The profound impact of the Covid-19 epidemic has triggered in society an inclination towards a deeper refection on life’s fragilities and a heightened sense of gratefulness for matters previously taken for granted. Society has become very mindful of the precious value of robust health and remaining safe in an uncertain world.

In this setting patients appear to more grounded than before, seeking natural outcomes from aesthetic treatments. While not extinguished, demands for excessive interventions appear to have diminished in concert with the somewhat faded phenomenon of the influencer industry. (1)

It is also timely for practitioners to reflect on the extraordinary endowment of the human face, mindful of the signification it imparts to fellow humans, even before the addition of speech.

In fact, it is the “first impression” of a person’s face that may influence a person to admire, dislike, love and indeed fear another human. Humans learn to trust their instincts on even in circumstances of fleeting facial signaling. It is in all likelihood an instinctive mechanism founded on survival in society.

Accordingly, when a patient seeks facial aesthetic intervention, practitioners must not only assess the face from an aesthetic perspective, but ideally also gain an impression of what the patient may seek to expressively impart to other people on facial appearance alone.

This often-neglected aspect of facial and personality assessment may be at least as challenging as the ideal aesthetic math of proportion and contour. For instance, some patients actually wish to appear bland while others may wish to appear with heightened gravitas. Aesthetic interventions should respect such variable aspirations of a patients preferred facial demeanor. A frequently observable error of intervention is when an actor can no longer facially signal an expressive quality that was uniquely associated with their celebrity.

Fascinatingly, humans are “hard wired” from infancy to recognize and sense beauty. This relates to the need for warmth, nurturing, security and love. Conversely, developmental failure to recognize the characteristics of a hostile face places some humans at a protective disadvantage.

Miguel Ibáñez-Berganza writes that the face is the part of the human body from which we infer the most information about others. This includes gender, identity, intentions, emotions, attractiveness, age and ethnicity. In particular, looking at a face, we are able to immediately acquire a consistent impression of its attractiveness. (2)

Humans are so drawn to facial perception that face pareidolia, the phenomenon of seeing faces in everyday objects, uses the same brain processes that we use normally to recognize and interpret other ‘real’ human faces. (3)

Facial pareidolia was once thought of as a symptom of psychosis. However, it is now recognized as a normal, human tendency. The human brain is specialized for face processing, yet we sometimes perceive illusory faces in objects. (4)

Hyper facial perception stems from an evolutionary need to recognize faces. Carl Sagan suggests in his 1995 book “The Demon-Haunted World”, that as soon as the infant can see, it recognizes faces. “We now know that this skill is hardwired in our brains” (5)

Newborns, despite their immature visual system, are able to recognize individual faces. A mother’s face is recognized and preferred over a female stranger’s face within hours from birth. (6)

Colin Palmer suggests that face perception isn’t just about noticing the presence of a face but also the need to recognize who a person is and read information from the face. It is socially important to perceive whether a person is paying attention to us and ascertain whether a person is happy or upset. There is an evolutionary advantage to being really good or efficient at detecting faces.

People afflicted by conditions like face prosopagnosia (a cognitive disorder of face perception in which the ability to recognize familiar faces is impaired) and autism spectrum can result in difficulties in “reading” other people's faces, such as their emotional state. (3)

“The Man Who Mistook His Wife for a Hat and Other Clinical Tales” is a 1985 book by neurologist Oliver Sacks describing the case histories of some of his patients including prosopagnosia. (7) Sacks himself suffered from this condition: “I have had difficulty recognizing faces for as long as I can remember. I did not think too much about this as a child, but by the time I was a teenager, in a new school, it was often a cause of embarrassment. My frequent inability to recognize schoolmates would cause bewilderment, and sometimes offense—it did not occur to them (why should it?) that I had a perceptual problem” (8)

It is hardly surprising that humans aspire to present themselves with a focus on felicitous facial impression. After all one’s face is a veritable “calling card”. Professional websites never feature photographs of a hostile faced aesthetic practitioner!

Humans are fascinated by faces, exemplified by the aforementioned phenomenon of pareidolia (observing faces in objects). (9) Conversely, one can only imagine the impediment of compromised facial recognition.

To summarize, aesthetic professions have been experiencing unprecedented demands for facial beautification and enhancement. Concurrently, along with traditional aesthetic surgery, minimal impact aesthetic medical procedures have become exceedingly popular. However, it is incumbent on all aesthetic medical practitioners to approach manipulation of a patient’s face, respecting the principles of beauty and avoiding distorted outcomes, while also respecting the impression or signaling that the patient may seek to impart.

References
(1) https://www.wired.com/story/influencer-economy-hurtles-first-recession/
(2) Ibáñez-Berganza, M., Amico, A. & Loreto, V. Subjectivity and complexity of facial attractiveness. Sci Rep 9, 8364 (2019). https://doi.org/10.1038/s41598-019-44655-9
(3) Palmer CJ, Clifford CWG. Face Pareidolia Recruits Mechanisms for Detecting Human Social Attention. Psychol Sci. 2020 Aug;31(8):1001-1012. doi: 10.1177/0956797620924814. Epub 2020 Jul 22. PMID: 32697673.
(4) Wardle, S.G., Taubert, J., Teichmann, L. et al. Rapid and dynamic processing of face pareidolia in the human brain. Nat Commun 11, 4518 (2020). https://doi.org/10.1038/s41467-020-18325-8
(5) Sagan, Carl (1997). The Demon-Haunted World: Science As a Candle in the Dark (Reprint ed.). Ballantine Books. ISBN 978-0345409461.
(6) Simion F, Giorgio ED. Face perception and processing in early infancy: inborn predispositions and developmental changes. Front Psychol. 2015;6:969. Published 2015 Jul 9. doi:10.3389/fpsyg.2015.00969
(7) Oliver Sacks, The Man Who Mistook His Wife for a Hat and Other Clinical Tales. Pan MacMillan Paperback 2015 ISBN: 978144727540
(8) https://www.newyorker.com/magazine/2010/08/30/face-blind
(9) https://www.boredpanda.com/pareidolia-everyday-objects/?utm_source=google&utm_medium=organic&utm_campaign=organic