Beauty of the face remains a complex and arguable concept. The paradigm of our understanding and appreciation of the beautiful face has changed. As facial plastic surgeons, we have abandoned such techniques that “pull tightly” and “make tiny” and “keep thin.” In so doing, the pendulum has swung far the opposite way, and we have more recently embraced concepts of volume enhancement, tissue preservation, and minimally invasive techniques.

Within the art of hair transplantation, we have moved from grafting “plugs” of hair to individual follicles placed diffusedly throughout the scalp. With facelifting, we have reservations about excising cheek and jowl fat, and instead try to replace that tissue where it once was, and where it belongs. With fat transfer techniques, we bring body fat from the abdominal region and replenish the lost volume of the upper cheeks – the ever-youthful “apple of the cheek,” if you will.

There seems no doubt, however, that as with many phenomena as this, perhaps the pendulum has swung too far. Disproportion exists to both extremes, and it seems as easy to recognize an aged face with volume loss as a voluminous face with fallen, displaced contours. The challenge of defining and creating Beauty, rests in one’s capacity to identify the strengths and needs of any given face. In so doing, the facial plastic surgeon must have a sense of Balance in mind. To balance a need for tightening or lifting with a concomitant need for filling or resurfacing leads to success. Autologous fat grafting or filler enhancement are often excellent tools for more youthful facial rejuvenation, but for some, so are deep plane face or neck lifting with liposuction.   Similarly, with hair transplantation, finer grafts throughout the scalp may ultimately compromise the appearance of density at the mid-scalp. There are times when higher density grafts (along with finer grafts feathered naturally in front) ultimately lead to the optimal result.

In essence, we can still appreciate the face according to our more recently learned volumetric standpoints, but we must remember to be comprehensive with these standpoints. As with everything in life, Balance seems the key to success.