Enhancements in Clinical Practice in the Contemporary Landscape of Male Facial Attractiveness

Abstract

The concept of gender has evolved significantly in recent decades, moving from a binary status to a multiplicity of gender types. In today’s world, the new reality of the concept of masculinity, as defined socially and historically, must be recognized and accepted by aesthetic medicine. Consequently, aesthetic doctors will have to adapt the views and treatment plans that they propose in their consultations to the ideals of beauty, as well as with the roles, behaviors, and attributes considered masculine within their society. Each facial feature suggests a personality characteristic that represents that individual. This expert opinion article aims to assess Caucasian male gender-related anatomical facial features and achieve an expert agreement on the association of specific features with the perception of attractiveness, masculinity, and personality traits in order to cover the wide range of current male representations, as well as to provide orientation for clinical practice improvement in the contemporary landscape of facial masculinization.

1. Introduction

Plastic surgeons and aesthetic medicine practitioners are recognizing a silent revolution in the notion of gender that is not only affecting their practice but also having widespread effects on society. The gap between masculine and feminine is disappearing, and the focus of masculinization and femininization in the clinic is adapting to reflect the very diverse representations of gender [1]. However, while gender, sexual orientation, and masculinity or femininity are related concepts, they have different meanings and applications, and it is important to distinguish them [2]. Nowadays, plastic surgeons and aesthetic medicine practitioners must evaluate the individual patterns that reflect the patient’s identity, behaviors, and psychological profile. More prominent jaws and chins are no longer the only traits that represent masculinity. Practitioners must consider the various identities and expressions of those who identify as male and how they want to be represented and recognized. While male attractiveness is based on physical and facial features, there is no single representative model of attractiveness [3]. Therefore, in order to cover the wide range of current male representations and to offer guidance for clinical practice improvement in the new era of facial masculinization, this document aims to evaluate Caucasian male gender-related anatomical facial features and reach an expert consensus on the association of specific features with the perception of attractiveness, masculinity, and personality traits. For this purpose, a group of aesthetic medicine practitioners and plastic surgeons with recognized experience in treating patients with an interest in modifying their appearance regarding masculine features discusses the current concepts and approaches.

2. Methods

A non-systematic literature search was carried out across various databases (PubMed and Web of Science) and non-specialized sources (Google Scholar, Google, and Bing) using a combination of the following terms: masculinization, masculinity, face, cosmetic surgery, facial male attractiveness, patient profile, aesthetics, emoticon, and feature. The authors contributed to the literature corpus with manuals and books from their personal collections. This literature corpus was shared with all authors. Scientific and professional discussions were held in three meetings. During the first two meetings, the five authors discussed the concept of masculinity, shared and discussed literature evidence, and exchanged proposals, suggestions, and their own experiences. A questionnaire was then built based on the current evidence, suggestions, and initial conclusions, containing features from the three regions of the face that might be associated with Caucasian masculine face attributes.

The questionnaire was designed to collect the association of a given facial feature with masculinity using a 5-level Likert form, from 1 (not transmitted) to 5 (fully transmitted). All authors gave their personal quantitative votes blindly via an online form. The responses were collected and summarized as median scores, which were finally discussed in a third meeting.

3. Results and Expert Opinion

3.1. Influence of Context: Gender and Masculinity/Femininity

As mentioned above, gender and masculinity/femininity are not exactly the same concept. Gender refers to our identity, its expression, and sociocultural experiences. It is a biopsychosocial state in which biology, psychological experiences, and social perspectives of each individual change over time to the extent that gender becomes a personal dynamic concept [4]. This is the setting in which plastic surgeons should apply their professional experience and best practices to support individuals in expressing their gender identity more authentically and comfortably. Non-surgical aesthetic medical procedures can help individuals take control of their own gender and achieve personal and social recognition.

Masculinity and femininity, however, are complex concepts defined culturally/socially based on expectations and norms that influence gender-related attitudes, beliefs, and behaviors. Their definitions evolve with social and cultural changes, and the attributes associated with male and female beauty change accordingly. The contemporary concept of beauty can differ significantly across time and location. Trends, fashion, social networks, and the media, complemented by our personal experiences, our memories, and our basic daily needs, largely define the image we want to project.

Contemporary masculinities are composed of four key elements: inclusivity, emotional intimacy, physicality, and resistance [5]. Inclusivity relates to an increased acceptance of homosexuality, a decrease in homophobia and misogyny, and a willingness to move towards social equality, encompassing sexual orientation, gender equality, and racial issues. This is a sign of increased social sensitivity compared with the orthodox or classical concept of masculinity [5]. There is also a shift towards emotional intimacy, emphasizing bonding, availability, and growth, leading to closer and more intimate relationships.

In the classical concept of masculinity, social pressure encouraged virility and discouraged general intimate and caring physicality, particularly between individuals of the same gender. However, contemporary masculinity encourages intentional proximity, physical contact, and open physical displays of affection, independently of the sex or gender of the other individual [5].

3.2. Current Canon of the Male Face

There is universal agreement on the attractiveness and unattractiveness of faces, which applies regardless of the different cultures of the individuals [6]. However, for practical purposes, to analyze the current canon of the beauty of the male face, we will focus our assessment on the Caucasian profile since significant variations have been reported among different geographical areas and ethnicities [7,8].

In general, two of the most important characteristics in the current facial canon are facial symmetry and averageness relative to the rest of the population to which an individual belongs [9,10,11].

A symmetrical face is usually associated with good health and good genes, and the ability to pass on the benefits of genetic quality may be attractive [12]. According to scientists who support the biological determinism of beauty, our brains are designed to recognize the genetic traits of individuals that are beneficial to the species as a whole, and individuals with these traits tend to elicit greater sexual desire. This phenomenon could be attributed to a biological aspect that suggests our attraction to symmetrical faces is rooted in the idea that symmetry suggests better genetic attributes [13,14]. A study conducted in pairs of monozygotic twins suggested that the twin with more symmetrical features was considered more attractive, reinforcing the importance of symmetry in transmitting attractiveness [15]. Thus, several studies suggest that increasing symmetry can, therefore, increase attractiveness [14,15,16].

With regard to averageness, various studies show that mean faces are usually attractive because their features are closely in line with those of the rest of the population to which they belong [16], while faces judged as non-average tend to have more extreme characteristics than the rest.

Below, we describe the features considered desirable in the current standard of male attractiveness [17,18,19].

The upper third most notably includes a wide sloping forehead with fine expression lines. The supraorbital crest should be prominent, and the eyebrows, which must be straight with no angles and denser than those of women, should begin below this protuberance. The external upper orbital angle should be so prominent that the tail of the eyebrow remains straight, and the temporal crest should be marked. The middle third of the face should have an acute nasofrontal and nasolabial angle with a straight nose that has a long, slightly wide profile. In this region, the anterior planes of the cheekbones should be prominent, and there should be a direct relationship between the mandibular angle and the sculpted cheeks.

The major feature of the lower third of the face is a widened jaw with a marked masseter muscle at a 90° angle. There is a link between the hormonal profile and the shape of the face [20] since a large jaw can reflect high testosterone levels and a robust immune system. Another desirable feature in the lower third of the face is a wide mouth with an upper-to-lower lip ratio of 1:3.

Other important components of current beauty standards are a strong smile (which indicates an attractive personality), a long, square, prominent chin, and well-hydrated skin with even color and tone with no facial blemishes. One current trend is a light, well-trimmed beard, which can sometimes compensate for the absence of well-defined mandibular angles or mandibular misalignment.

3.3. Facial Layout and Classification

Facial design or layout is determined according to the axes shown in Figure 1. Seven facial dispositions have been identified according to the ratios between these different axes [21]. The descriptions provided here are based on the author’s professional opinion and are supported by the referenced anatomical textbook.

3.3.1. Square Face

A square face is angular and characterized by a flat, wide forehead, chin, and prominent jaw. The chin is flat with a minimal curve, and the angle of the jaw is sharp. The forehead, cheekbones, and jaw are of very similar length, with differences of less than 2 cm (A = B = C).

3.3.2. Oval Face

This face shape has a very soft outline and smooth contour. It takes the form of a vertical oval, elongated and rounded in equal parts, characterized by a narrow forehead and jaw. The angle of the jaw is rounded, and the forehead and chin are slightly prominent (the chin is shorter than the forehead). The trichion–pogonion distance is greater than the bizygomatic distance, at about 5 cm (D > B), while the cheekbones dominate the contour (B > A = C).

3.3.3. Round Face

The most important feature of this facial type is that the contours are very soft and feminine, lacking marked features, and its voluminous and wide appearance. The angle of the jaw is poorly defined, with a rounded chin. The bizygomatic distance and the trichion–pogonion distance have similar measurements; the forehead and jaw also have similar measurements (A = C = D); the cheekbones are somewhat wider than the forehead and jaw (A < B).

3.3.4. Rectangular Face

This facial type is characterized by relatively similar sizes of forehead, cheekbones and jaw (A = B = C), and non-prominent features. The chin is almost the same width as the forehead, and the face is longer than it is wide (D > B) but shorter compared to the oval type.

3.3.5. Triangular Face

There are two types of triangular face: (i) one with a narrow forehead, narrow bizygomatic distance, wide jaw, and wide jawline (A = B > C); and (ii) an inverted triangle, with the forehead wider than the jaws, with well-defined cheekbones and a pointed, prominent chin (A = B < C).

3.3.6. Diamond-Shaped Face

This facial type is characterized by its angular shape and pronounced width and height. The forehead is narrow, while cheekbones are wide, marked, and prominent and usually protrude a little. The jaw and chin are pronounced and strong but narrower than the bizygomatic distance, while the chin is prominent. The diamond-shaped face resembles a heart, with similar forehead and cheekbone measurements, but the lower jaw is always smaller (B > C > A; A = B < C). The jaw is shorter in height compared to the triangular face and forms a square with a pronounced V-shaped chin. This is the shape that has the most features according to current standards of male beauty.

3.3.7. Heart-Shaped Face

The bizygomatic width in the faces of this shape is much greater than the forehead width, and the jaw is narrow (B > A > C). The trichion–pogonion distance is much smaller than that of diamond-shaped faces. It is also characterized by softer features compared to the diamond-shaped face.

3.4. Male Attractiveness

From an evolutionary perspective, male anatomical characteristics are sex-specific or dependent on hormonal influences (testosterone); therefore, they reflect biological attributes for reproductive success [6]. In The Divine Proportions, Luca Pacioli laid the first brushstrokes to the anatomical parameters to differentiate the female face from the male. To illustrate these, he commissioned drawings from Leonardo da Vinci. It could be considered that these parameters, although they were artistic, paved the way for the beginning of facial anthropometry. This anthropology branch is defined as the study of dimensions and proportions of human body parts for the purpose of understanding man’s physical changes and differences between races [22]. This compilation defines a set of measures taken at particular locations in a subject as characteristic points of the face and their differences between men and women [22] (

Table 1. Average anthropometric measurements of facial anatomical structures in men and women [22].

Anthropometric Measures	Male	Female
Vertical division
Upper half of the face
Height of the vertex to the inner edge	123.3 ± 7 mm	118.7 ± 6 mm
Lower half of the face
Height from internal edge to gnathion	117.7 ± 7 mm	102.7 ± 6 mm
Thirds
Trichion to the glabella	57 ± 7 mm	53 ± 6 mm
Glabella to subnasal	67 ± 5 mm	63 ± 4 mm
Subnasal to gnathion	73 ± 4.5 mm	64 ±4 mm
Horizontal division
Eye width	30–33 mm	29–32 mm
Intercanthal distance	30–36 mm	30–34 mm
Distance from medial to lateral canthus	30–36 mm	29–32 mm
Nasal wing base width	38.3 ± 6 mm	37 ± 5 mm

).

Small anatomical characteristics differentiate the male and female faces [23,24,25]. For instance, men’s skin is usually thicker, more sebaceous, and less elastic due to greater muscle volume and bone structure, which is wider overall with sharper bone angles. Many authors agree that the ideal classical male face has a square shape with a large jaw and balanced upper and lower facial proportions [19].

The arrangement of anatomical units and subunits is the origin of the anatomical classification by thirds, which is generally used for the aesthetic diagnosis of the face [18,26]. It is significant that in each third, there are individually specific sexual dimorphisms that establish male characteristics on their own [22,27]. The specific anatomical features of each third of the male face are defined in

Table 2. Gender-related features of male anatomical areas.

Upper Third	Middle Third	Lower Third
Hair implantation line: The position is higher than in the female, usually 7–8 cm from the eyebrows; the ideal shape for men is an M. [19,28]. Forehead: The male bone contour is convex, even in cases with a supraorbital skeletal protrusion or increased frontal sinus, which projects the eyebrows above the eyes and that gives an appearance of deep-set eyes [26,29,30]. Eyebrows: Male eyebrows are straighter and flatter, with no arch in the outer third. They are usually positioned right in the supraorbital arch or even a little lower [28,31]. Eyes: The distance between the ciliary border and the upper palpebral fold is smaller in men compared to women. The distance between the inner edges or the separation between the eyes is greater in men than in compared to women.	Nose: The male nose is wider in its three thirds and has a less curvilinear structure compared to the female. Additionally, it is the structure that presents more sexual dimorphism in the middle third. The upper bony third is usually more convex, and the frontonasal angle is sharper. The nasal tip is usually larger and less defined. The nasal tip projects with a rotation of 90–95 degrees [31]. Cheeks: Male cheeks are characterized by being more flattened in their medial part, and the zygoma projects laterally compared to the female in whom it is positioned in a more anterior position [28].	Lips: They are thinner and elongated. The upper lip has less definition of the philtrum and the edge of the vermilion and more distance from the edge of the vermilion to the nasal root. When smiling, there is less exposure of the canine teeth [23]. Chin: The male chin is longer vertically with a square outline, sometimes with a frontal bony cleft, which is one of the most flattering features [28,31]. The projection of the chin is within a line drawn from the lower lip or anterior to it. Mandible: The mandibular branch is higher and has an acute bigonial angle between 100–120 degrees. There is an increase in lateral bone projection and increase in volume of the masseter muscle [23,28]. The proportionality between the mandibular projection and the zygomatic arch is considered masculine [29]. Neck: In the male neck, the thyroid cartilage is more prominent and forms the so-called “Adam’s apple”; this occurs from the central union of the two thyroid cartilages at a 90° angle [23].

.

3.5. Perception of Personality Traits

Human beings have many characteristics and personal qualities that are conveyed through our facial features and by which we know and recognize each other. Each facial feature suggests a personality trait that is representative of that individual and determines their attributes of attractiveness [32]. As the literature on the subject is scant, we developed an expert recommendation to address our research question to examine the association between male facial aesthetics and perceptions of attractiveness, masculinity, and personality traits (aggressiveness, extroversion, likeability, risk-seeking, sociability, and trustworthiness) based on the study by Parsa et al. [33]. We proceeded to a blinded vote as described in the methods.

Table 3. Upper third. Scores obtained for (A) hairline implantations; (B) eyebrow shapes; (C) eye shapes. Scoring from 5 (fully transmitted (green)) to 1 (not transmitted (red)).

(A)	Low		Middle		High		“M”-Shape		Round	Rectangular		Alopecia
Aggressiveness	3.5		2.2		2		3		1.8	2.8		2
Extroversion	2		2.8		2.4		2.6		2	2.8		2.4
Likeability	2.2		3		3.4		3.4		3.2	3.2		3.2
Sociability	2.3		3.4		3		3.6		3.2	3.4		3.2
Trustworthiness	2.3		3		3		2.6		3.2	3		3
Risk-seeking	3.3		2.2		2		3.4		1.6	3.2		2.4
Attractiveness	3.2		4.2		2.4		3.6		2.4	3		2
Masculinity	3.7		3.8		2.6		4		2.2	3.2		2.8
(B)	Straight	Arched	Round	Low	High	Thin	Bushy	High Tail	Low Tail	Separated	Joined	Long	Short
Aggressiveness	2	2.8	1.4	4	2.8	2.6	3.6	4.4	1.4	2.4	4.4	2.4	2
Extroversion	2.6	2.6	2.8	2.4	3.4	2	2.8	3	2.6	2.4	1.4	2.4	2
Likeability	3.4	2	3.2	2.2	3	2	2.8	1.8	3	3	1.6	2.8	1.8
Sociability	3.6	3.6	3.4	2	3.2	2.2	2.8	2.2	3.4	2.8	1.8	2.8	2
Trustworthiness	3.8	2.6	3	2.2	2.8	2.2	3	2.2	3.4	3	1.6	2.8	2
Risk-seeking	2.8	3.2	2	3.8	3	2.4	3.6	4.2	1.8	1.8	3.8	3.4	2
Attractiveness	4.2	3	2.2	3.6	2.8	2.2	3.8	2.8	2.6	3	1.8	3	1.8
Masculinity	4.4	2.2	2.2	4	2.4	1.6	4.6	2.8	2.6	2.6	2.8	2.6	2
												Eyelashes
(C)	Almond	Round	Fallen	Slanted		Bulging	Deep	Asym-metrical	Joined	Separated		High Density		Low Density
Aggressiveness	2.2	2	2	3.4		2.6	3.2	2.8	4	2.2		2		3.4
Extroversion	2.8	3	1.8	3		2.2	2.6	1.4	1.4	2.8		2.2		1.8
Likeability	2.8	3.4	2.6	2.6		2.4	2.8	1.6	2	2.6		3		2.4
Sociability	3.2	3.4	2.6	3		2.8	2.8	1.6	1.6	3		3		2.2
Trustworthiness	2.6	3.4	2.8	2.8		2.8	3	1.6	1.8	2.8		3		2.2
Risk-seeking	2.4	2.4	2.2	4		2.2	3.4	1.6	3	2.6		3.2		2.8
Attractiveness	3	3.2	2.6	3.4		1.4	4.2	1.2	1.8	2.4		3.8		1.6
Masculinity	2.8	3.2	2.6	3.2		2	3.8	1.2	2.2	2.6		3.6		2.8

,

Table 4. Middle third. Scores obtained for (A) nose shapes; (B) cheek shapes. Scoring from 5 (fully transmitted (green)) to 1 (not transmitted (red)).

(A)	Straight	Convex Profile	Concave Profile	Large	Small	Asymmetric
Aggressiveness	1.8	3.6	2	3	1.8	4.4
Extroversion	3	2.6	2.8	3.8	3	2.2
Likeability	3.6	2.8	3.2	3	3	2
Sociability	3.6	3	3.4	3.4	3.2	2.2
Trustworthiness	4	2.6	3.2	3.8	2.8	2.2
Risk-seeking	2.6	3	2.8	2.8	1.8	3.6
Attractiveness	4.6	2.2	1.6	3.4	2.6	2
Masculinity	4.6	3.4	2.2	4	2.4	2.2
(B)	Hollow		Flat		Full
Aggressiveness	4.8		2.4		1.2
Extroversion	1.8		3.2		3.6
Likeability	1.4		2.8		4
Sociability	1.6		3.2		4.2
Trustworthiness	1.6		3.2		3.8
Risk-seeking	4.6		3.2		1.4
Attractiveness	2.8		4		2.2
Masculinity	3.2		4.2		1.8

,

Table 5. Lower third. Scores obtained for (A) lip shapes; (B) chin shapes; (C) jaw shapes. Scoring from 5 (fully transmitted (green)) to 1 (not transmitted (red)).

(A)	Fine	Medium		Thick			Very Thick	Long	Short		Long Nasolabial Distance		Short Nasolabial Distance
Aggressiveness	3.2	2.2		2.2			3	2.5	3.4		2.2		2.2
Extroversion	2	2.8		3			2.4	3.3	2.2		1.8		3.2
Likeability	2.4	3.6		3.6			3.4	4.0	2.2		1.6		3.6
Sociability	2.2	3.6		3.6			3.4	4.0	2.2		1.8		3.6
Trustworthiness	2.6	3.4		3			3	2.8	2		1.6		3.6
Risk-seeking	2.8	2.8		3			3.4	2.5	2.2		2		3
Attractiveness	2.4	4		3.6			3	3.5	2.2		1.6		3.4
Masculinity	3	4		3.2			2.2	3.3	2.2		1.6		4
(B)	Receding				Broad			Prominent			Cleft
Aggressiveness	1				4.6			4.4			4.4
Extroversion	1.2				3.4			3.4			3
Likeability	2.4				2.8			2.6			2.8
Sociability	2.2				3.4			3			3
Trustworthiness	2				3			2.6			3.2
Risk-seeking	1.2				4.4			4			4
Attractiveness	1.4				4			3			3.6
Masculinity	1				4.8			3.6			4.6
(C)	Marked (Acute Angle)		Narrow (Rounded Angle)			Soft Angle		Wider than Zygomatic Arch		Aligned to Zygomatic Arch		Width Less than Zygomatic Arch
Aggressiveness	4.2		2.2			2		4.5		2.6		1.7
Extroversion	3.2		2.8			2.6		2.8		4.2		3
Likeability	2.8		3.4			3.8		2.3		4.4		3.3
Sociability	3.2		3.4			3.8		2.5		4.2		3.5
Trustworthiness	3		3			3.75		2.3		3.8		3.5
Risk-seeking	4.6		1.8			2.25		4.8		3.2		1.7
Attractiveness	4.4		2.4			3.2		3		4.6		2.5
Masculinity	4.4		2.2			2.6		4.5		4.6		2

and

Table 6. Scoring for face shapes. Scoring from 5 (fully transmitted (green)) to 1 (not transmitted (red)).

	Square	Oval	Round	Heart	Diamond	Rectangular	Triangle
Aggressiveness	4.8	1.8	1.8	2.2	4.4	2.6	2.8
Extroversion	2.4	2.8	3.4	2.8	2.8	2.6	2.2
Likeability	1.6	3.8	3.8	3	2.6	3.2	2.8
Sociability	1.8	3.6	3.6	3.2	2.8	3.4	2.4
Trustworthiness	2.2	3.2	3.4	2.8	2.6	3.4	2.6
Risk-seeking	4	2.6	2.2	2.2	4.4	3.2	2.4
Attractiveness	3.8	3.8	3	3.2	4.2	3.2	2.6
Masculinity	4.6	3.8	2.6	3.4	4.6	3.6	2.6

show the scoring gradient for facial structures in the upper (Table 3), middle (Table 4), and lower third (Table 5) of the face and face shapes (Table 6).

3.5.1. Aggressiveness

Aggressiveness is a trait typically associated with masculinity. The facial features in the upper third of the face that are related to this characteristic are eyebrows that are low, joined, or with a high tail and close-set eyes (Table 3). In the middle third of the face, an asymmetrical nose and hollow cheeks are the facial features most closely related to aggressiveness (Table 4). In the lower third, in the lip section, this consensus did not identify any features with a score greater than 4, so this may be a more neutral element. In contrast, a broad, prominent, or cleft chin and a jaw that is wider than the zygomatic arch were agreed to be central elements in the transmission of aggressiveness (Table 5). Overall, a square or diamond-shaped face was most closely related to the transmission of aggressiveness (Table 6).

3.5.2. Extroversion

The ability to relate to others and openly show feelings is a personality trait that is more difficult to associate with certain features. Our consensus found that extroversion is associated with high eyebrows (Table 3), a large nose and full cheeks (Table 4), and a jaw aligned with the zygomatic arch (Table 5).

3.5.3. Likeability

Characteristics linked to transmitting an attractive or pleasant face to others were full cheeks (Table 4), long lips with a short nasolabial distance, and a jaw aligned with the zygomatic arch (Table 5).

3.5.4. Risk Seeking

Features that suggest a risk-seeking personality may be related to an impression of aggressiveness. The facial features of the upper third of the face that were linked to risk-seeking behavior are mainly eyebrows with a high tail and almond-shaped eyes (Table 3), and in the middle third, hollow cheeks are associated with this trait (Table 4). The chin and jaw were instrumental in transmitting this attribute (Table 5). As with aggressiveness, there is an expert consensus that square and diamond-shaped faces would transmit this quality the most (Table 6).

3.5.5. Trustworthiness

This attribute was related to straight eyebrows (Table 3), a straight and/or large nose, and full cheeks (Table 4). Again, the scores assigned in the assessment indicated that a jaw aligned with the zygomatic arch would transmit reliability, and this feature was associated, in general, with all the positive qualifying adjectives proposed in the analysis (Table 5).

3.5.6. Attractiveness

Facial features that would attract the attention or interest of someone seeking male attractiveness would be an average hairline height, straight bushy eyebrows, and deep-set eyes in the upper third of the face (Table 3); a straight nose and flat cheekbones in the middle third (Table 4); and medium-sized lips, a wide chin, and an aligned jaw in the lower third (Table 5). A diamond-shaped face was also identified as transmitting a greater degree of attractiveness (Table 6).

3.5.7. Masculinity

The interpretation of masculinity scores concluded that attractiveness and masculinity are closely linked. Furthermore, an M-shaped hairline is associated with greater masculinity. Based on the results derived from the assessment of masculinity using various anatomical characteristics as reference, three facial representations were suggested. These representations encompass features linked to masculinity, intermediate masculinity, and those devoid of masculine associations. The aim is to visually present the findings concerning eyebrows, zygomatic width, and chin characteristics (Figure 2).

4. Future Perspectives and Conclusions

The concept of masculinity is evolving in the wake of social changes, and features associated with gender are undergoing a significant transformation. Both men and women seek the help of plastic surgeons and aesthetic medicine practitioners to improve the visibility of their identity and self-perception. Aesthetic doctors cannot continue to use a model that fits a purely stereotypical image of masculinity, which is resolved almost exclusively by increasing mandibular volume and changing the shape of the chin. Society is dictating new forms of masculinity, and the role of women in today’s society is simultaneously transforming our perception of masculinity and its attributes. This shift moves away from the conventional aggressive and powerful image to values such as reliability, trustworthiness, sociability, companionship, or supportiveness, which are now seen as masculine. This introduces a more complex perspective of the male image.

Therefore, we suggest that healthcare professionals take a holistic view of the face. For example, short eyebrows, asymmetry in the eyes and nose, short lips, a long nasolabial distance, and a receded chin represent crucial aspects where non-surgical medicine can provide a significant chance for individuals to align their physical appearance with their self-perception. This paper contributes to broadening the understanding of the association between cosmetic interventions and the social perceptions of the individual. Cosmetic medicine, therefore, should be proposed within the governing ethical code as a medical intervention that, through progressive treatments, can adapt to the new needs of masculine subjects in line with their self-image and their desire to express their true character.

Incorporating expert opinions into a clinical study can provide valuable insights and guidance, especially in areas where empirical data may be limited. Nevertheless, this approach may also introduce several potential limitations that should be carefully considered. One of the main limitations of this study is the relatively reduced number of experts involved. However, it is crucial to emphasize that the experts selected for this study were chosen based on their extensive experience and proven track record in performing male treatments within the field of aesthetic medicine. The expert insights gathered in this study are both valuable and relevant, offering a critical foundation for ongoing discourse on the evolving standards of male beauty. Furthermore, given the current lack of extensive literature on this topic, we believe our study serves as an essential starting point for addressing the wide range of current male representations and providing guidance for clinical practice improvement in the contemporary landscape of facial masculinization.

Future studies could build upon this work by incorporating a larger and more diverse expert panel, potentially broadening the scope and applicability of the findings. Nonetheless, the current study provides a valuable foundation for understanding and advancing male aesthetic practices in an area where empirical data remains sparse.

In conclusion, this expert agreement describes the most important facial features of male beauty as they relate to the most notable personality traits that a patient wishes to highlight. All these factors are of special importance to equip plastic surgeons and aesthetic medicine practitioners to propose, implement, and promote treatments that achieve harmonized and patient-centric outcomes in the field of aesthetic medicine.