Vertical Localization of the Malar Prominence

BACKGROUND: During reconstruction or augmentation, it is important to localize the malar complex in a symmetrical and aesthetically pleasing position. Few studies have determined the location of this feature and none related the location to gender, age, or ethnicity. Some of these have attempted to relate the position to the aesthetically pleasing Golden Ratio φ. METHODS: We assessed the vertical location of the malar prominence relative to other facial landmarks, determined consistency among individuals, and compared this with values used in artistry. Study population consisted of a convenience sample of 67 patients taken from an otolaryngology practice at a large urban medical center. Coordinates of the malar prominence were referenced to distinct facial landmarks from which the ratio of chin-to-malar prominence to chin-to-eye canthus was determined. RESULTS: Average chin-to-malar prominence distance was 0.793 ± 0.023 (SD) of the chin-to-eye canthus distance. Variability due to the specific image chosen [coefficient of variation (CV) = 1.19%] and combined inter/intrareader variability (CV = 1.71%) validate the methodology. Variability among individuals (CV = 2.84%) indicates population consistency. No difference was found between gender and age groups or between whites and Hispanics. Individuals of other/unknown ethnicities were within the range common to whites and Hispanics. Our population’s value is not different from the value of 0.809 used in artistry, which is based on the Golden Ratio φ. CONCLUSIONS: The vertical position of the malar prominence is consistent among individuals, is clinically well-approximated by the value based on the Golden Ratio, and may be useful as a reference for surgical reconstruction or augmentation.