326 Review Article DOI: 10.1111/j.1610-0387.2009.07318.

“Beauty lies in the eye of the beholder”? Aspects

of beauty and attractiveness
Claudia Borelli1, Mirjam Berneburg2
(1) Department of Dermatology and Allergology, Ludwig Maximilian University, Munich, Germany
(2) Polyclinic for Orthodontics, Eberhard Karl University, Tübingen, Germany

JDDG; 2010 • 8:326–330 Submitted: 10.9.2009 | Accepted: 19.10.2009

Keywords Summary
• beauty Discussing aesthetic issues and their management with patients is a growing
• wrinkles area of dermatologic practice. Sometimes treatment options within one’s own
• skin texture discipline are rapidly discussed, without a clear idea of the various aspects of
• skin colour the face which all combine to produce beauty and attractiveness. We review
• facial aesthetics various features leading to the impression of beauty and attractiveness.
• profile Familiarity with these concepts should facilitate a broader discussion with the
patient on the aspects of beauty and attractiveness beyond the borders of
one’s own discipline and also lead to multidisciplinary treatment options. We
also examine the question how much the personality of the beholder himself
is involved in the perception of attractiveness and beauty (of the person sitting
opposite to him).
The “ideal” face has an average profile with slightly protrusive and full lips.
Attractiveness increases with average features and symmetry. Moreover, par-
ticular features such as the scheme of childlike characteristics combined with
aspects of maturity and expression make a female face appear especially
beautiful. Which attributes contribute to attractiveness of a man’s face are
controversial. Clear male signals such as a strong chin are likely not to increase
attractiveness.

Introduction
No one knows who first said “beauty lies
in the eyes of the beholder”, and indeed
the saying is only partly true. Beauty is
an ideal that is strongly influenced by
societal trends [1, 2]. What was consid-
ered beautiful in the Middle Ages is per-
ceived quite differently today, and vice
versa. The main factor contributing to
attractiveness is the appearance of the
face [3]. Studies have shown that there
are certain criteria, which are clearly de-
fined and sometimes even measurable,
that are perceived as beautiful and com-
bine to form an impression of “beauty.”
The perception of beauty is also strongly
influenced by the media, however, and
thus to a certain degree is subject to
changing trends. The desire to be beau-
tiful or attractive is of increasing con-
cern to patients visiting dermatologists,
plastic and aesthetic surgeons, maxillo-
facial surgeons, orthodontists, and doc-
tors in other fields, and thus more and
more doctors are offering aesthetic pro-
cedures. Given that beautiful people are
often thought to be nicer, have better so-
cial skills, and to be more interesting
largely explains this desire among pa-
tients to be more attractive [4]. Yet the
majority of patients seeking advice on
cosmetic procedures are not adequately
informed as to what actually makes a
person look attractive. Naturally, the
treating physician normally works
within his or her specialty to address the
problem. As this paper aims to demon-
strate, however, an overall impression of
attractiveness or beauty can also encom-
pass areas other than the doctor’s own
specialty. The goal of this paper is to
provide more comprehensive informa-
tion so that patients seeking advice on
cosmetic procedures can be referred as
necessary to the suitable specialty.

JDDG | 5˙2010 (Band 8) © The Authors • Journal compilation © Blackwell Verlag GmbH, Berlin • JDDG • 1610-0379/2010/0805
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Aspects of beauty and attractiveness Review Article 327

The ideal face

Averageness
What a person finds attractive, or what
motivates a person when choosing a
mate, is first of all averageness. There is a
general preference for a nose of average
shape and size and eyes that are set an av-
erage distance apart. The reason for this is
that people with average features, i.e.,
with facial characteristics close to the av-
erage, have a low number of genetic mu-
tations and thus also have a higher rate of
survival from an evolutionary perspective
[5]. In a study on the attractiveness of fa-
cial features, the faces that observers rated
as most attractive were those that were a
composite of several faces [6] (Figure 1).
Yet, attractiveness is somewhat more Figure 1: (a) The average female face calculated from 64 female faces. Morphed faces are considered
complex than mere averageness, as an- more attractive than original faces. (b) The average male face calculated from 32 male faces. Morphed
faces are considered more attractive than original faces. Copyright: www.beautycheck.de.
other study showed which reported
that the average face constructed from
60 women’s faces was considered less at-
tractive than the average face constructed
from 15 of the most attractive women in
the group [7]. This suggests that the com-
posite face constructed from the 15 most
attractive women’s faces must also con-
tain other features that are considered
particularly attractive. Similarly, some au-
thors have suggested that the most beau-
tiful faces contain unusual features [8].
This is demonstrated by the face of the
supermodel, Cindy Crawford: although Figure 2: On the left side a symmetrical face consist of 2 right side of faces, in the middle the origi-
the composite image constructed from nal unsymmetrical face and on the right side a symmetrical face consist of 2 left side of faces.
two left or right halves in a mirror image
is quite pretty, her actual face, consisting
of two asymmetrical halves, is particu- automatically ensure attractiveness [8]. ported by other studies on profile [16,
larly attractive (the figure could not be The observer’s own background and eth- 17] which further confirm that the per-
reproduced here due to copyright laws; nicity may also play a role, as studies ception of attractiveness depends at least
Figure 2 illustrates the idea). have found that people from developing in part on the observer.
countries tend to consider symmetry to
Symmetry be far more attractive than people from Lips
No human face is perfectly symmetrical. industrialized nations. According to Lit- Another factor which is important for at-
In most people, the facial features are tle and Zeidel [12, 13], one reason may tractiveness of the face is the lips - or
slightly asymmetrical. Asymmetry is es- be that symmetry is considered a sigh of rather, the lip profile. The lips are the
pecially apparent when the two halves of good health and that people living in de- central feature of the lower one-third of
the face are mirrored (Figure 2). The sci- veloping countries place greater weight the face. Full lips convey an impression of
entific opinion in the literature on the on good health as they must fight to be youth, health, and attractiveness, while
influence of symmetry on a face diverges, healthy and survive [12]. Obviously, the thinner and flatter lips convey the oppo-
with some authors claiming that symme- beholder is indeed a relevant factor in the site [18, 19]. The perception of what
try has a highly positive influence on a assessment and perception of beauty. makes the lips attractive is also subject to
face and increases its attractiveness [9, changing trends. In recent years the per-
10], while others state that the exact op- Profile ception of “ideal” features has shifted,
posite is true. A recent paper showed that An important factor in facial attractive- even among Caucasians, toward fuller,
asymmetry near the midline of the face is ness is its profile [14]. The ideal profile - more strongly protruding lips [1, 20–22].
relevant, but the more peripheral the based on studies by Spyropoulos [14] The 1968 Ricketts formula (if a line is
asymmetry the more irrelevant it be- and also based on evaluations of draw- drawn from the nose to the chin, the up-
comes [11]. Still other authors say that ings of ideal profile in another study [15] per lip should be 1-4 mm behind the line
marked asymmetry may be considered - appears to be the most average profile and the lower lip on or up to 2 mm in
unattractive, but that symmetry does not (Figure 3). These results have been sup- front the line) is thus outdated [23].

© The Authors • Journal compilation © Blackwell Verlag GmbH, Berlin • JDDG • 1610-0379/2010/0805 JDDG | 5˙2010 (Band 8)

328 Review Article
Figure 3: On the left the retroganthic profile, in the middle the ideal straight average profile, on the
right the prognathic profile.
Figure 4: Patient with papulopustular rosacea. Same patient with good skin condition.
Skin
Various aspects of the appearance of the
skin affect its attractiveness. Skin that ap-
pears “clear”, i.e., with no signs of disease
such as acne, atopic eczema, rosacea, or
similar disorders (which affect the color,
but also the surface characteristics of the
skin) is considered attractive (Figure 4).
Here, too, health plays a role. What is
perceived as healthy is also considered
more beautiful. Anything interfering
with skin color, such as telangiectasias,
hyperpigmentation, or color changes
due to other causes are rated negatively
[24, 25]. According to Matts, people can
determine and the age and overall health
of others with exceptional accuracy [25].
The texture of the skin is a further factor
that influences attractiveness. These
JDDG | 5˙2010 (Band 8)
days, unlined skin that is youthful, fine,
taut, and firm is considered attractive; in
dermatological parlance this is referred
to as: fine pores, youthful non-elastotic
skin. Clearly, in our society the youth
factor is perceived positively: anything
young or seemingly so is considered at-
tractive. Again, the perception of heath is
a relevant factor.
Facial features
With aging, the features begin to become
lax and the overall shape of the face
changes. A youthful face has sharp con-
tours and a more triangular, oval, or even
rhomboidal shape. In older or aging
faces, gravity acts on all of the tissues of
the face so that the face drops slightly
downward. This alters the shape of the
© The Authors • Journal compilation © Blackwell Verlag GmbH, Berlin • JDDG • 1610-0379/2010/0805
16100387, 2010, 5, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/j.1610-0387.2009.07318.x by Cochrane Philippines, Wiley Online Library on [19/04/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Aspects of beauty and attractiveness
face to a more square shape. Ptosis of the
soft tissue begins during the 30s near the
eyebrows with drooping in this area. The
tip of the nose also sags with age and
there is shortening of the columella,
making the nose appear longer. There is
also thinning of the nasal skeleton and
loss of subcutaneous fat about the nose
so that the bridge of the nose becomes
more convex and the nose widens. Fur-
ther signs of aging in the midface include
ptosis of buccal fat as well as a general re-
duction in subcutaneous fat and more
strongly pronounced nasolabial folds.
The lower one-third of the face also
droops and there is a shift of buccal fat
downward. This leads to the typical ap-
pearance in the lower lid area consisting
of elongation of the V structure in this
area so that the lower lid appears to be
elongated. In young people, the eye re-
gion is oval and the gaze is open; in the
aging face, it is round and the gaze is less
open as the upper lids begin to hang
downward [26]. The entire chin region
also falls due to a loss of skeletal support
in the chin are and a reduction in subcu-
taneous fat with loss of skin elasticity.
Dental aesthetics
Dental aesthetics have a comparably
small influence on attractiveness of the
face [27]. Nevertheless, certain points
concerning dental aesthetics do directly
affect the attractiveness of a face. Since
the front teeth are directly in the focus of
the observer, crowded teeth or gaps are
viewed negatively. Slightly protruding
front teeth and well-formed, slightly in-
clined teeth are considered a positive fea-
ture [28, 29] (Figure 5).
With increasing age, gravity causes the
upper lip line to drop by an average of
2 mm so that when speaking or laughing
less of the tooth in the upper dental row
is visible [30] (Figure 6).
In a study on possible color changes that
can occur with age and their effect on the
attractiveness of the face, Grosofsky and
colleagues found that color does not in-
fluence the perception of attractiveness
[31].
Sex-specific aspects of beauty
Different attributes are considered at-
tractive in woman and men. According
to Baudouin, childlike features, i.e.,
big eyes, full lips, thin eyebrows, small
nose and chin, are generally considered
attractive in a woman [9]. Prominent

Aspects of beauty and attractiveness
Figure 5: On the left, ideal dentition, on the right an unattractive dentition with spaces in the frontal area.
Figure 6: (a) A young smile. (b) An old/older smile.
cheekbones are also a plus, which accord-
ing to Draelos are the only obvious exter-
nal sign of high estrogen levels in women
and thus an indicator of reproductive po-
tential [32]. Edler has proposed that very
attractive women’s faces combine features
that are childlike with features that indi-
cate maturity and expression [33]. Child-
like features, consisting of large, wide-set
eyes, full lips, a small nose and chin,
would appeal to a protective instinct.
Prominent cheekbones indicate maturity
and a broad smile and arched eyebrows
make a face expressive.
What makes a man’s face attractive is
more controversially discussed in the
literature. Edler has suggested that in an
attractive man’s face, features indicating
maturity, such as prominent cheek-
bones, a large jaw, strong chin, thick
eyebrows, and thin lips dominate [33].
Scheib supports Edler’s hypothesis,
© The Authors • Journal compilation © Blackwell Verlag GmbH, Berlin • JDDG • 1610-0379/2010/0805
adding that women would conclude
that such features indicate genetic fit-
ness [34]. Other authors disagree, say-
ing that such attributes would have a
negative impact [35]. Perrett and col-
leagues found in one study that average
male faces which were “femininized”
(given fuller lips and a smaller nose and
chin) were perceived as more attractive
by viewers [35]. Studies by Cellerino
found that women preferred different
types of men depending on menstrua-
tion cycle or life situation [8]. During
ovulation or when seeking a short-term
partner, women preferred particularly
masculine men, but when looking for a
longer-term partner, less masculine
traits were preferred [36]. This in turn
supports the notion that the attractive-
ness of an individual depends on what
the observer considers attractive and
beautiful.
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Review Article 329
Influence of the observer on facial
attractiveness
The perception of attractiveness is also
influenced by factors such as educational
level as well as psychological and social
factors related to the observer [37]. Vari-
ous studies on the relationship between
educational level or social status have
shown that people with a higher educa-
tion or social status are more critical of
dental anomalies or malocclusion [38,
39]. Even children growing up in fami-
lies with a higher social status were found
to be more critical than children from
ethnic minorities [40]. A study done last
year reported that younger people of
both sexes prefer a different eye axis than
older people who prefer a horizontal eye
axis [41].
Conclusions
There are clear criteria involved in creat-
ing an impression of beauty and attrac-
tiveness. Today there is a preference for
fuller and slightly protruding lips in
women. In general, childlike features
combined with signs of maturity such as
high cheekbones and expressive features
are considered attractive in women.
Symmetry and averageness combined
with the above-mentioned features also
contribute to facial attractiveness. Which
features are considered attractive in a
man’s face are still controversially dis-
cussed. The perception of attractiveness
is subject to trends. But the observer, and
his or her background, social status, and
educational level indeed play a role in the
assessment and perception of attractive-
ness of others. Thus the title should
more aptly read: “Beauty also lies in the
eyes of the beholder.” <<<
Conflict of interest
None.
Correspondence to
Dr. med. Claudia Borelli
Klinik und Poliklinik für Dermatologie
und Allergologie
Ludwig-Maximilians-Universität
München
Frauenlobstr. 9–11
D-80337 München
Tel.: +49-89-5160-6151
Fax: +49-89-5160-6153
E-mail:
claudia.borelli@med.uni-muenchen.de
JDDG | 5˙2010 (Band 8)

330 Review Article
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