Key PointsQuestionsAre objects in the face ideally organized into 3 oblique and parallel relationships and their size based on multiples of the iris width? FindingsIn this survey study of 419 respondents evaluating 43 digitally adjusted pictures and line drawings of faces, the ears' ideal position was found to support the oblique relationships found in the face. Ideal lip, nose, and eye aesthetics are based on the iris width, horizontal aperture of the eye, and the total distance between the eyes. MeaningFacial shapes appear to be ideally related to each other through 3 oblique relationships; size and positioning also appear to be defined progressively by the iris width, horizontal aperture of the eye, and total distance between the eyes. ImportanceA theory on facial beauty might allow clinicians to achieve better results. ObjectivesTo find the ideal vertical position of the ears, total lip length, lip pucker length, distance between the irises, and starting point for the nasal radix. Design, Setting, and ParticipantsIn this subjective survey, 11 sets of 43 total digitally adjusted pictures (DAPs) and line drawings of actual faces were ranked based on attractiveness by 419 clients at a facial plastic surgery clinic. The data were collected from July 13 to August 29, 2015, and were analyzed from September 17, 2015, to March 21, 2016. Main Outcomes and MeasureSix groups of line drawings and 5 groups of DAPs of an actual person were used to test the ideal position of the ears to determine whether the face is organized into oblique and parallel relationships and whether the total lip length and the lip pucker length are associated with multiples of an iris width (IW), and to determine the start of the nasal radix and its association with the superior margin of the iris and distance between the irises. ResultsOf the 419 survey respondents, the ear aligned with the second oblique was considered the most ideal by the participants. The preferred total lip length was 4.0 IWs in the DAPs and 5.0 IWs in the line drawings. For the lip pucker length, 2.0 and 3.0 IWs were considered the best. The ideal start of the nasal radix was tangential with the superior margin of the iris. The distance of 5.5 IWs from iris to iris and 3.0 IWs from the horizontal level of the iris to the nasal tip was preferred. Conclusions and RelevanceThe face may be ideally organized into 3 parallel obliques. The IW, horizontal aperture of the eye, and then iris to iris distance may best determine the size and shape of progressively larger objects in the face. The absolute position of the eye was considered important by the participants in the ideal positioning of other objects in the face. Level of EvidenceNA. This survey study evaluates the relationships between various measures of the face considered attractive by clients at a facial plastic surgery clinic to assess the circles of prominence theory on facial beauty.
