In a world dominated by social media, we always struggle to look good in every situation. We idolize famous people for their beauty and their charm: they always look perfect, no matter what, with perfect face and body. But what is driving us in recognizing their beauty? Why there is a common thread that makes us agree on beauty and appearance?

In On the Origin of Species (1859) [1], Charles Darwin discusses the concepts of ‘Natural Selection‘ and ‘Survival of The Fittest‘: despite the common genetic basis of any individual, variation exists within all populations of organisms because their genomes interact with the environments, causing variations in traits. Natural selection is the process by which individuals with desirable traits are systematically favored for reproduction (survival of the fittest).

This is how the animal world works, with selection of the fittest for reproduction and survival of the species as ultimate goal. But how do animals recognize the fittest? Let us see some examples:

  • Red coloration, based on hemoglobin, is thought to provide signals of health or hormonal condition or social status in birds [2].
  • Male macaques show facial reddening in the mating season, in response to increased levels of testosterone [3]. Similarly, the anogenital skin of females reddens in response to increased levels of ovarian oestrogen in most fertile periods [4]. This redness attracts greater visual attention from opposite sex individuals, suggesting that it acts as a signal of condition and reproductive status [4].
  • Some female fishes are attracted to larger-bodied males, which sired sons and daughters with higher growth rates, and daughters with higher reproductive output [5].

In all these examples there is a common thread: the fittest in the animal world is selected based on the appearance. And man is an animal as well: beauty is health and we are attracted by those features that are clear signs of health, for the selection of the fittest (healthiest).

We use a number of facial cues from other people and we judge the health in others all the time. Indeed, humans can detect whether someone is sick just by looking at their faces, spotting signs of sickness at a glance [6]. Figure 1 shows averaged images of 16 individuals, during experimentally induced sickness (A) and placebo (B). The composites display the average shape, color and texture recreated with 184 facial landmarks. The differences are really subtle, but looking to Figure 1, in which face you recognize signs of sickness?

Figure 1 – Averaged images of 16 individuals, during experimentally induced sickness (A) and placebo (B). The composites display the average shape, color and texture recreated with 184 facial landmarks. (From [6])
A more swollen face, paler lips, droopier corners of the mouth, more hanging eyelids and redder eyes are some of the signs of sickness. Also, the coloration of the skin plays an important role: faces of sick people are lighter and less red [7], and judged as less healthy [8].

Skin-color also depends on our nutrition: an increased consumption of fruit and vegetables is associated with a carotenoid tone of skin-color [9]. When given a choice as in Figure 2, people perceives the carotenoid skin-coloration as healthier and more attractive [9,10,11,12]. After all, it is not a secret that consumption of fruit and vegetables, as well as whole grains, has been strongly associated with reduced risk of cardiovascular diseases, cancer, diabetes, Alzheimer’s disease, cataracts, age-related functional decline, allergies, asthma and rhinitis [13,14,15,16,17,18,19].

Figure 2 – Same person, with different skin-colors: in the center, there is the normal tone, while on the left suntanned coloration and carotenoid on the right. A carotenoid color comes from higher consumption of fruit and vegetables. People in several studies found more attractive and healthier the skin-color on the right. (From [58])
Judgement of a person’s health based on facial appearance is a daily occurrence. Facial traits largely depends on the the maxilla: notice in Figure 3 how traits of eyes, nose, cheekbones and occlusion are determined by how maxilla develops.

Figure 3 – Frontal and medial view of the maxilla. Notice how many facial traits are affected by its development: nose, eyes, cheekbones, occlusion. (From [59])
Bones remodel according to force stimuli [20,21], that in the case of maxilla come from the tongue and teeth in contact (through masseter muscles). As highlighted in Figure 4, when these forces are missing the maxilla drops down and back, reducing the eye support, flattening the cheekbones, narrowing the nasal airway, lengthening the mid facial third, and lowering the palate, which narrows and create malocclusion as a consequence [22].

Figure 4 – Tongue posture directly affects maxilla remodeling. When the tongue is correctly on the roof of the mouth, maxilla is remodeled up and forward (above case). Instead, when the tongue is not in the correct position, maxilla misses its forces and remodels down and back (bottom case). Notice the difference in cheekbones, eyes support, nose shape, length of the face and lips shape. (Adapted from [23] and [60]).
Changes in the maxilla development leads to tremendous changes in the facial appearance: a more forward and horizontal growth of maxilla is considered more attractive [24] and perceived as healthier [25,26]. Ask yourself, who is more attractive and looks healthier between Shanina Shaik (Australian model) and Stefani Joanne Angelina Germanotta (singer, known as Lady Gaga) in Figure 5? And did you know that Lady Gaga suffers of Fibromyalgia?

Figure 5 – On the left, Shanina Shaik. Notice her forward and horizontal maxilla development, affecting shape of eyes, nose, lips and cheekbones. On the right, Lady Gaga. Notice in this case the vertical growth of the maxilla. Who is more attractive? Our perception of beauty depends on healthiness of individuals: indeed, Lady Gaga suffers of Fibromyalgia.

If you think that craniofacial development has no implication on our health, then it is better that you rethink about it. When the maxilla grows down and backward, the mandible swings back and the head tilts forward in a forward head posture [27,28]. Then, the body finds the center of gravity by means of compensations, thanks to muscle chains that run from head to feet: here is where kyphosis, lordosis and tilted pelvis originate, with reduced neck mobility [29], neck pain [30,31], migraine [32], tension-type headache [33] and back pain [34].

Both individuals in Figure 6 are 20 years old and there should be no doubts in deciding who is more attractive and who could also be healthier. Individual on the left probably mouth breathes. Notice the impact this has on his general appearance: the maxilla has grown back, bringing back the mandible. The head then tilts forward, causing the body to compensate with increased kyphosis and rounded shoulders. Notice also his hair loss.

Figure 6 – On the left, Ali Gaboose, 20 years old. On the right, Igge Karbaashe, 20 years old as well. Notice the difference in the maxilla development and how this affects the body posture. (From [61])
Cranial distortions are another sign of poor craniofacial development: the mandible deviates to one side as a consequence of the occipital bone position, while the maxilla rotates to the other side, mapping the sphenoid bone. As a consequence, facial features are asymmetrical and the head is tilted on one side [35]. When head tilts, the body compensates creating a scoliotic curve [36,37], with consequent pain in several anatomical locations [38,39,40]. Not surprisingly, a symmetrical face is considered more attractive and perceived as healthier [41,42,43]. Notice the different facial symmetry of Halle Berry and Tina Fey in Figure 6: who looks more attractive?

Figure 7– On top, Halle Berry (51). On the bottom, Tina Fey (47). Notice the differences in facial symmetry. Who looks more attractive? (From [62])
Body posture is a direct consequence of craniofacial development and it also reflects our health status. Among the ones proposed in Figure 8, which posture you think is better looking? Spinal alignment is fundamental in body’s integrity and it is what determines the dependence in activities of daily living [44] and our life satisfaction [45] when we become older. Spinal posture is also what predicts our mortality [46].

Figure 8 – Spinal alignment is fundamental in preserving body’s integrity. Indeed, good posture is also better looking. (From [63])
Our perception of attractiveness has a clear link with what we consider healthier. And this can be applied to everything. Look at teeth in Figure 9, which ones look better? The ones on the left show periodontitis (gum inflammatory disease that can lead to loss of teeth) that is associated with coronary heart disease, rheumatoid arthritis, erectile dysfunction and higher mortality [47,48,49,50]

Figure 9 – On the left, periodontitis: inflammatory diseases affecting the tissues surrounding the teeth, involving progressive loss of the alveolar bone. It has been associated with increased risks of cardiovascular disease, total mortality, rheumatoid arthritis, mental illness and erectile disfunction. On the right, healthy teeth.

Another example. Hair plays an important role in determining self-image, social perceptions, and psychosocial functioning and it is perceived as a sign of youth and good health [51]. Hair loss is a stressful experience for both sexes since it causes generally less favorable initial impressions, including lower ratings of physical attractiveness, judgments of less desirable personal and interpersonal characteristics, and misperceptions of age (Figure 10) [52]. Also in this case, beauty is health: many studies have associated baldness with higher risk of coronary heart disease [53,54,55,56,57].

Figure 10 – Hair transplant result. Many men recur to this technique because worried of their appearance and social impression. (From [64])
So, starting from our facial appearance, our body really shows the state of our health. Attractiveness is just a consequence of our health and, if you are worried about it, then probably it is better that you look to your health first!


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Other websites

[58] Looking good on greens, University of Nottingham

[59] The Maxilla, by Kenhub

[60] Maxilla, single most important bone in the body?, by Claiming Power

[61] Oldest photographs of Somalis, by The Apricity

[62] The Symmetry of “Hottest” Celebrities, by runningmandible

[63] Are you standing the right way?, by

[64] Hair transplant techniques and surgery, by Hair Transplant Abroad