Minimally invasive and non-surgical treatments have become increasingly popular, and taboos or negative attitudes attached to medical aesthetic treatments are almost extinct from the social memory of the middle-aged group and younger generation. Improved international socio-economic status and ease of travel has meant that most aesthetic practitioners are now seeing patients with different ethnic backgrounds.
It is more important than ever for aesthetic practitioners to understand that different ethnicities have:
- A different facial structure and morphology
- Different standards of beauty
- Different expectations from their clinicians
- Different expectations from their treatments
- Cultures that regard aesthetic treatments/facial changes differently.
This is further complicated due to media and social media, as well as relative local and international trends.
To make this more relevant, the following example can be easily comprehended by aesthetic practitioners. Enhancement of the jawline and jaw angle has become very popular in recent years. Internationally, Western aesthetic practitioners have been showcasing their work on social media channels, such as Instagram, creating strong jaw angles and crisp jawlines in both men and women. These images create dramatic reactions, and more practitioners are drawn to providing such treatments, while more patients seek them out. However, there are a myriad of factors that are being ignored on multiple levels:
- The psychological and social impact of these treatments
- Male/female facial morphology (masculinisation of female faces and hypermasculinisation of the male face), which can have a negative social and interpersonal impact
- Ethnic differences.
East Asians have clear differences in their facial structure and morphology in comparison to Caucasian populations. Furthermore, the ideals of beauty are not the same. An angular jawline in Asian women is not desirable, as it is considered to make them look ‘harsh’: ‘A woman who has a wide and square face is thought to bring unhappiness’ (Kim et al, 2001). Figure 1 showcases the differences between Western and Eastern beauty ideals.
Hence, surgical and non-surgical reduction of the jaw angle is the second most popular treatment in Asia after the upper-eyelid surgery (Ahn et al, 2004; Mu, 2010). Mandibular angle reduction and zygoma reduction are popular in East Asia. These treatments are effective in altering one's facial bone structure, resulting in a more rounded, less angular face shape, which is considered desirable in the region (Morris et al, 2007; Chen et al, 2011; Samizadeh, 2022a).
Avoid generalising
Asian people make up the world's largest ethnic group. It is important to note that not all Asian populations are similar, nor do they all have identical face morphology, cultural beliefs or ideals of beauty. Hence, generalisation is impossible. China alone contains 56 distinct ethnic minorities, each with a unique facial morphology.
Ideals of beauty
Findings of studies regarding the ideals of beauty in the region reported the following as desired aspects of facial beauty (Liew et al, 2016; Wu et al, 2016; Samizadeh and Wu, 2018; Samizadeh, 2019a; Samizadeh, 2022b):
- Facial shape: oval, heart/inverted triangle
- Jawline: obtuse jawline for both men and women
- Nose: high bridge, 90-degree tip
- Chin: round and pointy chin for both women and men (albeit less pointy for men)
- Lips: full medially and tapering off laterally with well-defined borders and a well-defined Cupid's bow.
Facial skeleton and morphology
The facial features are related to specific skeletal features. Various people who are indigenous to East Asia, Central Asia, Southeast Asia, North Asia and Polynesia have Mongoloid ancestry (Roomi et al, 2011). Certain phenotypic traits are common among this population (Figure 2) (Liew et al, 2016).
Patient demographics
In Asia, younger generations seeking facial enhancement and ‘beautification’ make up a large proportion of those attending cosmetic clinics. This is usually to enhance the three-dimensional structure of the face by volumising the midface, enhancing the nose height and chin.
Differences in anatomy
Some differences in anatomy have been noted and should be understood by aesthetic practitioners. For example, the submuscularis fibroadipose tissue layer and a lower-positioned transverse ligament are found exclusively in the Asian eye (Saonanon, 2014).
Cultural aspects
It is not unusual for East Asian populations to pay particular attention to skincare and beauty from childhood. For example, Koreans know how to take good care of their skin from childhood, and skincare regimes and routines have recently become popular. It is common for attention to be paid to diet and nutrition. Rice and barley water, in different formats, have been used in the region as part of skincare for centuries. Their anti-ageing properties are being studied and reported on (Burlando and Cornara, 2014; Marto et al, 2018).
Increased bitemporal width
| Asian skeletal features compared to Caucasians | Clinical features in Asians |
|---|---|
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Adapted from Liew et al (2016)
If you happen to dine with Chinese or Asian friends, it is not uncommon to hear them discussing the benefits of various ingredients in the food for health and beauty.
Their avid avoidance of the sun is no secret. Ultraviolet (UV) protective umbrellas are frequently used by men and women, and, recently, Chinese full bodysuits for swimming have made national news.
Belief in facial physiognomy is still alive and practised in the region (Samizadeh, 2019b; Samizadeh, 2022c). For millennia, physiognomy, sometimes known as ‘the art of face-reading’, has been practised around the world. Individuals' mental or moral character, fortune and future are judged based on their facial features (McGrath et al, 2002). Certain features of the face are believed to bring about luck or good fortune and vice versa (Kim et al, 2005). For example, the mandibular angle is very important in the female facial shape in Asia, as ‘a woman who has a wide and square face is thought to bring unhappiness’ (Kim et al, 2001). Internationally, judgements and decision-making on facial features are made by everyone.
Facial ageing in Asian populations
Facial ageing among Asians is different from Caucasian populations (Samizadeh, 2022d). Asians also exhibit distinct signs and rates of facial ageing (Nouveau-Richard, 2005; Tsukahara et al, 2007; Liew et al, 2016). Distinct facial structure, genetics, environmental variables and lifestyle factors, such as eating habits, skincare and an early emphasis on beauty, as well as sun avoidance, all contribute to Asians having different facial ageing patterns than those in Caucasian populations. In East Asians, the midface typically possesses few rhytids, and moderate-to-severe ptosis occurs with age. Increased superficial fat in conjunction with a thicker dermis results in a decrease in the prevalence of superficial rhytids. Additionally, there are abundant fat and fibrous linkages between the superficial musculoaponeurotic system and the parotideomasseteric fascia in Asians, which contribute to a reduction in soft tissue ptosis. In contrast to periorbital and perioral rhytids in Caucasian patients, skin pigmentation is an early indicator of ageing in East Asians (Samizadeh, 2022d).
The desire for Westernised facial characters among Asians is much debated. There was a period when beauty was defined in terms of Eurocentric notions of beauty (Jin, 2016). However, Asian aesthetic values are different from ideals of beauty in the West, with Western women having preferences for high cheekbones, hollowness of the prezygomatic area and an angular jaw angle. There is ample evidence that Asian people embrace their ethnic characteristics and seek harmonisation, augmentation of their own features for self-improvement and preservation of ethnic features, rather than Westernisation (Lam, 2002; Kim, 2003; Dobke et al, 2006; Oullette, 2009; Wong, 2009; Holliday and Elfving-Hwang, 2012; Luo, 2012; Jin, 2016; Wu et al, 2016).
Conclusion
Asian and Caucasian populations differ in their ideals towards beauty and aesthetic standards, facial architecture, facial ageing and patient demographics. An in-depth awareness of the fundamental aesthetic issues, ideals of beauty, anatomical alterations and requirements for the Asian face is required to develop effective facial aesthetic treatments. In terms of time course, perceived changes and observable changes, Asian and Caucasian populations experience facial ageing differently. Generally, both young and older Asian patients seeking cosmetic treatment prefer to avoid surgery with long downtime and are interested in enhancing their own beauty with natural-looking outcomes. Therefore, Asians seeking facial rejuvenation and contouring require strategies that vary from those of Caucasian populations.
Key Points
- Asian and Caucasian populations differ in terms of facial morphology, standards of beauty, cultural aspects and beliefs, timing and pattern of facial ageing and patient demographics
- Asian patients have different expectations from their treatments and outcome
- Cultural aspects, such as belief in facial physiognomy, affect the treatments requested and outcomes expected.
CPD reflective questions
- What are the main differences between the facial morphology of East Asians and Caucasians?
- What are the early signs of facial ageing in East Asians and how are they different from Caucasians?
- How are patient demographics different among East Asians?