Eight choices of facial shape were given in the questionnaire: heart, square, pear, rectangle, round, oval, diamond and oblong, provided as illustrations without a written description. The same eyes, nose, and lips were included in all of the sketches but no hair to understand the preferences of the responders for facial shape without including gender-specific features. The facial shapes most preferred by responders were oval (39.94%, long, thin face with pointy chin), followed by heart shape (24.06%, inverted triangle shape), and oblong shape (15.17%, long, thin, pointy chin) (Fig. 1). The square facial shape with a square jaw angle and chin was the least preferred facial shape.
Surgical
and non-surgical aesthetic treatments are very popular throughout Asia and in particular in China. With the globalisation and immigration of Chinese people to other countries where many seek treatment from Western-trained doctors, it is important to understand the ideals of beauty amongst Chinese people so as to achieve optimal results. We conducted an online survey to understand the preference of Han Chinese laypersons for facial shape, profile (straight, convex, concave), jaw angle and shape, and shape of the chin, nose, and lips. In addition, the participants were asked about their educational level, geographic location, likelihood to have cosmetic surgery, preference for surgical or non-surgical cosmetic procedures and whether “being beautiful” would affect their daily life. A total of 1417 responses were collected from 599 male and 818 female participants, the majority of them who were 25–35 years old (58.93%). The responses showed that the majority of participants preferred an oval face shape, with a smoothly tapered jaw angle for both men and women, round and pointy chin for both genders, straight to concave nose profile and full lips with well-defined cupid’s bow. Most responders indicated they were not willing to undergo cosmetic surgery; however, when given a choice between surgical and non-surgical cosmetic procedures, 82.22% of the participants preferred non-surgical procedures. The majority of respondents (83%) thought that being beautiful has an effect on daily life and improves quality of life.
Level of Evidence V
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Keywords
Aesthetic medicine Facial aesthetics Chinese Chinese faces Chinese facial aesthetics Facial shape Facial profile Nose Lips Jaw angle Jawline Chin
This paper was made open access with funds provided by King’s College London
Introduction
The idea of a universal standard for facial beauty is a widely debated topic and is of interest to researchers, sociologists, and aesthetic professionals including plastic surgeons orthodontists, dermatologists and aesthetic practitioners. Ideals of facial beauty, perception of attractiveness, and preferences for different shapes and forms of facial features were previously believed to vary greatly amongst different cultures and between historical times. For example, in many Asian cultures, having white skin is considered a significant factor in female beauty and hence skin whitening is very popular [1]. Other examples of features perceived as attractive and modifications made to obtain such features include having a very long neck, stretched earlobes and lips, different variations of facial tattoos and paintings, and changes to the shape and size of teeth. However, there is evidence to suggest that although there is heterogeneity in the specific features, shapes, or characteristics that are considered beautiful in different parts of the world; the broader ideals of beauty and the goals of beautification are universal.
Across all human cultures characteristics such as averageness, symmetry, harmony, and balance are key features of perceived attractiveness and facial beauty [2, 3]. Recent studies have reported that perception of attractiveness is consistent independent of race, nationality, or age [4]. In a study by Cunningham et al., men of different races were asked to judge the attractiveness of females from their own and different racial groups. The study reported that Asian, Hispanic, and White men were consistent in their judgment of female attractiveness, independent of race. All three groups of men provided similar ratings for a panel of Asian, Hispanic, and White female faces, and the mean ratings did not appear to be influenced by exposure to Western media [5]. A similar study by Rhodes et al. found a preference for symmetry and averageness in facial features which was cross-cultural; similar judgements of attractiveness were reported by Chinese and Japanese participants in the study with no preference for own-race over other-race pictures presented [6]. Furthermore, in a meta-analytic and theoretical review, Langlois et al. reported that within and across cultures there appears to be agreement about who is attractive and who is not [7]. The theory that beauty standards are innate has been a subject of debate and can be supported by a study that was carried out by Langlois et al. in which infants (2–3 and 6–8 months old) were shown faces that were pre-rated as attractive and unattractive [8]. Both groups of infants looked significantly longer at the pre-rated attractive faces [8]. This study found that the preferences for attractive faces exists from early infancy and remain consistent across ages, gender, and ethnicity. Further supporting the theory of innate beauty standards is the consensus paper, “Changing Trends, Attitudes, and Concepts of Asian Beauty” by Liew et al., in which an expert panel agreed that whilst retaining distinct ethnic features, beautiful people of all races show similarity in many facial characteristics [3]. Therefore, the general principles of beauty and aesthetic enhancement appear to be relatively homogeneous independent of race and cultural background, with similar aesthetic goals that are only modestly influenced by culture, environment, and media.
Despite the cross-cultural homogeneity of the broader ideals of human beauty and facial aesthetics, the more nuanced variations which exist between different races and cultures remain important considerations for the aesthetic professional. The facial shape of Asians, and Chinese in particular, is different from Caucasians, with an increased bizygomatic, bitemporal and bigonal width, retruded forehead, orbital rims, medial maxilla, pyriform margins, chin, and low nasal bridge with deficient anterior projection [3]. Asians also age differently than the Western population, which requires the development of race-specific management and treatment planning strategies. Furthermore, in Asia the demand for cosmetic procedures is high amongst the younger generations and their demands and expectations are different from the middle-aged and older individuals who would typically be the largest demographic for cosmetic procedures in Western countries [3]. Importantly, in China and Asia, facial physiognomy and facial features are important in one’s daily life, as self-confidence, and marriage and career prospects are influenced by appearance. Assessments of individuals’ mental or moral character, fortune, and future are often judged based on facial features [9]. Certain features of the face are believed to bring about luck or good fortune and vice versa [10]. For example, the mandibular angle is very important in female facial shape in Asia as “a woman who has a wide and square face is thought to bring unhappiness to her husband [11]”. Despite the large and growing demand for aesthetic procedures (surgical and non-surgical) amongst the Chinese and Asian population, the ideals of beauty specific to these groups are not well studied and are poorly understood both inside and outside Asia. Given this situation, an enhanced understanding of the ideals of facial beauty amongst Asian people would be of great value to aesthetic professionals.
We conducted an online survey to better understand the ideals of beauty amongst Han Chinese laypersons with regards to individual facial features including facial shape, facial profile, nose and lips, jaw angle, and chin shape for men and women. The survey also aimed to better understand people’s preference for surgical or non-surgical cosmetic procedures and the importance of “being beautiful” in daily life.
Methods
Survey Design and Distribution
To determine the key ideals of facial beauty amongst the Han Chinese population, an online survey of the general population was carried out. The survey was conducted through a Chinese online platform designed for such surveys (www.wjx.cn). There were no specifications for selection of the participants as we wanted to have as wide a sample as possible including all ages, both sexes, and all regions of China. A link to the survey was available online and was disseminated via the survey website itself and also via a popular Chinese social media channel (WeChat) by the first author. Multiple-choice questions were used with a random sample frame. A total of 18 questions were asked including collection of basic demographic data, preference for facial features including facial shape, facial profile, nose, lips, jaw angle, and chin shape as well as preference for cosmetic procedures (surgical vs. non-surgical). The full questionnaire can be found in the Supplementary Materials. Simple sketches were provided to illustrate facial features, and these illustrations were placed in a random order to remove bias from participants’ decision making. The forms could only be completed once by each individual and answers could not be modified after submission.
Statistical Methods
Survey responses were collected and summarised using descriptive statistics.
Results
Participants
A total of 1417 responses were collected from 599 men and 818 women. Most of the responders were aged 30–35 years (26.64%), followed by 25–30 years (29.29%) with an average age of 33.5 years and 90% of the responders had a university education (Table 1). The 1417 responders represented 32 provinces across China including Hong Kong S.A.R., with a significant representation from Shanghai, Beijing, and Guangdong. There were no participants from Macau.
Surgical
and non-surgical aesthetic treatments are very popular throughout Asia and in particular in China. With the globalisation and immigration of Chinese people to other countries where many seek treatment from Western-trained doctors, it is important to understand the ideals of beauty amongst Chinese people so as to achieve optimal results. We conducted an online survey to understand the preference of Han Chinese laypersons for facial shape, profile (straight, convex, concave), jaw angle and shape, and shape of the chin, nose, and lips. In addition, the participants were asked about their educational level, geographic location, likelihood to have cosmetic surgery, preference for surgical or non-surgical cosmetic procedures and whether “being beautiful” would affect their daily life. A total of 1417 responses were collected from 599 male and 818 female participants, the majority of them who were 25–35 years old (58.93%). The responses showed that the majority of participants preferred an oval face shape, with a smoothly tapered jaw angle for both men and women, round and pointy chin for both genders, straight to concave nose profile and full lips with well-defined cupid’s bow. Most responders indicated they were not willing to undergo cosmetic surgery; however, when given a choice between surgical and non-surgical cosmetic procedures, 82.22% of the participants preferred non-surgical procedures. The majority of respondents (83%) thought that being beautiful has an effect on daily life and improves quality of life.
Level of Evidence V
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Keywords
Aesthetic medicine Facial aesthetics Chinese Chinese faces Chinese facial aesthetics Facial shape Facial profile Nose Lips Jaw angle Jawline Chin
This paper was made open access with funds provided by King’s College London
Introduction
The idea of a universal standard for facial beauty is a widely debated topic and is of interest to researchers, sociologists, and aesthetic professionals including plastic surgeons orthodontists, dermatologists and aesthetic practitioners. Ideals of facial beauty, perception of attractiveness, and preferences for different shapes and forms of facial features were previously believed to vary greatly amongst different cultures and between historical times. For example, in many Asian cultures, having white skin is considered a significant factor in female beauty and hence skin whitening is very popular [1]. Other examples of features perceived as attractive and modifications made to obtain such features include having a very long neck, stretched earlobes and lips, different variations of facial tattoos and paintings, and changes to the shape and size of teeth. However, there is evidence to suggest that although there is heterogeneity in the specific features, shapes, or characteristics that are considered beautiful in different parts of the world; the broader ideals of beauty and the goals of beautification are universal.
Across all human cultures characteristics such as averageness, symmetry, harmony, and balance are key features of perceived attractiveness and facial beauty [2, 3]. Recent studies have reported that perception of attractiveness is consistent independent of race, nationality, or age [4]. In a study by Cunningham et al., men of different races were asked to judge the attractiveness of females from their own and different racial groups. The study reported that Asian, Hispanic, and White men were consistent in their judgment of female attractiveness, independent of race. All three groups of men provided similar ratings for a panel of Asian, Hispanic, and White female faces, and the mean ratings did not appear to be influenced by exposure to Western media [5]. A similar study by Rhodes et al. found a preference for symmetry and averageness in facial features which was cross-cultural; similar judgements of attractiveness were reported by Chinese and Japanese participants in the study with no preference for own-race over other-race pictures presented [6]. Furthermore, in a meta-analytic and theoretical review, Langlois et al. reported that within and across cultures there appears to be agreement about who is attractive and who is not [7]. The theory that beauty standards are innate has been a subject of debate and can be supported by a study that was carried out by Langlois et al. in which infants (2–3 and 6–8 months old) were shown faces that were pre-rated as attractive and unattractive [8]. Both groups of infants looked significantly longer at the pre-rated attractive faces [8]. This study found that the preferences for attractive faces exists from early infancy and remain consistent across ages, gender, and ethnicity. Further supporting the theory of innate beauty standards is the consensus paper, “Changing Trends, Attitudes, and Concepts of Asian Beauty” by Liew et al., in which an expert panel agreed that whilst retaining distinct ethnic features, beautiful people of all races show similarity in many facial characteristics [3]. Therefore, the general principles of beauty and aesthetic enhancement appear to be relatively homogeneous independent of race and cultural background, with similar aesthetic goals that are only modestly influenced by culture, environment, and media.
Despite the cross-cultural homogeneity of the broader ideals of human beauty and facial aesthetics, the more nuanced variations which exist between different races and cultures remain important considerations for the aesthetic professional. The facial shape of Asians, and Chinese in particular, is different from Caucasians, with an increased bizygomatic, bitemporal and bigonal width, retruded forehead, orbital rims, medial maxilla, pyriform margins, chin, and low nasal bridge with deficient anterior projection [3]. Asians also age differently than the Western population, which requires the development of race-specific management and treatment planning strategies. Furthermore, in Asia the demand for cosmetic procedures is high amongst the younger generations and their demands and expectations are different from the middle-aged and older individuals who would typically be the largest demographic for cosmetic procedures in Western countries [3]. Importantly, in China and Asia, facial physiognomy and facial features are important in one’s daily life, as self-confidence, and marriage and career prospects are influenced by appearance. Assessments of individuals’ mental or moral character, fortune, and future are often judged based on facial features [9]. Certain features of the face are believed to bring about luck or good fortune and vice versa [10]. For example, the mandibular angle is very important in female facial shape in Asia as “a woman who has a wide and square face is thought to bring unhappiness to her husband [11]”. Despite the large and growing demand for aesthetic procedures (surgical and non-surgical) amongst the Chinese and Asian population, the ideals of beauty specific to these groups are not well studied and are poorly understood both inside and outside Asia. Given this situation, an enhanced understanding of the ideals of facial beauty amongst Asian people would be of great value to aesthetic professionals.
We conducted an online survey to better understand the ideals of beauty amongst Han Chinese laypersons with regards to individual facial features including facial shape, facial profile, nose and lips, jaw angle, and chin shape for men and women. The survey also aimed to better understand people’s preference for surgical or non-surgical cosmetic procedures and the importance of “being beautiful” in daily life.
Methods
Survey Design and Distribution
To determine the key ideals of facial beauty amongst the Han Chinese population, an online survey of the general population was carried out. The survey was conducted through a Chinese online platform designed for such surveys (www.wjx.cn). There were no specifications for selection of the participants as we wanted to have as wide a sample as possible including all ages, both sexes, and all regions of China. A link to the survey was available online and was disseminated via the survey website itself and also via a popular Chinese social media channel (WeChat) by the first author. Multiple-choice questions were used with a random sample frame. A total of 18 questions were asked including collection of basic demographic data, preference for facial features including facial shape, facial profile, nose, lips, jaw angle, and chin shape as well as preference for cosmetic procedures (surgical vs. non-surgical). The full questionnaire can be found in the Supplementary Materials. Simple sketches were provided to illustrate facial features, and these illustrations were placed in a random order to remove bias from participants’ decision making. The forms could only be completed once by each individual and answers could not be modified after submission.
Statistical Methods
Survey responses were collected and summarised using descriptive statistics.
Results
Participants
A total of 1417 responses were collected from 599 men and 818 women. Most of the responders were aged 30–35 years (26.64%), followed by 25–30 years (29.29%) with an average age of 33.5 years and 90% of the responders had a university education (Table 1). The 1417 responders represented 32 provinces across China including Hong Kong S.A.R., with a significant representation from Shanghai, Beijing, and Guangdong. There were no participants from Macau.
