Study on the Evolution of “Facial Aesthetic” Concepts in Modern Chinese Literature and the Orientation of Contemporary Craniomaxillofacial Aesthetic Surgery

OBJECTIVE: This study aims to trace the evolution trajectory of the concept of "facial aesthetics" in modern Chinese literature (from the Late Qing Dynasty to the Republic of China period) and its social and cultural roots; by integrating the clinical practice and aesthetic orientation of contemporary craniofacial aesthetic surgery, it explores the operational reference significance of the literary aesthetic concept for the "personalization and localization" development of contemporary craniofacial aesthetic surgery, thereby providing humanistic support for clinical aesthetic decisions and addressing prominent clinical issues such as aesthetic homogenization and excessive plastic surgery. MATERIALS AND METHODS: This study adopted a combined research design of qualitative textual analysis and comparative research. (1) Qualitative textual analysis: we included 56 representative works of Modern Chinese Literature from 1840 to 1949, covering late Qing satirical novels, May Fourth Literature, and popular literature of the Republic of China. Using NVivo 12 software, we conducted standardized coding analysis on the facial aesthetic descriptions in the texts, with a double-coder back-to-back coding procedure to ensure coding reliability (kappa ≥0.85). (2) Comparative research: we systematically retrieved clinical research literature on craniomaxillofacial aesthetic surgery from 2015 to 2026, extracted the core elements of clinical aesthetic orientation and surgical practice, and conducted dimensional matching analysis with the coding results of literary aesthetic concepts from 3 dimensions of "individuality, localization, and humanistic care." Close textual reading and cultural interpretation were used to analyze the evolutionary characteristics of aesthetic concepts against the background of social transformation in modern China. RESULTS: The facial aesthetic concepts in Modern Chinese Literature have gone through three core stages: the adherence to the traditional paradigm of dignified countenance in the Late Qing Dynasty, the aesthetic awakening of natural vividness in the May Fourth Period, and the aesthetic compatibility of Chinese-Western integration in the Republic of China Period. Statistical results of textual coding showed that 100% of positive facial descriptions in the Late Qing Dynasty conformed to the "dignified countenance" paradigm, 81.6% of facial descriptions in the May Fourth Period focused on "natural vividness" of individual traits, and 76.8% of facial descriptions in the Republic of China Period presented the feature of "Chinese-Western integration". Its evolution is closely related to ideological emancipation, the impact of Western culture, and social stratum mobility. Contemporary craniomaxillofacial aesthetic surgery is undergoing a transformation from "standardized templates" to "individualized adaptation", and from "pure pursuit of morphology" to "equal emphasis on function and aesthetics". The concepts of "respect for individual traits", "conformity to local aesthetics", and "balance between external form and inner verve" in literature are highly consistent with the development orientation of contemporary craniomaxillofacial aesthetic surgery, with clear clinical convergence points verified by comparative analysis. CONCLUSION: The evolution of facial aesthetic concepts in Modern Chinese Literature provides abundant humanistic and clinical references for contemporary craniomaxillofacial aesthetic surgery, which is conducive to promoting the realization of "technical precision, aesthetic localization, and humanistic individualization" in clinical aesthetic practice, and avoiding problems such as excessive plastic surgery and aesthetic homogenization. This study provides a standardized interdisciplinary research framework for the integration of literary aesthetics and clinical aesthetic surgery.