Historical Tools of Anthropometric Facial Assessment: A Systematic Raw Data Analysis on the Applicability of the Neoclassical Canons and Golden Ratio

Background The fundamental tenets of facial aesthetic surgery education have not changed in centuries. Research is beginning to demonstrate that the Neoclassical Canons and the Golden Ratio, Phi, have limited use in populations other than those of White European extraction. Objectives The purpose of this study is to analyze the comparable raw data in the literature to determine 1) if there is interethnic variability in Neoclassical Canon and Phi measurements and 2) if the measurements in these representative samples differ from the “ideal.” Methods A PubMed/Scopus search was performed. Manuscripts with raw data and individuals aged ≥16 were included. Measurements were extracted and used to calculate the Neoclassical Canons and Phi. One-way ANOVA tests were run to compare mean measurements across six ethnic groups. p<0.05. Results Twenty-seven articles were included. Every continent was represented except Antarctica and Australia. Men were less commonly studied than women. Subject ages ranged from 16 to 56. Averaged Canons 2, 6-8 measurements had significant interethnic differences in males whereas Canons 5-8 had significant differences across ethnicities in females. For men, there was significant interethnic variability in measurements of Phi 2, 5, 8, 10 and 17. For women, Phi 1, 2, 5, 8, 10 and 17 varied across ethnicities. No ethnic/gender group showed consistent approximation of the “ideal” for both the Neoclassical Canons and Phi. Conclusions Today, the utility of the Neoclassical Canons and Phi is limited. It is incumbent on our field to systematically study and define the anthropometric measures that define the “ideal.”