Cirugia plastica y reconstruccion

Plastic and Reconstructive Surgery • May 2007
viduals who carried out most of the previous studies of the device were not specifically looking for fat atrophy, however, and subtle degrees of change could have been missed in many of the studies published to date. The Thermacool TC device protects the epidermis from the effects of radiofrequency energy with a cryogen, and focuses the greatestamount of energy on the dermal layer. Heat would be expected to gradually dissipate with distance from the primary area at which the energy is focused. Localized heat from the device is reported to be generated up to 8 mm from the epidermal surface. This could clearly expose the superficial subcutaneous fatty layer to a significant amount of heat energy. It appears, therefore, to be a realisticpossibility that subcutaneous fat damage and atrophy could occur as a result of treatment with the device. The likelihood of this complication could conceivably vary with the handpiece utilized, the pressure with which the handpiece is applied to the skin, the anatomic area being treated, and the relative thickness of the patient’s skin. As use of the device expands and more long-term results becomeavailable, the true incidence of this complication and the factors that contribute to it will, it is hoped, become better defined. I hope that Dr. Youn’s letter will encourage future researchers to pay particular attention to this potential complication.
DOI: 10.1097/01.prs.0000259778.69875.1f

W. Thomas Lawrence, M.D.
Sutherland Institute Kansas University Medical Center 3901 Rainbow BoulevardKansas City, Kans. 66160 tlawrence@kumc.edu

REFERENCES
1. Lawrence, W. T., and the Plastic Surgery Educational Foundation DATA Committee. Nonsurgical face lift. Plast. Reconstr. Surg. 118: 541, 2006. 2. Bassichis, N. S., Dayan, S., and Thomas, J. R. Use of a nonablative radiofrequency device to rejuvenate the upper onethird of the face. Otolaryngol. Head Neck Surg. 130: 397, 2004.

AnObjective System for Measuring Facial Attractiveness
Sir: r. Guyuron1 addressed several problems in the way of analyzing facial attractiveness in the article by Dr. Bashour.2 We also tried to apply the facial mask as a facial analyzing tool since Marquardt3 introduced the golden facial mask on the Internet, but our efforts were in vain. We encountered some contradictory examples when using the facial orphi mask to analyze facial attractiveness in subjects of different ethnic backgrounds. For example, when the mask was tested on

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Fig. 1. Application of the Phi mask to an average or attractive composite face. It is possible to extractthePhimaskfromBashour’sarticleusingAdobePhotoshop8.0(AdobeSystems,SanJose, Calif.) to overlap and freely transform the Phi mask on a facial image. (Left) ThePhi mask applied to an attractive German face. (Original photograph reprinted with permission from Martin Gruendl, Prototypic female face of high attractiveness. Available at http:// www.beautycheck.de/. Accessed May of 2006.) (Right) The Phi mask applied to an average Caucasian face. (Original photograph reprinted with permission from Rhodes, G., Lee, K., Palermo, R., et al. Attractiveness ofown-race, other-race and mixed race faces. Perception 34: 319, 2005.)

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Volume 119, Number 6 • Letters and Viewpoints
average or attractive composite morphing faces created by Chung,4 Gruendl,5 and Rhodes et al.,6 we found hardly any facial features that explained the relationship of the mask to attractiveness among races (Fig. 1). Bashour wrote that the phi mask method relies on thehypothesis that attractiveness is averageness, but there is controversy regarding the significance of average and attractive. Perrett et al.7 insisted that highly attractive facial configurations are not average. It was proved that attractive faces are very different according to race.7,8 The concept of facial beauty is not a fixed one, and it differs according to time, generation, age, sex, and...