Facial attractiveness affects daily interpersonal relationships. A positive personal image or attractive face builds confidence, which is essential for developing self-esteem. As the standard of living improves, an increasing number of people are taking every opportunity to enhance their facial aesthetics through non-invasive, minimally invasive, and invasive procedures. Furthermore, the evolving definition of beauty, which may differ from historical standards, is subject to continuous change [1]. Several factors drive these shifts in aesthetic preferences, including age, sex, demographic origin, exposure to media portraying ‘ideal’ faces, and diverse educational backgrounds [2]. Although the balance between the proportions and symmetry of a person’s face determines its beauty [3], the definition of an attractive and beautiful face is subjective and inconclusive.

In Malaysia, the three predominant ethnic groups, Malay, Chinese, and Indian, each hold distinctive views and preferences regarding aesthetic value and personal appearance. One factor influencing each ethnic group’s preference for beauty is the diversity of their traditions, cultures, and religions [4-6]. Moreover, external factors such as media exposure, fashion, and popular trends may influence the judgment of beauty across different ethnicities, particularly among younger generations [7]. Thus, the ideal aesthetic preferences of both doctors and patients can greatly influence the enhancement of facial features [8,9]. This trend is evident in Malaysia, where beauty assessments rely heavily on individualized and subjectively interpreted facial aesthetic preferences. The anthropometric measurements of perfect facial features published in cosmetic surgery textbooks and journals do not universally represent the value [6]. Asians have a unique facial anatomy, including monolids, darker skin tones, and flatter facial structures, leading to distinct interpretations of beauty compared to Western standards [8,9].

Given these considerations, the proposed study aimed to uncover the diverse views on facial beauty, focusing specifically on preferences related to overall facial profiles, including forehead height and slope, cheekbone height, nasal bridge shape, nasolabial angle, nasal width-length ratio, eyebrow shape, presence of epicanthal fold, lips, and chin shape. By examining these factors, this study seeks to highlight the variations and similarities in how these ethnic groups perceive beauty. Such an understanding can provide invaluable insights for aestheticians, enabling them to cater more effectively to their patients’ unique needs and expectations within each ethnic group.

Study design and participants

This cross-sectional study, conducted between August 2021 and February 2022, was approved by the Ethics Committee for Research Involving Human Subjects at Universiti Putra Malaysia (JKEUPM-2021-810). The study population comprised of women, aged ≥18 years, from diverse ethnic backgrounds in Malaysia to explore facial aesthetics preferences across multiple cultures in Malaysian society. Self-administered questionnaires were distributed through messenger applications and social media platforms, enabling convenient and accessible modes of participation. Participants were asked for their consent at the beginning of the questionnaire before proceeding to answer the rest, and only those who agreed were included.

The questionnaire comprised two sections. Section 1 (demographic information): This section collected basic demographic data such as age, sex, ethnicity, highest education level, occupation, monthly household income, place of residence, and experience with aesthetic treatment. Section 2 (photograph selection of woman aesthetic features): In this section, participants evaluated a series of images (Fig. 1-12) sourced from Mediceuticel Clinic, Johor Bahru, Malaysia. These images served as reference points for evaluating facial aesthetic criteria preferences. Images derived from selected photographs of Asian models were modified using special editing software to align visuals with the diverse ethnic backgrounds of Malaysian participants. Furthermore, these modifications aimed to preserve the models’ anonymity and remove skin imperfections, thereby reducing the risk of selection bias. The number of images representing each facial characteristic was reduced to minimize misinterpretation (e.g., eyelid creases and epicanthal folds). The images focused on the forehead (forehead height and slope), cheekbones (cheekbone height), chin, facial shape, eyes (eyebrow shape and presence of eyelid creases and epicanthal [inner eye] fold), nose (nose bridge shape, nasolabial angle, and nose width-length), and lips (lip thickness).

Figure 1. Photo of facial shape.

Figure 2. Photo of forehead height (height from the hairline to the glabella).

Figure 3. Photo of forehead slope.

Figure 4. Photo of cheekbone height.

Figure 5. Photo of nasal bridge shape.

Figure 6. Photo of nose tip angle.

Figure 7. Photo of nasal width-length ratio.

Figure 8. Photo of eyebrow shape.

Figure 9. Photo of presence of eyelid crease.

Figure 10. Photo presence of epicanthic fold.

Figure 11. Photo of lips thickness.

Figure 12. Photo of chin shape.

Statistical analyses

Descriptive and inferential statistical tests were performed using the SPSS version 27 (IBM Co.). The results were expressed as frequency and percentage (%). Correlation between respondents’ ethnicities and their aesthetic features preferences were evaluated using Pearson’s chi-squared test. Statistical significance was determined at a p-value <0.05.

Sociodemographic characteristics of participants

Table 1 summarizes the participants’ sociodemographic characteristics. A total of 290 Malaysian women responded to the facial preference survey, with the majority having never undergone aesthetic procedures or surgery (n=194, 66.9%), in contrast to those who have undergone aesthetic procedures or surgery (n=96, 33.1%). Among the participants, 71.0% (n=206), 15.9% (n=46), 10.0% (n=29), and 3.1% (n=9) were of Malay, Indians, Chinese, and other ethnicities, respectively. Additionally, most of them (n=275, 94.8%) had a tertiary level of education and were working in the private sector (n=114, 39.3%) with a mean age±standard deviation of 31.6±9.2 (range, 20–62) years. Among the participants, 106 (36.6%) had low income (ringgit Malaysia [RM] 1000–RM4000) per month and 73 (25.2%) had no income. Furthermore, 82.1% (n=238) of the participants lived in urban areas, whereas 17.9% (n=52) lived in rural areas.

Table 1 . Sociodemographic characteristics of participants (n=290).

Variable	Frequency (%)	Mean±SD (min–max)
Age (yr)		31.6±9.2 (20–62)
Gender
Woman	290 (100.0)
Ethnicity
Malay	206 (71.0)
Chinese	29 (10.0)
Indian	46 (15.9)
Others	9 (3.1)
Highest education
Secondary	15 (5.2)
Tertiary	275 (94.8)
Occupation
Unemployed	5 (1.7)
Housewife	7 (2.4)
Government officer	55 (19.0)
Self employed	33 (11.4)
Private sector	114 (39.3)
Retiree	2 (0.7)
Degree student	74 (25.5)
Income/month
No income	73 (25.2)
<​RM1000	10 (3.4)
RM1000–RM4000	106 (36.6)
RM4001–RM6000	29 (10.0)
RM6001–RM10000	50 (17.2)
>​RM10000	22 (7.6)
Place of stay
Urban	238 (82.1)
Rural	52 (17.9)
Undergo any aesthetic treatments
Yes	96 (33.1)
No	194 (66.9)

SD, standard deviation; RM, ringgit Malaysia..

Preferences for facial aesthetic features among 3 major ethnicities in Malaysia

Table 2 summarizes the facial aesthetic feature preferences among the 3 major ethnicities in Malaysia–Malay, Chinese, and Indian.

Table 2 . Preferences for facial aesthetic features among women from three major ethnicities in Malaysia (n=281).

Facial features	Ethnicity			Total	χ2 (p-value)
	Malay (n=206)	Chinese (n=29)	Indian (n=46)
Face shape					0.003
Oval	83 (40.3)	12 (41.4)	19 (41.3)	114 (40.6)
Diamond	17 (8.3)	4 (13.8)	14 (30.4)	35 (12.5)
Round	31 (15.0)	4 (13.8)	2 (4.3)	37 (13.2)
Inverted triangle	75 (36.4)	9 (31.0)	11 (23.9)	95 (33.8)
Forehead height					0.057
<1/3 from a facial height	37 (18.0)	3 (10.3)	16 (34.8)	56 (19.9)
>1/3 of facial height	48 (23.3)	9 (31.0)	10 (21.7)	67 (23.8)
Equal	121 (58.7)	17 (58.6)	20 (43.5)	158 (56.2)
Forehead slope					0.121
Convex	14 (6.8)	4 (13.8)	7 (15.2)	25 (8.9)
Slope	81 (39.3)	12 (41.4)	11 (23.9)	104 (37.0)
Straight	111 (53.9)	13 (44.8)	28 (60.9)	152 (54.1)
Cheekbone height					0.659
High	135 (65.5)	17 (58.6)	26 (56.5)	178 (63.3)
Medium	56 (27.2)	9 (31.0)	14 (30.4)	79 (28.1)
Flat	15 (7.3)	3 (10.3)	6 (13.0)	24 (8.5)
Nasal bridge shape					0.371
Concave	29 (14.1)	5 (17.2)	8 (17.4)	42 (14.9)
Convex	22 (10.7)	6 (20.7)	8 (17.4)	36 (12.8)
Straight	155 (75.2)	18 (62.1)	30 (65.2)	203 (72.2)
Nasolabial angle					0.590
High (110 degree)	11 (5.3)	2 (6.9)	5 (10.9)	18 (6.4)
Low (105 degree)	62 (30.1)	11 (37.9)	13 (28.3)	86 (30.6)
Straight (100 degree)	133 (64.6)	16 (55.2)	28 (60.9)	177 (63.0)
Nasal width-length ratio					0.039
>1	80 (38.8)	10 (34.5)	26 (56.5)	116 (41.3)
1	35 (17.0)	8 (27.6)	2 (4.3)	45 (16.0)
<1	91 (44.2)	11 (37.9)	18 (39.1)	120 (42.7)
Eyebrow shape					0.057
Eyebrow peak at lateral canthus	25 (12.1)	4 (13.8)	8 (17.4)	37 (13.2)
Eyebrow peak at mid pupillary	15 (7.3)	3 (10.3)	2 (4.3)	20 (7.1)
Eyebrow peak at lateral limbus	48 (23.3)	5 (17.2)	20 (43.5)	73 (26.0)
Straight	118 (57.3)	17 (58.6)	16 (34.8)	151 (53.7)
Eyelid creases					0.284
Yes	192 (93.2)	25 (86.2)	44 (95.7)	261 (92.9)
No	14 (6.8)	4 (13.8)	2 (4.3)	20 (7.1)
Epicanthal fold					0.362
Yes	182 (88.3)	23 (79.3)	41 (89.1)	246 (87.5)
No	24 (11.7)	6 (20.7)	5 (10.9)	35 (12.5)
Lip thickness					0.061
Thin	13 (6.3)	3 (10.3)	7 (15.2)	23 (8.2)
Moderate	124 (60.2)	18 (62.1)	18 (39.1)	160 (56.9)
Thick	69 (33.5)	8 (27.6)	21 (45.7)	98 (34.9)
Chin					0.125
Convex	132 (64.1)	17 (58.6)	38 (82.6)	187 (66.5)
Vertical	70 (34.0)	11 (37.9)	8 (17.4)	89 (31.7)
Diagonal	4 (1.9)	1 (3.4)	0 (0.0)	5 (1.8)

Values are presented as frequency (%)..

Participants’ preference for facial shapes

Four types of facial shapes–oval, diamond, round, and inverted triangles–were used as references (Fig. 1). A significant association was observed between ethnicity and the preference for facial shape (p<0.05). Oval face was the most preferred facial shape among Malay (40.3%, n=83), Chinese (41.4%, n=12), and Indian (41.3%, n=19) women because of its long, narrow, and rounded chin. The second most favored facial shape among Malay (36.4%, n=75) and Chinese (31.0%, n=9) women was an inverted triangle or heart shape face, characterized by a retracted and narrow jaw, prominent chin, wide forehead, and broad cheekbones. Conversely, Indian women preferred diamond face (30.4%, n=14), which was the least preferred among Malay (8.3%, n=17) and Chinese women (13.8%, n=4). Notably, the least favored facial shape among Indian women was round (4.3%, n=2) (Table 2).

Participants’ preference for forehead shapes (height and slope)

The forehead height was classified into narrow (<1/3 of the facial height), equal, and broad (>1/3 of the facial height) categories (Fig. 2). Equal forehead height was the most preferred by Malay (58.7%, n=121), Chinese (58.6%, n=17), and Indian (43.5%, n=20) women. Conversely, a narrow forehead height was the least favored by Malay (18.0%, n=37) and Chinese (10.3%, n=3) women, whereas Indian (21.7%, n=10) women least preferred a broad forehead height.

The forehead shapes were classified into convex, sloped, and straight (Fig. 3). Interestingly, Malay (53.9%, n=111), Chinese (44.8%, n=13), and Indians (60.9%, n=28) women displayed a preference for a straight forehead. Conversely, the convex forehead was the least favored among Malay (6.8%, n=14), Chinese (13.8%, n=4), and Indians (15.2%, n=7) women.

However, despite these preferences, the study did not find a significant association between ethnicity and the preference for forehead shape (height and slope) (Table 2).

Participants’ preference for cheekbone height

The cheekbone height was categorized as high, medium, or flat (Fig. 4). High cheekbones were preferred by Malay (65.5%, n=135), Chinese (58.6%, n=17), and Indian (56.5%, n=26) women. Conversely, the flat cheekbone type was the least preferred among Malay (7.3%, n=15), Chinese (10.3%, n=3), and Indian (13.0%, n=6) women. However, no significant association was observed between ethnicity and the preference for cheekbone height (Table 2).

Participants’ preference for nasal bridge

The nasal bridge was classified as concave, convex, and straight (Fig. 5). A straight nasal bridge was preferred by Malay (75.2%, n=155), Chinese (62.1%, n=18), and Indian (65.2%, n=30) women. Conversely, a convex nasal bridge was the least favored among Malay women (10.7%, n=22), a concave nasal bridge among Chinese women (17.2%, n=5), and both concave and convex nasal bridges among Indian women (17.4%, n=8). Despite these preferences being observed among different ethnic groups, no significant association was observed between ethnicity and the preference for nasal bridge shape (Table 2).

Participants’ preference for nasolabial angle

The nasolabial angle, defined as the intersection between the nose tip and alar crease, was categorized as high (110°), low (105°), or straight (100°) (Fig. 6). Malay (64.6%, n=133), Chinese (55.2%, n=16), and Indian (60.9%, n=28) women considered a nasolabial angle of 100° as the most desirable type. Conversely, 5.3% (n=11) of Malay women, 6.9% (n=2) of Chinese women, and 10.9% (n=5) of Indian women found that a high nasolabial angle was the least attractive choice. Nonetheless, no significant association was observed between ethnicity and the preference for nasolabial angle (Table 2).

Participants’ preference for nasal width-length ratio

The nasal width-length ratio was categorized as >1, 1, and <1 (Fig. 7). A ratio >1 indicated a wider nasal width than nasal bone length, a ratio <1 represented a narrower nasal width than nasal bone length, and a ratio of 1 indicated an equal ratio between nasal width and nasal bone length. A significant association was observed between ethnicity and participants’ preference for the nasal width-to-length ratio (p<0.05) (Table 2). Malay (44.2%, n=91) and Chinese (37.9%, n=11) women perceived a nasal width-to-length ratio <1 to be attractive, whereas Indian women (56.5%, n=26) preferred a nasal width-to-length ratio >1. Across the three ethnicities, Malay (17.0%, n=35), Chinese (27.6%, n=8), and Indian (4.3%, n=2) women perceived an equal ratio of nasal width to nasal bone length as the least attractive choice.

Participants’ preference for eyebrow shape

The eyebrow shapes were categorized as eyebrow peak at the lateral canthus, eyebrow peak at the mid-pupillary, eyebrow peak at the lateral limbus (LL), and straight eyebrows (Fig. 8). The findings revealed that Malay (57.3%, n=118) and Chinese (58.6%, n=17) women preferred a straight eyebrow shape, whereas Indian (43.5%, n=20) women favored an eyebrow peak at the LL type. Additionally, across the three ethnicities, Malay (7.3%, n=15), Chinese (10.3%, n=3), and Indian (4.3%, n=2) women did not prefer the eyebrow peak at the mid-pupillary. However, no significant association was observed between ethnicity and the preference for eyebrow shape (Table 2).

Participants’ preference for eyelid creases

Participants were asked for their preference regarding the presence of eyelid creases (Fig. 9). The findings revealed a consistent preference for eyelid creases across all three ethnicities: Malay (93.2%, n=192), Chinese (86.2%, n=25), and Indian (95.7%, n=44) women. However, no significant association was observed between ethnicity and the preference for eyelid creases.

Participants’ preference for epicanthic fold

Participants were asked for their preferences regarding the presence of an epicanthic fold (Fig. 10). The results revealed that most Malay (88.3%, n=182), Chinese (79.3%, n=23), and Indian (89.1%, n=41) women expressed a preference for epicanthic folds. However, no significant association was observed between ethnicity and the preference for an epicanthic fold (Table 2).

Participants’ preference for lip thickness

Lip thickness was classified into thin, moderate, and thick (Fig. 11). The findings indicated that Malay (60.2%, n=124) and Chinese (62.1%, n=18) women tended to prefer moderately thick lips, whereas Indian women (45.7%, n=21) preferred thick lips. Conversely, thinner lips were the least preferred choice among Malay (6.3%, n=13), Chinese (10.3%, n=3), and Indian (15.2 %, n=7) women. However, no significant association was observed between ethnicity and the preference for lip thickness (Table 2).

Participants’ preference for chin shape

Chin shapes were categorized into convex, vertical, and diagonal (Fig. 12). A convex chin shape is characterized by slight protrusion of the chin from the face, resulting in a rounded or pointed chin, whereas a diagonal shape features a noticeable backward angle. The findings revealed that most Malay (64.1%, n=132), Chinese (58.6%, n=17), and Indian (82.6%, n=38) women perceived a convex chin shape as an attractive feature. Conversely, a minimal percentage of Malay (1.9%, n=4), Chinese (3.4%, n=1), and Indian (0.0%, n=0) women perceived the diagonal chin shape as the least attractive characteristic. However, no significant association was observed between ethnicity and the preference for chin shape (Table 2).

People’s choices and preferences for each facial feature depend mainly on their ethnicity, age, sex, culture, personal preferences, life experiences, and their perception of beauty. In Malaysia, individuals from various ethnic groups have unique facial characteristics and bony structures [9-11]. This may have a significant impact on cosmetic surgery outcomes, resulting in suboptimal outcomes and low satisfaction levels. To overcome this problem, aesthetic practitioners must recognize and address the differences in patients’ perceptions of beauty.

An oval face with a gradual transition from the forehead through temples, zygoma, and cheeks, jaw angle and jawline, and the chin, without indentations or projection in the line, is universally considered attractive [9,12,13]. Park et al. [14] and Ahn et al. [15] reported that Asian women prefer individuals with a delicate, oval facial shape and “oval and almond-shape faces”. Similarly, our study demonstrated that an oval facial shape was the most attractive across all ethnicities. This shape is characterized by a long, narrow, and rounded chin, making it aesthetically pleasing. This study provides valuable insights into preferences for facial shapes across different ethnicities, providing information that can inform future marketing and product design strategies.

Nose shape is a distinctive feature that reveals an individual’s race, age, and sex. Variations in size, shape, and proportion of the nose contribute to diverse interpretation of beauty depending on an observer’s personal preferences. Recent data have shown racial- and sex-based anatomical variations in the shape and size of the nose [16-19]. Previous research has shown that Asian people typically have small nose, with a straight bridge and broad nasal tip [17,18]. However, our findings revealed that the preference for a straight nasal bridge and straight nasolabial angle was not exclusively associated with any particular ethnic group. However, a correlation was observed between ethnicity and the preferred nose width-to-length ratios. Malay and Chinese women preferred smaller nasal width-to-length ratios, whereas Indian women preferred larger ratios. Nevertheless, research conducted by Broer et al. [20] concluded that no single parameter could define the ideal nose aesthetics across all cultures and ethnic backgrounds.

The upper third of the face, including the eyebrows, is essential for facial expressions and appearance. All facial angles and contours used the eyebrows as reference [21]. The concept of the ideal eyebrow has been argued over the years and is influenced by various cultural trends, as well as differences in race, age, and sex [22-24]. Our results showed that Malay and Chinese women preferred straight eyebrows, whereas Indian women preferred eyebrows that peaked at the LL, which is indicative of the traditional South Asian aesthetic, where curved eyebrows are considered more attractive.

The absence or presence of an upper eyelid crease distinguishes individuals of Asian and Western descent [25,26]. The three types of Asian eyelids are single, low/incomplete eyelid creases, and double eyelids. Most of the studies have focused on the morphology of eyelids in native Chinese population and people of Chinese descent. Moreover, studies have reported that the absence of an upper eyelid crease is more common in Chinese ethnic groups [26,27]. Therefore, the current study sought to investigate eyelid preferences among Malaysian women from Malay, Chinese, and Indian ethnic groups. Previous anthropometric studies have shown that the absence of an upper eyelid crease is common in the Chinese ethnic group [26,28]. However, our study revealed that ethnicity does not play a significant role in determining the preference for eyelid creases.

The epicanthal fold, which gives the eye a narrow appearance, distinguishes Asian upper eyelids from those of Caucasians [29]. Preechawai [30] observed similar results in their study including Thai, Chinese, Thai-Malay, and Thai-Chinese ethnic groups. The absence of an epicanthal fold was significantly higher in the Chinese group than in the other ethnic groups. In our study, women from Malay, Chinese, and Indian ethnic groups in Malaysia expressed a preference for having an epicanthal fold. However, no significant association was found between ethnicity and the preference of an epicanthal fold. Although the convex chin shape emerged as the preferred choice among all ethnicities, no significant association was observed between ethnicity and the preferences for chin shape.

Conclusion

In conclusion, this study demonstrated that women from Malay, Chinese, and Indian ethnic groups in Malaysia have different perceptions of beauty. While certain facial features such as epicanthic folds, eyelid creases, lip thickness, and chin shape were universally preferred regardless of ethnicity, other factors such as face shape and nasal width-to-length ratio were significantly associated with ethnicity. These findings highlight the importance for practitioners in the field of aesthetics to be aware of the diversity of ethnic identities and the individual attitudes, concerns, and complexities of each patient. Recognizing and respecting these differences can ensure that aesthetic treatments and procedures are tailored to meet the specific needs and preferences of individuals from different ethnic backgrounds.

Limitations of the study

This study has a few limitations. First, the participants had a limited choice of facial preferences from the photos provided, and the photos might not precisely reflect how they perceived human faces in actual life. However, the addition of arrows and sketches to the image assisted participants in making correct decisions based on the survey questions. Second, the recruitment method could have led to a biased sample as not everyone had access to or used social media. This method can lead to a less diverse sample, with individuals within the authors’ networks potentially sharing similar preferences or viewpoints. Additionally, participants who were not active on social media or who lacked connections with the authors were excluded from the study. Therefore, the results may not be generalizable or may be skewed toward specific demographics or beliefs. Consequently, there was an unequal distribution of participants among the different ethnicities in the study, which could potentially impact the generalizability of the findings or affect the reliability of the conclusions drawn regarding specific ethnic perspectives on beauty perceptions. However, this approach facilitated random selection of respondents from various social classes and cultural backgrounds. Finally, this survey-based research lacks longitudinal data and carries the risk of inconsistent participant responses.

The authors would like to thank the entire Esthetic Medical Solution team and Dr. Siti Nur Hanis Mamood from USMARI for contributing to this study.

The authors have nothing to disclose.