Relating the rejuvenation of the eye in terms of the Asian face, this article covers the unique set of strategies for this population that include understanding cultural and aesthetic aspects of the Asian patient, anatomy of the Asian patient, and techniques that would be appropriate based on these cultural and anatomic considerations. Along with strategic planning, a detailed surgical technique is presented with graphic examples, in addition to a brief guide to postoperative care.
Surgical management of the Asian upper eyelid requires a thorough understanding of two essential concepts:
Supratarsal crease creation
Evaluation and treatment of the aging upper eyelid complex.
Successful treatment mandates a unique set of strategies that include understanding the cultural aspects of the Asian patient, the anatomy of the Asian patient, and the techniques that would be appropriate based on these cultural and anatomic considerations.
An essential element to success in these cases is a firm understanding of the cultural bias and aesthetic standards of the Asian patient. Without this, it is common for the Western surgeon to become easily frustrated and potentially fail to meet the expectations of the patient. These issues are explored in depth in this article, and it is hoped the reader will thereby gain better insight and sensitivity.
Often, the Asian patient seeking cosmetic facial enhancement may have a separate layered agenda beyond simply desiring aesthetic improvement. Cultural and folkloric beliefs may not be overtly expressed but should be gently investigated to ensure patient satisfaction following a procedure. For example, the desire to obtain a larger nose through augmentation rhinoplasty may only be desired because of its association with greater wealth or the chance of obtaining it. Asian patients can be very obsessed with unblemished skin as a sign of beauty and also of good fortune.
Asians can also be much more secretive about undergoing plastic surgery than Caucasians, especially if the Asian has only recently immigrated to the West. Although HIPAA (Health Insurance Portability and Accountability Act) rules apply universally, the surgeon should be particularly circumspect when talking with any family member or friend regarding an Asian patient’s surgery. Asian patients can also tend to be more negative in opinion of each other following cosmetic surgery, and the surgeon should prepare the patient for this possibility. Certain negative remarks by family members or social peers may be made to the patient consequent to the less socially acceptable nature of plastic surgery as compared with its more recently accepted position in the reality-television dominated Western culture.
Another important trend to consider is the desire and expectation to preserve ethnicity following cosmetic surgery. Despite the global images of Western beauty that permeate Asia, and the once widely held belief that facial cosmetic enhancement should “westernize” the core Asian facial characteristics, it is clear today that maintenance of Asian anatomic features are essential to a successful outcome. With respect to management of the Asian eyes, it is essential to keep in mind that eyelid creases that appear too high may not only be unacceptable to the Asian patient but also to the surgeon striving to achieve ethnically appropriate and natural-appearing results. With respect to the aging Asian eyelid, maintaining a natural eyelid crease following rejuvenative blepharoplasty lies at the core of this article and is discussed in the following sections.
Despite some of these cultural similarities among Asians, there are also very distinct differences that exist between nationalities. For example, the Vietnamese and Koreans are more predisposed toward having cosmetic enhancement. The Chinese are only now becoming enamored with cosmetic surgery, given their recent newfound wealth in a surging Chinese economy (and given its illegal status before 1979 in China). Even Asians who have emigrated from the Far East carry these cultural biases for or against plastic surgery from their native country. Second- or third-generation Asian Americans may begin to shake off some of these long-standing cultural biases as they assume more of a Western perception toward plastic surgery and toward life in general.
Delving into the underlying motivation for cosmetic surgery beyond merely improving one’s aesthetic appearance can be a fundamental aspect to dealing with the Asian patient. Cultural biases may be overt or unspoken, but should be investigated as appropriate during cosmetic consultation with a prospective Asian patient.