1 The Changing Face of Aesthetic Facial Plastic Surgery among East Asians
Pearls
Asians, particularly those in East Asia, have seen rapid development in the field of aesthetic facial plastic surgery, especially in the refinement of Asian-specific techniques, over the past two decades.
The typical Asian belief in not altering the physical appearance of one’s face, attributed to respect for the elderly and one’s ancestors, has evolved with globalization, resulting in a more neutralized Asian culture, which is a cross between East and West. More Asians realize that to be at the leading edge of society, an attractive appearance plays an important role in determining success. There has been a shift in social acceptance of aesthetic surgery, and we see more demand for it than ever before.
East Asian features of the face are discussed in detail in the following chapters, with particular attention to single-eyelid, small palpebral aperture, flat nasal bridge and tip, malar prominence, broad mandible, retruded premaxilla, and many other Asian-specific aesthetic surgeries.
Common aesthetic surgeries of East Asians also include double-eyelid surgery, epicanthoplasty, rhinoplasty, facial bone contouring surgery, fat injection, and many other techniques discussed in this book.
Newer techniques, including the combination of nonsurgical techniques in facial rejuvenation such as fillers and botulinum toxin, and laser hair removal and hair transplantation specific to East Asian characteristics, are discussed in detail. The pros and cons of nonsurgical techniques such as laser and ultrasound for facial rejuvenation are also thoroughly described to keep readers updated with the latest technologies and the options available to achieve desired outcomes.
Most important, this book not only contains surgical techniques and pearls from surgeons who are experts in their respective fields of aesthetic facial plastic surgery, but also incorporates comments on pitfalls and complications, and how to overcome them, in detail.
Introduction
The recent surge in the number of people seeking aesthetic facial surgery is a testament to the emphasis placed on one’s looks as a way to gain considerable leverage in society. The new movement also involves the concept of eternal youthfulness; being young is considered attractive, and looking younger can improve the competitiveness of a worker.1,2 This trend, which started in Western countries around the end of the twentieth century, is fast becoming worldwide.
As of this writing Asia is the most actively growing economy in the world. With more than half of the world’s population residing on this continent, the impact of any movement in Asia will be influential.3 With the population getting more affluent and with the increasing affordability of a higher standard of living, the past 10 years have seen many Asians seeking aesthetic procedures to enhance their facial features or to attenuate the aging process. Although the broad term Asians is generally used to denote people who originate from Asia, in truth various ethnicities and races with different facial morphologies reside in Asia. West and South Asia stretches to Turkey and India, where Caucasoid people (i.e., Turks and Indians) are found. In East Asia, where China, Korea, and Japan are located, people possess East Asian features. Although East Asians are grouped in the Mongoloid strain along with the Southeast Asians (Indonesians, Thai, Polynesians, etc.), the facial features among the Mongoloids are still quite distinct from each other.3 Fig. 1.1 depicts the average of different beautiful Asian faces as described by Rhee.4 Indians, Chinese, and Japanese are all considered Asians; however, their facial features can be quite different.
Due to Asia’s long-standing trade routes connecting East and West, modern Asian cities are often comprised of multiple ethnic groups, reflecting the modern trends of interracial marriages and globalization. There is a rapidly transforming effect of globalization on facial features as well, although at this time we still see rather characteristic Oriental features among East Asians.
Aesthetic facial surgery in East Asia has expanded and developed at an exponential rate in the past two decades. Such rapid progress has enabled us to develop surgical techniques suitable for Asians and to accumulate a considerable amount of experience (Fig. 1.2). The new skill sets and experience have been translated into technical advancement and better surgical outcomes. Those experiences and advances in aesthetic facial surgery more suited for Asians are becoming more and more popular, especially among the more affluent Asians living in the Western countries. Authors of this book believe there is no better time than now to have our knowledge and experience gathered and shared to stimulate more development in this field.
Many years have passed since the introduction of specific techniques for Asian aesthetic surgery. Much has evolved over the years, and the current focus seems to be on refining the techniques to address the stigma faced by Asian patients. Although we still find a handful of patients coming to the surgeon wanting to look like a particular public figure, many are steering away from that trend. Patients these days often request a naturallooking face and wish to enhance their current appearance while retaining their facial characteristics, and they especially want to prevent their plastic surgeries from being noticed by others. While embracing their existing facial characteristics, patients prefer not to look the same as others who desire the ideal composition of a beautiful face, albeit all similar looking. This has resulted in surgeons reinventing themselves and moving into the next level of aesthetic facial surgery, combining less invasive procedures with surgery whenever possible. The art of combining nonsurgical and surgical techniques to create a beautiful face will no longer be based on a gut feeling but will be objectively described in this book.
The Change in Cultural Beliefs and the Modernization of Asian Thinking
The Asian desire for a pleasant face is heavily influenced by facial physiognomy in the past. The combinations of pleasantlooking features described in the ancient books were illustrated with pictures of faces that dictated the future of a person, down to the position of moles on the face and body.5 There was a realization of the need for an aesthetically pleasing face, but few other than Shusrata ventured into the aesthetic surgical field. Individuals with pleasantlooking faces were more likely to be judged to have a good life and a good job, and those with unpleasantlooking features were often associated with socially less respectable jobs or even criminality. The latter types of faces were deemed inauspicious and still very much influence how a person is judged in modern society. Despite this, there was little development in this field. Few wanted to change their looks surgically, partly due to the unrefined state of surgical skills at that time and the strong influence of Confucianism all over Asia, which emphasized the sanctity of the physical body as a sacred gift from our parents. Altering one’s physical appearance was considered disrespectful to one’s ancestors.1
As globalization and Westernization exerted more influence in Asian society via Western media, the definition of beauty became associated with white Caucasian features, such as double eyelids and tall, well-defined noses. Fair skin is seen as the marker of class. One ancient saying in Japanese, Korean, and Chinese societies goes, “A white complexion overrides three appearance flaws,”6 emphasizing the long-standing importance of light-colored skin in multiple countries across Asia. This was reinforced during the Western colonization period, when the Europeans were present in Asia and enjoyed high social status. In “The History of White People,” Neil Painter even argued that Caucasians produce “the most beautiful race of men” and that Chinese eyes are an “offence to beauty.”7 The ideal beauty of Caucasians was once the well-accepted definition of beauty in Asia.
Recently, Asian countries have become stronger and more influential economically. Scholars have started to debate about “Eurocentric” beauty and the phenomenon in Asia where it has become the norm to alter one’s facial appearance using plastic surgery to be more Westernized. With growing confidence within Asian society, however, Asians have started to embrace their ethnic features. The fusion of certain desirable Western features with Asian features is now seen as the ideal form of beauty in Asia. The key concept now is to blend attractive features rather than having a certain defined template, a concept that has been heavily criticized and is rapidly falling out of favor. The good-looking features are, of course, those that suit a person’s facial structure, personality, and the person as a whole. Enhancement rather than alteration of the facial features has become the new trend.
Statistics show that up to 58% of women in Korea have plastic surgery by the age of 50.1,8 The percentage is growing in their male counterparts too. The desire to obtain aesthetic plastic surgery is often driven by the psychosocial aspiration of the patient. Rapid development in this field is largely driven by the need to appear more attractive in order to be better accepted in a society that places a lot of emphasis on beauty and pleasant appearance. Looking more beautiful becomes an investment to achieve higher socioeconomic status and to ensure one will find a wealthy romantic partner. Thus a new culture or trend has emerged, unstoppable by past cultural beliefs and taboos, and strongly driven by novel concept of beauty, wealth, and a good life. As this concept has grown, the subjects seeking cosmetic enhancement have become younger and younger. As Korean dramas and movies have become more popular throughout Asia, so has the influence of the Korean definition of beauty spread all across Asia. This phenomenon of “Han Ryu” (the Korean trend) was popular among viewers of all ages. With attractive actors and actresses portrayed as heroes and heroines, many fantasized becoming like one of them, which could be achieved by altering their looks.
This trend became a strong driving force in the development of aesthetic surgery in Asia, enabling surgeons to grow and achieve a new level of understanding of aesthetic surgeries. However, it is up to the conscience of individual practitioners to guard the sanctity of this field, preventing the double-edged sword of harm to our patients and to the practice of aesthetic surgery, by prescribing only appropriate and scientifically sound procedures to patients and providing the best surgical practices tested by time and experience.
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