General health Attractiveness, facial features, and health & development. (Jun 2019)

Michael Harrop

Active member
Jul 6, 2023
When this was brought up in a recent discussion I learned that apparently this is a contentious topic so I looked into the research.

My position:​

Health absolutely reflects in the face. Does that mean every person with an attractive face is healthy? No. Does that mean we can determine someone's health only by seeing their face? No. But there definitely are facial features/cues we can use to gauge a person's health and development.

My face changes drastically depending on my health. I'm vastly more attractive when I'm feeling better. People notice and mention it all the time. I've seen a number of other people with CFS discuss/confirm this too. This includes changes to skin/hair, and here's a supporting study:

Probiotic Bacteria Induce a ‘Glow of Health’ (2013): - Mice have Shinier Fur After Eating Probiotic Yogurt or L. Reuteri.

You can do a web search for "face gains" to see increased facial attractiveness is a very common phenomenon in people who make improvements in physical fitness.

There is a large overlap between athletes and models. Most top athletes are not unattractive.

From what I've noticed, people are generally using makeup and digital filters to hide poor health.

10 Signs of Disease That Are Written All Over Your Face

Positive link to health:​

Oxygenated-Blood Colour Change Thresholds for Perceived Facial Redness, Health, and Attractiveness (2011) "results suggest redness preferences do not reflect a sensory bias, rather preferences may be based on accurate indications of health status"

Adaptive significance of female physical attractiveness: role of waist-to-hip ratio (1993): "Evidence is presented showing that body fat distribution as measured by waist-to-hip ratio (WHR) is correlated with youthfulness, reproductive endocrinologic status, and long-term health risk in women"

Physical Attractiveness and Health in Western Societies: A Review. (2005): "Among the cues that the authors review, only female waist-to-hip ratio and weight appear to predict both attractiveness and health. The authors find that there is some indication that attractiveness has an overall relationship with health among women, but little indication that male attractiveness relates to male health"

Facial appearance reveals immunity in African men (2017): "We show that men with a stronger cytokine response are considered significantly more attractive and healthy. We build on previous evidence to show that men’s facial features do indeed reveal aspects of immunity, even better than more traditional measures of health, such as body mass index (BMI)."

Ugliness Judgments Alert us to Cues of Pathogen Presence (Jul 2020)

"Recent research has shown facial adiposity (apparent weight in the face) to be a significant predictor of both attractiveness and health" (2014):

"Here we show positive relationships between testosterone, facial attractiveness and immune function (antibody response to a hepatitis B vaccine) in human males" (2012): - some critiques:

"Facial adiposity has also been linked to various health outcomes such as cardiovascular disease, respiratory disease, blood pressure, immune function, diabetes, arthritis, oxidative stress, hormones, and mental health" Facial Adiposity, Attractiveness, and Health: A Review (Dec 2018).

"At present there is at least some empirical support for the notion that people can reliably detect and agree on facial cues that contribute to facial attractiveness and perceptions of health"
While there is strong support for the link between various facial cues and attractiveness, the link between facial attractiveness and actual health outcomes has been mixed
A statistically significant correlation between perceived health and actual health was found
In partial contrast to Kalick et al. (1998), Henderson and Anglin (2003) did find a significant correlation between rated attractiveness and longevity for 50 facial photographs taken from a high school yearbook
Fitness-related theories of human behavior suggest that key phenotypic cues influence our judgments of others because they evolved as cues to general health and mate quality

Testosterone is one marker that's associated with various facial traits and health/immune system. And digit ratio:

Facial asymmetry increases with age. The Relationship between Age and Facial Asymmetry (2018)

Your Adult Facial Features Can Reveal Your Childhood Conditions. Greater deprivation in childhood is associated with lower symmetry in old age. Symmetry of the face in old age reflects childhood social status (2013)

Facial recognition zeroes in on genetic disorders (2018)

Could mental illness be written in a face? (2007)

Image comparisons in Weston A. Price's book:


Research, conducted by Stockholm University in Sweden and published in the journal Sleep, found that a bad night's sleep affects our facial features - "sleep deprived individuals were perceived as having more hanging eyelids, redder eyes, more swollen eyes, darker circles under the eyes, paler skin, more wrinkles/fine lines and more droopy corners of the mouth".

Beauty sleep: experimental study on the perceived health and attractiveness of sleep deprived people (2010) "Our findings show that sleep deprived people appear less healthy, less attractive, and more tired compared with when they are well rested"

Negative effects of restricted sleep on facial appearance and social appeal (2017) "when sleep-restricted, participants were perceived as less attractive, less healthy"

No link or mixed:​

Predictors of facial attractiveness and health in humans (2017): "In women, there was little evidence that female appearance predicted health. In men, we found support for the phenotype-linked fertility hypothesis that male masculinity signalled semen quality. However, we also found a negative relationship between averageness and semen quality. Overall, these results indicate weak links between attractive facial traits and health."

Does Human Facial Attractiveness Honestly Advertise Health? Longitudinal Data on an Evolutionary Question (1998): "implies that attractiveness suppressed the accurate recognition of health"

Second to fourth digit ratio, testosterone and perceived male dominance (2003) "Our results show that male 2D : 4D was significantly negatively related to perceived dominance and masculinity but not attractiveness. Circulating testosterone levels were not related to dominance, masculinity or attractiveness. We conclude that facial dominance and masculinity reflect a male's perceived status rather than his physical attraction to women."

Facial fluctuating asymmetry is not associated with childhood ill-health in a large British cohort study (2014)

Most attractive fat mass for women was lower than the healthy range, but for men it was inline with healthy range:
The Body and the Beautiful: Health, Attractiveness and Body Composition in Men’s and Women’s Bodies (2016):

My takeaway is what I've said before - that people's perceptions of health and attractiveness are warped/poor. Many of these studies are limited in that they only looked at the face (missing rest of body).

Plus you have to take into account factors that cause different people to judge attractiveness differently:
individuals higher in pathogen disgust reported greater attraction to facially attractive profiles compared to those with lower pathogen disgust. We found that individuals who are sensitive to pathogens place greater importance on traits associated with good health – in this case, facial attractiveness and facial sexual dimorphism

So certainly some people are going to be better at gauging health via attractiveness.


Just an argument:
The Evolutionary Psychology of Facial Beauty (2006):

A lot of them seem to only be gauging "perception" of health & attractiveness. IE: Visible skin colouration predicts perception of male facial age, health and attractiveness (2012):

Observers are able to accurately predict personality traits based on appearance (2009)

Some haven't been studied:
Perception of health from facial cues (2016) "Skin colour alters over a short time and has strong effects on perceived health, yet links to health outcomes have barely been evaluated"


What does the average person think determines attractiveness? Genetics? Well there is major interplay between genetics, the immune system, and the gut microbiome:
To think that "good genes" would only impact attractiveness and not other aspects of the human body, including health, seems very misguided/myopic. Throughout most of our history, if you chose an unhealthy mate and had unhealthy children you'd die out to natural selection. Thus attractiveness and health were intrinsically linked.

Original 30 Jun 2019.