Male Aesthetics: A Review of Facial Anatomy and Pertinent Clinical Implications

The upper third extends from the hairline (trichion) to the glabella, the middle third from the glabella to the subnasale, and the lower third from the subnasale to the inferior most aspect of the chin (menton). The neoclassical canon of facial proportions divides the face vertically into fifths, with the ocular width, the intercanthal distance, and the nasal width all measuring one-fifth (See Figure 2).¹⁰

Sexual dimorphism refers to phenotypic differences between sexes of the same species. In humans, differences in external genitalia, hair growth, muscle mass, and skeletal size are apparent. Sexual dimorphism in facial structure is often less obvious. Women have a smaller skull and more prominent upper facial characteristics, with a gradual taper in the facial silhouette from upper to lower. In contrast, men have a squarer face, a more angled and larger jaw, and equally balanced upper and lower facial proportions. In the following section, male facial anatomy is further described to aid practitioners performing cosmetic procedures in men (See Table).

Forehead height and width are greater in men than in women.¹¹ The male forehead has extensive supraorbital bossing, and superior to this, there is a flat area before the convex curvature of the upper forehead begins. In females, there is considerably less or absent bossing, and a more continuous mild curvature.¹²

In women, the eyebrow lies just above the orbital rim. The female eyebrow has an arch, that peaks in the lateral third, and a central medial downward slope with the medial head of the eyebrow lying at or just below the rim.¹³ In males, the eyebrow is flatter in contour and sits lower along the orbital rim.14 As women age, their eyebrow becomes straighter and moves closer to the eye, appearing more masculine.¹⁵ On average, the inferior border of the male eyebrow is 11 mm above the pupil. Men with deep-set eyes and a prominent supraorbital rim have a slightly lower set brow.¹⁶ The medial supraorbital ridge in men blends into the glabella, resulting in a larger glabellar prominence is men than women.¹⁷ Glabellar width and projection were historically used for skeletal sex determination.^3,18

Although the orbit is absolutely larger and more round in men, the male orbit is proportionally smaller in relation to the size of the skull.¹⁹ The male upper eyelid crease is positioned 8 mm above the lid margin, whereas in women it is 12 mm above the lid margin.²⁰ The male upper lid, unlike that of the female lid, tends to be fuller and more redundant. Aging causes a downward shift of the lower eyelid that is more severe in men compared to women.

The ideal male dorsal nose is wide and straight, whereas in females it is narrow and laterally concave. The contour of the male nasal dorsum follows a straight line from the radix to the tip. In women, there is a subtle 2 mm concavity along this line.²¹ The female nose has an inflection point before the tip starts to elevate, known as the supratip break, which is typically absent in men.²¹ The nasolabial angle ranges from approximately 90°-95° in men and 95°-100° in women, causing a slight upward rotation of the female nasal tip and more nostril show.²¹

Compared to the female cheek, the male cheek has more anteromedial fullness, a broader based malar prominence, and an apex that is more medial and subtly defined.²² The frontal and zygomatic processes are wider in males, creating a flatter appearance.²³ The malar prominence in females has a well-defined apex and is located high on the mid face, below and lateral to the lateral canthus.²²

Labial sexual dimorphism is well reported in the literature. The upper lip is larger than the lower lip in women and older men, while young men have a larger lower lip. In a 2014 Italian study of 20 Caucasian men and 20 Caucasian women ages ^21-65, the upper lip was 24.1% thicker in males compared to females (10.8 mm vs 8.7 mm, respectively). The lower lip was 14.2% thicker in males (14.5 mm vs 12.7 mm, respectively); however, this difference did not reach statistical significance.²⁴ After the fifth decade of life, the lips become smaller and thinner in both sexes.²⁵ The ideal male upper lip projects 2 mm beyond the lower lip.²¹

The male mandible, which includes a prominent jaw and chin, is one of the most characteristic features of a masculine face. In a study of British men and women, subjects were asked the gender of a prototypical female face within which male features were digitally grafted. The results showed that the jaw, eyebrows/eyes, and chin, in descending order, effected the most significant change in perceived gender.²⁶ Males have a protruding chin with well-developed lateral tubercles that combine to give a wide, square appearance to the lower jaw.²⁷ Men also have large masseter muscles, which provide further definition. Prominent angulation of the mandibular ramis is typical of the male jaw and is commonly used in skeletal sex determination.²⁸ As men age, the mandible becomes longer and wider in shape.²⁹