Facial Cosmetic Surgery is perhaps the most challenging aspect of Cosmetic Surgery. Firstly it is to do with the most exposed areas of the body. Secondly the results are easily noticeable by anyone. And thirdly it projects the personality of the individual.
Before anyone attempts Facial Cosmetic Surgery, one has to be familiar with the concepts of beauty,- its evolution with time. Also the surgeon must be familiar with the ethnic variations.
It is an art. Art which is mastered with experience. Every individual has got its own ethnic and genetic traits. The aim is to improve those traits without jeopardising its originality. That is where the art and experience of the surgeon To know about individual comes in.
In considering the facial profile as a whole, - we all know nasion, nasal base and chin must be in a straight line in the lateral profile. This is the western concept. The grannies in Kolkata would hug a newly wed bride by her chin. So mild mental protrusion may be the concept of a Bengali beauty. Here chin augmentation or sliding genioplasty, would start off the groundwork. American beauty would be classed by a thin face with malar prominence. In Kolkata malar augmentation would destroy the ethnic characteristics. In my opinion, indications of malar augmentation are very limited in Bengal.
“Beauty is in the eyes of the ‘beholded'”- if one organ is most important in a face, it is the eyes. Many a poets have written volumes on its beauty, many a artists have flown with its dream - even sculptors at Coomortooli will say this forms the mainstay of sculpting of Goddess Durga. Its disposition varies with the ethnic trait of the individual. The distance is broad in an eastern Asian ( Japanese, Chinese etc.), whereas narrow intra-canthal distance is typical of a European face. Bengali face is somewhere in-between. This can be cosmetically shaped to right aesthetic appearance by movement of the orbit bilaterally. Large ocular opening with a slight upward slant of the lateral canthus is probably the most attractive Bengali eye. Shaping it to this form is easily possible by cosmetic surgery.
After eyes, most people would view the nose. Where does the root of the nose originate? In a Greek it will probably be at the nasion. In an Anglo-Saxon, it is slightly lower down. In Bengalis it is usually further down. An even dorsal line would be the most aesthetic nose on the lateral profile. But did it ever occur to you, whether Barbara Streisand's nose is beautiful or not? So a standard reduction rhinoplasty, as is practised by most Europeans, would not be the right solution for a Bengali nose. I would agree with George Peck, here reduction has to be combined with augmentation. But that is where the difficulty starts. We all know African or Arabic Nose (especially males) have a broad nasal tip, British nasal tip is relatively thin - Bengali nose has a softer hue with significant equidistant separation of the three point reflex. Will supra-tip projection enhance beauty? In my opinion, it would. Which means, addition of the supra-tip projection. What about the nasal base? Type II alar reduction would reduce the ethnic characteristics of a Bengali female. What would be the tip to nasal aperture ratio and what would be its proportion to the nasal base? In my opinion, the height to the base has to be 1:1.5 and tip to aperture ratio 1:2. Now talking of the columello-labial angle in a Bengali face this would be 1050.
When treating the nose to maintain the lateral profile, adequate proportion of the lips is important in relation to nasion and mentum. This may require an augmentation with adequate lip lining.
But having done all these, does she still look beautiful? Cosmetic dentistry and proper orthodontics forms an integral part to complete the story.
‘Double Chin', one of the most common problems in a Bengali past thirty - spoils the whole appearance by obliterating the mendibulo-cervicval angle. Submental lipectomy can leave scars, liposuction is always incomplete and looks dreadful if it is not combined with a lower partial face lift. What happens to a young girl? Face-lift is contra-indicated in normal circumstances. I believe mental adjustment can mask the submental lipectomy scars. In the middle-aged, the situation is somewhat different. Doing a lower face lift without correcting the upper face can cause serious facial disharmony. Since most Bengalis have a ‘sinthi', bicoronal brow lift has very limited role. Only endoscopic brow lift can fulfil this problem. Face lift can rejuvenate a face, but in a Bengali face, skin lift has but very little role. Extended SMAS to Hamara lift might correct the naso-labial jowl correctly - as this is a common problem in an ageing Bengali face.