Plastic surgeons strive to help their patients look their best possible. But what is the “best possible”? The standards of beauty have recently been called into question, with the sudden rise of Asian plastic surgeries across the globe. According to the American Society of Plastic Surgeons (ASPS), plastic surgery among Asian-Americans increased 58% from 2004 to 2005, translating into 437,000 surgeries. The growing number of Asian-Americans going under the knife has generated concern among Asians about whether plastic surgery is erasing Asian ethnic features and creating a “Westernized” look in its place. In
In Asia, there has also been tremendous growth in the plastic surgery industry, with
Rise in Asian Plastic Surgery
The increased popularity of plastic surgery in
Top Asian Plastic Surgery Procedures
According to the ASPS, the three most commonly requested surgical procedures among Asian-Americans in 2006 were nose reshaping, breast augmentation and eyelid surgery. The top five requested surgical procedures overall in 2006 were breast augmentation, nose reshaping, liposuction, eyelid surgery and tummy tucks. An examination of different procedures follows below.
Double-Eyelid Surgery (Blepharoplasty)
Asians are increasingly asking their plastic surgeons for wider and rounder eyes. Other Asian patients who have mono-lids (no crease in the eyelid) are seeking to have a fold created to achieve a double-eyelid. For these reasons, eyelid surgery (blepharoplasty) is the most popular plastic surgery done among Asians in the world. In the
For those Asians with a double eyelid, the crease curves: it starts out small and near the eyelashes at the corner of the eye, and then gradually becomes larger, reaching its maximum at the center of the eye. The crease then continues in a parallel slope downward away from the nose. Among Caucasians, the crease does not run parallel to the eyelash line, but instead folds in an upside-down “U” shape. The crease in Caucasians is also about 20% larger than an Asian eyelid crease, according to Dr. Charles Lee. For the 50% of Asians who do not have a crease, a natural-looking fold can be created without “Westernizing” the patient.
There are various techniques that can be used to achieve the double-eyelid. The first one, often called the “suture method” involves making small incisions inside the lid along the new crease line and placing tight sutures underneath the skin. The skin is lifted and folded back to create the fold. The suture method has the advantage of being less invasive than other double-eyelid methods as little surgery is involved, the procedure costs less, and can be performed quickly, often in as little as fifteen minutes. Despite these advantages, the suture method has some serious drawbacks in that the result is not long-lasting and the crease fades away after several years because the sutures weaken after a few years. In some cases, the sutures can break after a few months and lead to the disappearance of the crease. This method also results in a less natural look, as the newly-created crease is always there and does not go away when the eyes are closed or when one blinks. Furthermore, the crease created by the suture method does not follow the shape of the patient’s eye as closely as the full incision method (discussed below), and the resulting double-eyelid looks more “Western” than Asian. While the suture method is often described as being non-surgical, it does actually involve making a few incisions and the scar that results is virtually the same as the scar that is formed from the superior full incisional method. Finally, the suture method has another key limitation in that future eyelid surgeries that are necessary to do once the crease fades are more difficult and expensive to perform because of the formation of scar tissue resulting from the incisions. For these above reasons, the suture method is less favored by many plastic surgeons compared to more effective and long-lasting incisional methods.
Today, the “gold standard” in double-eyelid surgery is the full incision method, where a crescent-shaped incision is made along the new crease line, and in the process small strips of muscle and orbital septum are removed and in some cases also some fat. The amount of tissue removed affects the height and shape of the newly created crease. Then, the two sides are sutured together permanently. The incision method is a superior technique because of the long-lasting results that it produces and there is no risk of sutures breaking since they do not play a role in creating the crease. The incision method is more natural-looking and does not have the problem of creating a permanent crease, as when a person closes or blinks their eyes the crease disappears.
There is also a hybrid method called the Double Stranded Twist (DST) method that combines the suture and incisional techniques, where a series of small incisions are made to remove fat, while the lid is still lifted through the use of sutures. This technique leads to longer-lasting results than the less invasive suture method and patients reportedly do not experience weakening of the sutures and loss of their crease. According to an article in the American Society for Aesthetic Plastic Surgery (ASAPS) peer-reviewed journal, the results from the DST method have lasted as long as 10 years. Furthermore, the procedure is said to be “virtually scar free.”
Following an eyelid surgery, patients may experience swelling. Bruising can also occur and last anywhere from one to two weeks to a month. There may also be uncomfortable side effects on the eyes, such as gumminess, burning, itching, or sensitivity to light. Patients are mobile after a few days, and after two weeks, these side effects begin to subside. Scars may show slightly for at least six months, at which point they fade away. There are various products one can use to accelerate the healing process and minimize bruising and swelling, including cold/hot eye compresses, homeopathic remedies such as Arnica
The double eyelid, achieved through the surgery, does create a rounder, bigger appearance of the eye and looks more “Western” than a monolid. However, plastic surgeons who perform this surgery are careful to state that they do not want to change a patient’s ethnic appearance, but instead want to make their patients look the best possible while retaining their patient’s ethnic characteristics. The results of the eyelid surgery can be regulated by the doctor, who can create a double eyelid without overly “westernizing” the look of the patient. While women seek a more dramatic result with a higher crease, men opt for a more conservative lower crease which does not look overdone. Beyond the aesthetic benefits of the procedure, women patients who have had double eyelid surgery frequently cite greater ease of applying eyeliner as a major benefit of doing the surgery.
Nose Reshaping (Rhinoplasty)
As with blepharoplasty, nose surgery (rhinoplasty) differs between Caucasians and Asians. Among Caucasians, rhinoplasty is typically performed to reduce the nose and help it fit better with the face, while the nose is usually augmented among Asians. According to Dr. James Penoff, Asians usually have “flat or low nose bridges,” and “poorly projected nose tips.” Consequently, Asians seek to address these issues in their nose reshaping procedures.
During the surgery, the skin is separated from the underlying bone and cartilage, and an implant is placed to shape and augment the nose. The implants are typically alloplastic (artificial material) rather than live tissue, because of the relative scarcity of the body’s tissue in comparison to the augmentation required, according to an article by Dr. Lee. Scarring is minimal, when the opening is properly closed. There may be soreness and swelling in the face post-surgery and some bleeding is also common. Patients are usually mobile after two days, and a full recovery time is about one to two weeks. Learn more about nose surgery recovery products that can accelerate healing, reduce swelling and bruising, and minimize scar appearance.
Plastic surgeons working with Asians emphasize the desire to make their patients look the best possible, as with blepharoplasty, and deny working towards a Western standard of beauty. Instead, a more defined nose can add balance to a face.
Chin Surgery (Mentoplasty)
Chin surgery is often done in conjunction with nose surgeries to enhance the effect, because nose reshaping can disrupt the balance of a face. The surgery is done by making an incision along the jawline on the bottom of the chin, or in the inside of the lower lip between the lip and gum. In chin augmentations, synthetic material that can be shaped as desired is implanted. In chin reductions, surgeons sculpt and reposition the bones into the desired shape. The incision is then closed, with minimal scarring. Soreness, swelling and bruising is common after surgery, with these symptoms slowly diminishing and fading away over a period of about six weeks. Patients may need a soft-food diet for the first few days after surgery, to limit chewing and strain on the chin.
Surgeons are careful to emphasize that breast augmentations are carefully structured to fit each patient’s individual body frame, so that the increased bust size does not look unnatural. Since Asians generally have smaller, narrower bodies, a modest increase in bust size is encouraged as opposed to large implants. Incisions can be made in different areas — along the fold under the breast, the areola, or the armpit — depending on the patient’s body and preference. Saline or silicone implants can be placed behind breast tissue or between the pectoral muscle and chest wall. Scarring is minimal. Mild soreness and a burning sensation may occur post-surgery, but the patient is usually able to resume some activity within the first week. Swelling that occurs takes anywhere from three to five weeks to subside. Learn more about breast augmentation recovery products that can accelerate healing, reduce swelling and bruising, and minimize scar appearance.
Liposuction & Tummy Tuck (Abdominoplasty)
Both liposuction and tummy tucks are procedures performed to help improve the contour of one’s body and reduce fat deposits. Among Asians, fat is more likely to collect on the arms and waist, resulting in liposuction procedures commonly done in those areas. While liposuction is effective on the legs of Caucasians, it is less effective on Asians because muscle — as opposed to fat — accounts for most of an Asian’s leg mass.
Tummy tucks specifically focus on removing excess fat and skin in the middle to lower abdomen. Tummy tucks result in a permanent scar for every patient. However, there is a mildly increased concern for Asians when it comes to scarring, as less than 3% of Asians develop keloids. Keloids occur when the scar tissue grows past the edges of the original wound, resulting in a larger growth than normal. Fortunately, keloids can be treated with scar reduction creams such as Kelo-cote and Scar Esthetique, as well as with silicone scar sheets manual massaging. Learn more about liposuction recovery products that can accelerate healing, reduce swelling and bruising, and minimize scar appearance.
Face Lifts (Rhytidectomy)
Due to having thicker, tighter skin, and moderately pigmented skin that ages well, Asians usually choose to have face lifts later in life than Caucasians. Asians who do opt for face lifts generally desire a younger appearance, through tightening skin to reduce sagging and wrinkles. Face lifts are also done differently among Asians and Caucasians due to differences in facial anatomy. Caucasians who get a face lifts generally need to reduce sagging along the jawline, neck, and lips. In contrast, Asians experience less sagging in the lower face, due to higher cheekbones, and more sagging in the upper area because of a flatter forehead. For this reason, a brow lift (forehead lift) may be more appropriate for an Asian plastic surgery patient needing to correct signs of aging in the foreahead area. In brow lifts, incisions are made along the scalp, and the sagging skin in the forehead is raised to tighten it. In face lifts, muscles are also tightened, fat may be removed, and the skin then re-draped over the incision. Mid facelifts can also be performed when the cheeks begin to sag due to age, with incisions made below the lower eyelid, or behind the ears. Discomfort can occur, such as swelling or numbness, but disappears in weeks. Bruising may also be apparent for up to two weeks. Learn more about face lift recovery products that can accelerate healing, reduce swelling and bruising, and minimize scar appearance.
Cheek Surgery (Malarplasty)
Caucasians generally opt for cheek surgery to better define their cheekbones. For Asians, however, the opposite holds true as most Asian patients want to reduce highly defined cheekbones to improve the balance of their face. This can be done by making an incision behind the lip or along the hairline, and then shaving the bone or pushing it inward. According to a Time Asia article, Botox injections are also used to atrophy muscles and shrink cheeks. Numbness and bruising can occur and may last for anywhere from a few days to a week or longer. Swelling may also occur and may take anywhere from weeks, a month or longer to fully resolve itself.
As the leading non-surgical treatment among Caucasians, Botox is used by Caucasians to eliminate wrinkles, and to create a more youthful appearance. The toxin botulinum paralyzes muscles temporarily, resulting in smoother skin. Botox is also the most popular minimally-invasive treatment among Asians, according to ASPS. While Asians use Botox to achieve a younger facial appearance, Botox is also used for other purposes, especially in
So Are Asians Trying To Look More White?
These days, there is a quiet dispute happening among Asians about whether Asians going under the knife are subconsciously trying to look more white. Asians who have been cosmetically enhanced claim that their reasons for surgery are to look better, but that they want to remain natural and do not want to erase their ethnic characteristics. Plastic surgeons are also careful to emphasize that when they perform these procedures on Asian patients, they have the patient’s best interests in mind, stating that they are attempting to create a better personal look for each patient, and are not working towards a Caucasian ideal or “standard” of beauty. This is validated by the rise in Asian plastic surgery techniques whose objectives are to preserve the person’s ethnic look and whose results are more subtle. For example, doctors are increasingly more conservative in removing eye fat in the lower eyelid, which leads to a more subtle change that does not make one’s eye look Caucasian.
This growing movement towards striking a balance between the desire for cosmetic enhancement and the need to keep one’s Asian ethnic traits is dubbed as “Ethnic correctness” by Anna M. Park of Audrey Magazines. “With a growing appreciation for diversity and a higher social awareness come advances in technique and deeper understanding of the anatomy of the Asian eye, resulting in more ethnically sensitive procedures.”
While ethnic correctness sounds great in principle, it’s still difficult to deny that rounder eyes, double-eyelids, a more prominent nose and chin, or bigger breasts are not in any way steps towards a Caucasian beauty standard. After all, bigger eyes and breasts are the stuff of Caucasian beauty standards. As a result, there is a contradiction between what the patients and surgeons are saying, and what the actual cosmetic results show.
Perhaps it is not so much that Asians are subconsciously “westernizing” their ethnic looks, but rather that the Western beauty ideal is becoming a universal beauty standard embraced by people of all ethnicities and nationalities. As globalization continues to take the world by storm, cultural barriers are breaking down. As these barriers disappear, the Western beauty standards could become more and more widespread, especially through the increased accessibility of international media. Yet while certain attributes of the Western ideal become universal, certain ethnic characteristics will be retained, such as a generally Asian look…but with modified eyelids, bigger breasts and a more projected nose. This is confirmed by Time Asia, which says that the Asian trends towards bigger breasts, bigger eyes, and double-eyelids are parts of the “leggy, skinny, busty Western ideal that has become increasingly universal.”
It is important to note that there is a divide between American Asians and Asians living in
It also seems that American Asians are more likely to worry about whether plastic surgery will affect their ethnic identities. One theory is that in Asia where people have similar eye features, an eyelid surgery will give them a unique look, while in
Asian Celebrity Plastic Surgery
Others of a different generation, however, have opted for surgery, such as action film star Jackie Chan, who underwent a blepharoplasty (double-eyelid surgery) in 1976. It is said that he wanted a more “Western” appearance. Shortly after, in 1980, he began starring in foreign films — namely American ones.
There is much more speculation about celebrities and plastic surgery in Asia than
The one major, well-known celebrity who has not had any surgery is one of Asia’s most popular current singers and actor Rain, who looks traditionally Korean yet is still rapidly gaining an international fanbase. Rain admitted in a CNN interview that he was actually rejected from several initial auditions for being “too ugly,” and for not having double-eyelids. It is said that he has not had any plastic surgery, which does not seem to have hindered his fame — he was named one of Time magazine’s “100 Most Influential People Who Shape Our World.”
Plastic surgery, a complex topic, is only further complicated by ethnic considerations. There is no one standard of beauty for everyone, and surgeons try instead for the “best possible” personal result. Differing techniques for procedures do need to be developed, to address the varying needs of different ethnicities. If nothing else, one thing is clear: cosmetic surgery is personal, and every issue needs to be addressed personally.
This is the debut article of a new area on Make Me Heal which will feature daily articles on Asian Plastic Surgery News and Ethnic plastic surgery.
Tags: celebrity, plastic, surgery