Ethnic Rhinoplasty in Female Patients: The Neoclassical Canons Revisited

Saad A, Hewett S, Nolte M, Delaunay F, Saad M, Cohen SR.

What this paper says

Measuring photographs of Miss Universe and Miss World nominees from 2005 to 2015 across seven ethnic groups, the authors found that ideal nasal proportions vary by ethnicity rather than following one universal standard.

Overview

The neoclassical canons are proportion rules inherited from classical art and still used to plan facial surgery. Their critics argue they describe a narrow subset of North American Caucasians. This study compared those canons against measured proportions of faces widely judged attractive from seven regional backgrounds.

Sections of note

Subjects were beauty pageant winners, Miss Universe and Miss World nominees, from 2005 to 2015, assigned to seven regionally defined ethnic groups.
Front and side images were obtained from Google, Wikipedia, and the Miss Universe and Miss World websites.
Facial measurements were taken in Adobe Photoshop, standardized into proportions, and compared with the neoclassical canons.
The data reflected an ethnic-dependent preference for the multiple fitness model.
Wide-set eyes, larger mouth widths, and smaller noses were significantly relevant in Eastern Mediterranean and European groups.
East African and Asian groups were exceptions to that pattern.
Level of evidence IV. The abstract gives no number of subjects and no measurement values.

What it means for a patient

There is no single set of ideal nasal proportions that applies across ethnicities.
Planning against a proportion standard drawn from one population risks producing a nose out of keeping with the rest of a patient's face.
Limits: subjects are pageant contestants, a narrow and self-selected group; measurements come from web photographs of uncontrolled angle and lighting; no subject count is given.
The findings describe measured proportions of chosen faces, not what any individual patient wants.

Why this paper matters

Ethnic rhinoplasty planning has long borrowed a single canon, and this documents that the canon does not describe faces from most of the world. Using ethnicity-specific proportions is the proposed correction. The photograph-based method and pageant sample limit how firmly the numbers can be relied on.

Terms

Neoclassical canons: Inherited proportion rules from classical art used in facial analysis.
Anthropometry: Direct measurement of body or facial dimensions.
Multiple fitness model: A theory that several distinct facial patterns can be judged attractive rather than one ideal.
Anteroposterior view: The front-facing photograph.
Ethnic rhinoplasty: Nose surgery planned in keeping with a patient's ethnic facial features.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

From the abstract

“Despite the substantial amount of research devoted to objectively defining facial attractiveness, the canons have remained a paradigm of aesthetic facial analysis, yet their omnipresence in clinical assessments revealed their limitations outside of a subset of North American Caucasians, leading to criticism about…”

Excerpt; the full abstract is on PubMed.