Dynamic Changes of Facial Supporting Cornerstones (Pillars): Considerations in Aesthetic Approach

Among the features valued in studies on facial beauty, symmetry, and proportionality seem to be regarded as paramount.^1-6 Proportionality is considered present in beautiful things, namely the Golden ratio, a mathematical ratio of 1.618:1, in which the number 1.618 is also known as Phi.¹ Some authors have suggested that our perception of physical beauty is related among other things to how closely one’s features reflect Phi.¹ As in any construction, supporting pillars not only provide the foundation for the different layers, but also define the shape and beauty of the building, circus tent, or other structure. Similarly, the bones of the face are the major cornerstones for defining facial shape and structure.⁷ The bony components of the face are important for the overall three-dimensional facial contour because they provide the framework upon which the soft-tissue envelope rests.The facial symmetry and proportionality of one´s face depends upon this support – a symmetrical and proportionate face arises from the morphological patterns and anthropometrical measurements of a symmetrical skull, and an asymmetric face arises from an asymmetrical skull.^8,9 Like construction pillars, facial pillars (Figure 1) are also dynamic and variable according to the demands placed upon them, for instance the presence or absence of teeth. These pillars also vary according to gender and the stages of aging.⁷ Thus, a more profound knowledge of facial supporting pillars and their dynamic behavior by physicians who practice minimally cosmetic procedures would allow for a more natural approach to facial beautification. It would help them to rebalance age-related and asymmetric congenital imperfections, and minimize any harmful stigma associated with bad cosmetic practice.

This study was approved by the national research ethics committee (# CAAE: 55561816.5.0000.5119).Between 2010-2015, 241 skulls from the Forensic Anthropology Department of the Institute of Forensic Medicine of Belo Horizonte, Brazil were evaluated according to gender and age group (< 20 years, 20-50 years, > 50 years).

Frontal PillarThis pillar represents the superior third of the entire face and is highly influenced by gender and aging. In females, the forehead is straighter, more upright, and more exposed, and in males it is more oblique, presenting a more prominent elevation called the supraorbital rim (Figure 2).^10,11 Furthermore, the frontal region, unlike the other facial bones, experiences continuous expansion due to bone deposition in the external wall of the frontal bone, especially in the supraorbital rim (Figure 3).When necessary, this supporting pillar should be assessed. For example, using fillers to contour the forehead of a woman with