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Facial Aesthetics: Concepts & Clinical Diagnosis

Section Editor(s): Lambros, Val M.D.

Plastic and Reconstructive Surgery: October 2012 - Volume 130 - Issue 4 - p 971
doi: 10.1097/PRS.0b013e31826ba2be
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Ronald P. Gruber, M.D.

Review Editor

Clinicians of whatever stripe pay most attention to the things they know how to fix, which is why, like the blind men and the elephant, the various disciplines understand the face in different ways. Fig 1 Dr. Naini, an orthodontist and consultant from the United Kingdom, has conceived a book of ambitious scope that looks at the face in a holistic way, not only in the soft-tissue realm so familiar to plastic surgeons, but also in the relationships of soft and hard tissues of the face. He has largely succeeded in this endeavor. This is not a therapeutic work; it is observational. As the author correctly states, observation and diagnosis are the necessary precursors of treatment. He has a keen eye and the wisdom of years of practice that he shares with us here.

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This book runs 434 pages and, unlike many coffee table–size medical books common today that consist of large margins with scant text, the pages are full and well designed, with abundant illustrations, references, photographs, quotes, and aphorisms. The obligatory chapters on beauty and the evolution of facial perception are done in a sensible, historical way. Many publications on facial attractiveness are (in this reviewer’s opinion) tedious, not definitive, and overly breathy in their conclusions. The author covers this ever popular and inconsistent ground without hyperbole. Counter to current fashion, the element of subjectivity in perception is not deemphasized.

The tools of anthropometry and cephalometry are reviewed and placed in the context of the face. These to me are among the most valuable of the book’s chapters.

The book then proceeds regionally with chapters encompassing aesthetic analysis of all major areas of the face, discussing the mouth, lips, nose, ears, and smile aesthetics, among others. Not surprisingly, his orientation is more maxillofacial and numerical than most plastic surgeons are used to in discussions of soft tissues. Nonetheless, I found many new insights into anatomy and configurations that I had wondered about and finally understood.

Some of these chapters are better than others. The nose, for example, is underdiscussed; and facial aging, one of the major drivers of facial surgery in the United States, is given only two pages. The maxillofacial chapters are the best written and most authoritative; the author has struck a reasonable balance between being exhaustive and still comprehensible to the nonspecialist. The chapters on orthodontia are perhaps less relevant to the plastic surgeon than many of the others.

I think this a remarkable effort from a single author: it is clearly a labor of love. Although not a necessity for the practicing plastic surgeon, those serious about understanding the face will find great pleasure and value in this book. Most residents in plastic surgery, facial plastic surgery, or maxillofacial surgery should be exposed to this material in their training, and this is a good place to get that exposure in one place.

©2012American Society of Plastic Surgeons