontal and vertical facial proportions was a poor guide to facial analysis for Korean-American women. Only one subject (1.4 percent) validated the neoclassical canon for the en-en=al-al (orbitonasal canon) and three subjects (4.2 percent) validated the middle 1/3 = lower 1/3 facial canon. The racial differences revealed by this study were expected. Visually, the most influential canons contributing to the differences between the faces of the two races was the quality of the relationship between the mouth and nose width (naso-oral canon): a narrow-mouth/wide-nose disproportion and the wide intercanthal distance relative to the length of the eye fissure and/or the width of the nose (orbital and orbitonasal canons) seen more frequently in Korean-American women than NAC norm. Furthermore, the Korean-American women had a longer face (with the middle third being the longest) than the NAC norms. Our results were similar to the previous Asian facial analysis studies. In addition to the differences in horizontal and vertical proportions, the lip was thicker and the ear length was longer but less inclined in Korean-American women. A wider nasofrontal and nasofacial angles but more acute nasolabial angle was also seen in Korean-American females.

The subjects were divided for facial attractiveness determined by a panel of Korean-American judges. Statistical analysis showed a negative correlation between the facial measurement data and the attractiveness scale with respect to special forehead height, lower face height, interocular distance, mouth width, facial width, total lip thickness, and nasal root width but a positive correlation to nasolabial angle. The ear length, lower lip thickness, and alar length nearly achieved statistical significance.

Conclusions: Facial analysis and proportions are important for facial plastic surgeons to assess and critique the face during the planning stages of cosmetic and reconstructive facial surgery. Thus far, many facial plastic surgeons have relied on neoclassical standards for facial analysis regardless of patient's racial and ethnic background. This study reveals that the average Korean-American woman does not fit the neoclassical facial proportion and that significant differences exist as compared to the North-American Caucasian norms. Accordingly, the neoclassical canon model may serve as a valuable surrogate for certain present-day proportional indices of the face, but it should not be viewed as the "gold standard". The research also found that subjective judging found that many of the attractive Korean-American women's facial features reflected the facial features of the North-American Caucasians. These findings bolster the need for a broader view of facial analysis and trans-culture aesthetics.