Aesthetic Rejuvenation in the Patient of Asian Ancestry

Introduction

Asia is the largest and most populous continent and encompasses a myriad of cultures and ethnicities. As such, “Asian aesthetics” also encompass diverse issues and vary significantly throughout the continent. For the purposes of this chapter, we will discuss aesthetics as it relates to people of East and Southeast Asian heritage.

Although certain aesthetic concerns are nearly universal across ethnicities, patients of Asian ancestry seeking cosmetic surgery often want enhancement of specific features rather than complete transformation. Frequent areas of focus on the face include the eyelids, the nose, the cheek, and jawline. A recent survey showed that the Asian country with the highest rate of surgical cosmetic surgery procedures per capita is South Korea, second only to Italy worldwide, followed in order by Taiwan, Japan, Thailand, and China .

The eyelids are a prominent and distinctive feature of an Asian face. The characteristic broad and arched brow, flatter supraorbital bridge, and fullness of the eyelid along with sharp canthal angles and accentuated almond shape confer uniqueness to the Asian eye as an aesthetic unit that is immediately recognizable and imparts its ethnic identity ( Fig. 15.1 ).

Of all surgical cosmetic procedures, blepharoplasty is the most common facial procedure performed among people of Asian ancestry . Aesthetic eyelid surgery often appeals to the younger Asian population that requests the formation of a supratarsal eyelid crease, or “double eyelid” . In lay terms, a “double eyelid” refers to an eyelid that has a visible eyelid crease, whereas a “single eyelid” does not. Procedures that create or accentuate an eyelid crease have been termed “double eyelid procedures.” It is important to recognize that most Asians do not seek a westernized look, but rather want to accentuate their natural ethnic features .

Anatomy

Skin

There are major differences between ethnic groups that translate into functional and aesthetic differences. Compared with Caucasians, Asian skin is typically thicker, has more melanin, and has more subcutaneous and submuscular fat. Consequently, Asian faces have less solar keratosis, fewer rhytids, and delayed age-related changes ( Fig. 15.2 ).

The same pigmentation that confers protection against ultraviolet-mediated photodamage also makes Asian skin more prone to solar lentigines and postinflammatory hyperpigmentation, which can follow surgery, chemical peels, laser procedures, or any form of cutaneous trauma. Skin in people of Asian ancestry is also more prone to developing hypertrophic scars as compared with Caucasian skin ( Fig. 15.3 ).