Skip to main content

Advertisement

SpringerLink
Log in

Consensus on Changing Trends, Attitudes, and Concepts of Asian Beauty

  • Original Article
  • Aesthetic
  • Published:
Aesthetic Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

Asians increasingly seek non-surgical facial esthetic treatments, especially at younger ages. Published recommendations and clinical evidence mostly reference Western populations, but Asians differ from them in terms of attitudes to beauty, structural facial anatomy, and signs and rates of aging. A thorough knowledge of the key esthetic concerns and requirements for the Asian face is required to strategize appropriate facial esthetic treatments with botulinum toxin and hyaluronic acid (HA) fillers.

Methods

The Asian Facial Aesthetics Expert Consensus Group met to develop consensus statements on concepts of facial beauty, key esthetic concerns, facial anatomy, and aging in Southeastern and Eastern Asians, as a prelude to developing consensus opinions on the cosmetic facial use of botulinum toxin and HA fillers in these populations.

Results

Beautiful and esthetically attractive people of all races share similarities in appearance while retaining distinct ethnic features. Asians between the third and sixth decades age well compared with age-matched Caucasians. Younger Asians’ increasing requests for injectable treatments to improve facial shape and three-dimensionality often reflect a desire to correct underlying facial structural deficiencies or weaknesses that detract from ideals of facial beauty.

Conclusions

Facial esthetic treatments in Asians are not aimed at Westernization, but rather the optimization of intrinsic Asian ethnic features, or correction of specific underlying structural features that are perceived as deficiencies. Thus, overall facial attractiveness is enhanced while retaining esthetic characteristics of Asian ethnicity. Because Asian patients age differently than Western patients, different management and treatment planning strategies are utilized. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Carruthers JD, Glogau RG, Blitzer A, Facial Aesthetics Consensus Group Faculty: Advances in facial rejuvenation: botulinum toxin type A, hyaluronic acid dermal fillers, and combination therapies-consensus recommendations. Plast Reconstr Surg 121, 5S–30S (2008)

    Google Scholar 

  2. Rzany, B., Fratila, A.A., Fischer, T.C., Hilton, S., Pavicic, T., Rothhaar, A., Sattler, G., Sommer, B., Pickett, A.: Recommendations for the best possible use of botulinum neurotoxin type a (Speywood units) for aesthetic applications. J Drugs Dermatol 12, 80–84 (2013)

    CAS  PubMed  Google Scholar 

  3. Dessy, L.A., Fallico, N., Mazzocchi, M., Scuderi, N.: Botulinum toxin for glabellar lines: a review of the efficacy and safety of currently available products. Am J Clin Dermatol 12, 377–388 (2011)

    PubMed  Google Scholar 

  4. Raspaldo, H., Baspeyras, M., Bellity, P., Dallara, J.M., Gassia, V., Niforos, F.R., Belhaouari, L., Consensus, G.: Upper- and midface anti-aging treatment and prevention using onabotulinumtoxin A: the 2010 multidisciplinary French consensus–part 1. J Cosmet Dermatol 10, 36–50 (2011)

    PubMed  Google Scholar 

  5. Raspaldo, H., Gassia, V., Niforos, F.R., Michaud, T.: Global, 3-dimensional approach to natural rejuvenation: part 1–recommendations for volume restoration and the periocular area. J Cosmet Dermatol 11, 279–289 (2012)

    PubMed  Google Scholar 

  6. Raspaldo, H., Niforos, F.R., Gassia, V., Dallara, J.M., Bellity, P., Baspeyras, M., Belhaouari, L., Consensus, G.: Lower-face and neck antiaging treatment and prevention using onabotulinumtoxin A: the 2010 multidisciplinary French consensus–part 2. J Cosmet Dermatol 10, 131–149 (2011)

    PubMed  Google Scholar 

  7. Fagien, S., Cassuto, D.: Reconstituted injectable hyaluronic acid: expanded applications in facial aesthetics and additional thoughts on the mechanism of action in cosmetic medicine. Plast Reconstr Surg 130, 208–217 (2012)

    CAS  PubMed  Google Scholar 

  8. Fang, F., Clapham, P.J., Chung, K.C.: A systematic review of interethnic variability in facial dimensions. Plast Reconstr Surg 127, 874–881 (2011)

    CAS  PubMed  PubMed Central  Google Scholar 

  9. Farkas, L.G., Katic, M.J., Forrest, C.R., Alt, K.W., Bagic, I., Baltadjiev, G., Cunha, E., Cvicelova, M., Davies, S., Erasmus, I., Gillett-Netting, R., Hajnis, K., Kemkes-Grottenthaler, A., Khomyakova, I., Kumi, A., Kgamphe, J.S., Kayo-daigo, N., Le, T., Malinowski, A., Negasheva, M., Manolis, S., Ogeturk, M., Parvizrad, R., Rosing, F., Sahu, P., Sforza, C., Sivkov, S., Sultanova, N., Tomazo-Ravnik, T., Toth, G., Uzun, A., Yahia, E.: International anthropometric study of facial morphology in various ethnic groups/races. J Craniofac Surg 16, 615–646 (2005)

    PubMed  Google Scholar 

  10. Gu, Y., McNamara Jr., J.A., Sigler, L.M., Baccetti, T.: Comparison of craniofacial characteristics of typical Chinese and Caucasian young adults. Eur J Orthod 33, 205–211 (2011)

    PubMed  Google Scholar 

  11. Le, T.T., Farkas, L.G., Ngim, R.C., Levin, L.S., Forrest, C.R.: Proportionality in Asian and North American Caucasian faces using neoclassical facial canons as criteria. Aesthetic Plast Surg 26, 64–69 (2002)

    PubMed  Google Scholar 

  12. Sim, R.S., Smith, J.D., Chan, A.S.: Comparison of the aesthetic facial proportions of southern Chinese and white women. Arch Facial Plast Surg 2, 113–120 (2000)

    CAS  PubMed  Google Scholar 

  13. Nouveau-Richard, S., Yang, Z., Mac-Mary, S., Li, L., Bastien, P., Tardy, I., Bouillon, C., Humbert, P., de Lacharriere, O.: Skin ageing: a comparison between Chinese and European populations. A pilot study. J Dermatol Sci 40, 187–193 (2005)

    CAS  PubMed  Google Scholar 

  14. Tsukahara, K., Fujimura, T., Yoshida, Y., Kitahara, T., Hotta, M., Moriwaki, S., Witt, P.S., Simion, F.A., Takema, Y.: Comparison of age-related changes in wrinkling and sagging of the skin in Caucasian females and in Japanese females. J Cosmet Sci 55, 351–371 (2004)

    PubMed  Google Scholar 

  15. Shirakabe, Y., Suzuki, Y., Lam, S.M.: A new paradigm for the aging Asian face. Aesthetic Plast Surg 27, 397–402 (2003)

    PubMed  Google Scholar 

  16. Wong, G.R., Chen, W.P.: Phosphatidylcholine/deoxycholate lipolysis and hyaluronic acid augmentation to enhance nonsurgical lower facial contouring using botulinum toxin type A. J Cosmet Dermatol 10, 159–162 (2011)

    PubMed  Google Scholar 

  17. Liew, S., Dart, A.: Nonsurgical reshaping of the lower face. Aesthet Surg J 28, 251–257 (2008)

    PubMed  Google Scholar 

  18. Rhee, S.C., Lee, S.H.: Attractive composite faces of different races. Aesthetic Plast Surg 34, 800–801 (2010)

    PubMed  Google Scholar 

  19. Swift, A., Remington, K.: BeautiPHIcation: a global approach to facial beauty. Clin Plast Surg 38, 347–377 (2011)

    PubMed  Google Scholar 

  20. Wu, W.T.L.: Non surgical facial rejuvenation with the 4r principle: innovative uses of BOTOX and the woffles lift. In: Panfilov, D. (ed.) Aesthetic surgery of the facial mosaic, pp. 636–649. Springer, Berlin (2007)

    Google Scholar 

  21. Wu, W.T.: Botox facial slimming/facial sculpting: the role of botulinum toxin-A in the treatment of hypertrophic masseteric muscle and parotid enlargement to narrow the lower facial width. Facial Plast Surg Clin North Am 18, 133–140 (2010)

    PubMed  Google Scholar 

  22. Wu, W.T.L.: Facial sculpting and facial slimming with neurotoxins. In: Sundine, M., Connell, B. (eds.) Aesthetic rejuvenation of the face. Thieme Publishers, New York (2015)

    Google Scholar 

  23. Jayaratne, Y.S., Deutsch, C.K., McGrath, C.P., Zwahlen, R.A.: Are neoclassical canons valid for southern Chinese faces? PLoS One 7, e52593 (2012)

    CAS  PubMed  PubMed Central  Google Scholar 

  24. Wang, D., Qian, G., Zhang, M., Farkas, L.G.: Differences in horizontal, neoclassical facial canons in Chinese (Han) and North American Caucasian populations. Aesthetic Plast Surg 21, 265–269 (1997)

    CAS  PubMed  Google Scholar 

  25. Chan, W.N., Listi, G.A., Manhein, M.H.: In vivo facial tissue depth study of Chinese-American adults in New York City. J Forensic Sci 56, 350–358 (2011)

    PubMed  Google Scholar 

  26. De Greef, S., Claes, P., Vandermeulen, D., Mollemans, W., Suetens, P., Willems, G.: Large-scale in vivo Caucasian facial soft tissue thickness database for craniofacial reconstruction. Forensic Sci Int 159(Suppl 1), S126–S146 (2006)

    PubMed  Google Scholar 

  27. Hwang, H.S., Park, M.K., Lee, W.J., Cho, J.H., Kim, B.K., Wilkinson, C.M.: Facial soft tissue thickness database for craniofacial reconstruction in Korean adults. J Forensic Sci 57, 1442–1447 (2012)

    PubMed  Google Scholar 

  28. Chung, J.H.: Photoaging in Asians. Photodermatol Photoimmunol Photomed 19, 109–121 (2003)

    PubMed  Google Scholar 

  29. Halder, R.M., Bridgeman-Shah, S.: Skin cancer in African Americans. Cancer 75, 667–673 (1995)

    CAS  PubMed  Google Scholar 

  30. Gloster Jr., H.M., Neal, K.: Skin cancer in skin of color. J Am Acad Dermatol 55, 741–760 (2006)

    PubMed  Google Scholar 

  31. Rawlings, A.V.: Ethnic skin types: are there differences in skin structure and function? Int J Cosmet Sci 28, 79–93 (2006)

    CAS  PubMed  Google Scholar 

  32. Tsukahara, K., Sugata, K., Osanai, O., Ohuchi, A., Miyauchi, Y., Takizawa, M., Hotta, M., Kitahara, T.: Comparison of agerelated changes in facial wrinkles and sagging in the skin of Japanese, Chinese and Thai women. J Dermatol Sci 47, 19–28 (2007)

    PubMed  Google Scholar 

  33. Querleux, B., Baldeweck, T., Diridollou, S., de Rigal, J., Huguet, E., Leroy, F., Holloway Barbosa, V.: Skin from various ethnic origins and aging: an in vivo cross-sectional multimodality imaging study. Skin Res Technol 15, 306–313 (2009)

    PubMed  Google Scholar 

  34. Hsu, S.: Green tea and the skin. J Am Acad Dermatol 52, 1049–1059 (2005)

    PubMed  Google Scholar 

  35. Chung, J.H., Lee, S.H., Youn, C.S., Park, B.J., Kim, K.H., Park, K.C., Cho, K.H., Eun, H.C.: Cutaneous photodamage in Koreans: influence of sex, sun exposure, smoking, and skin color. Arch Dermatol 137, 1043–1051 (2001)

    CAS  PubMed  Google Scholar 

  36. Tzou, C.H., Giovanoli, P., Ploner, M., Frey, M.: Are there ethnic differences of facial movements between Europeans and Asians? Br J Plast Surg 58, 183–195 (2005)

    CAS  PubMed  Google Scholar 

  37. Lee, J.M., Lee, H., Park, M., Lee, T.E., Lee, Y.H., Baek, S.: The volumetric change of orbital fat with age in Asians. Ann Plast Surg 66, 192–195 (2011)

    CAS  PubMed  Google Scholar 

  38. Regensburg, N.I., Wiersinga, W.M., van Velthoven, M.E., Berendschot, T.T., Zonneveld, F.W., Baldeschi, L., Saeed, P., Mourits, M.P.: Age and gender-specific reference values of orbital fat and muscle volumes in Caucasians. Br J Ophthalmol 95, 1660–1663 (2011)

    PubMed  Google Scholar 

  39. Rohrich RJ, Pessa JE (2007) The fat compartments of the face: anatomy and clinical implications for cosmetic surgery. Plast Reconstr Surg 119:2219–2227 discussion 2228–2231

  40. Fitzgerald, R., Graivier, M.H., Kane, M., Lorenc, Z.P., Vleggaar, D., Werschler, W.P., Kenkel, J.M.: Update on facial aging. Aesthet Surg J 30(Suppl), 11S–24S (2010)

    PubMed  Google Scholar 

  41. Ozdemir R, Kilinc H, Unlu RE, Uysal AC, Sensoz O, Baran CN (2002) Anatomicohistologic study of the retaining ligaments of the face and use in face lift: retaining ligament correction and SMAS plication. Plast Reconstr Surg 110:1134–1147 discussion 1148–1139

  42. Sykes, J.M.: Management of the aging face in the Asian patient. Facial Plast Surg Clin North Am 15, 353–360 (2007)

    PubMed  Google Scholar 

  43. Wu WTL, Liew S, Chan HH, et al (2015) Consensus on current injectable treatment strategies in the Asian face. Submitted to Aesthetic Plast Surg

  44. Kim, H.J., Paik, D.J., Choi, B.Y., Chung, M.S., Han, S.H., Hwang, Y.I., Sohn, H.J., Chung, R.H., Koh, K.S.: Measurements of the zygomatic bones and morphology of the zygomaticofacial and zygomaticotemporal foramina in Koreans. Korean J Phys Anthropol 10, 225–234 (1997)

    CAS  Google Scholar 

  45. Kim, S.H., Whang, E., Choi, H.G., Shin, D.H., Uhm, K.I., Chung, H., Song, W.C., Koh, K.S.: Analysis of the midface, focusing on the nose: an anthropometric study in young Koreans. J Craniofac Surg 21, 1941–1944 (2010)

    PubMed  Google Scholar 

  46. Song, W.C., Kim, J.I., Kim, S.H., Shin, D.H., Hu, K.S., Kim, H.J., Lee, J.Y., Koh, K.S.: Female-to-male proportions of the head and face in Koreans. J Craniofac Surg 20, 356–361 (2009)

    PubMed  Google Scholar 

  47. Han, S.H., Hwang, Y.I., Lee, K.H., Koh, K.S., Choi, B.Y., Lee, K.S., Lee, H.Y., Sir, W.S., Chung, M.S., Kim, H.J., Kim, D.W., Kang, H.S.: Craniometric study in modern Korean adults. Korean J Phys Anthropol 8, 205–213 (1995)

    Google Scholar 

  48. Song, W.C., Kim, S.J., Kim, S.H., Hu, K.S., Kim, H.J., Koh, K.S.: Asymmetry of the palpebral fissure and upper eyelid crease in Koreans. J Plast Reconstr Aesthetic Surg 60, 251–255 (2006)

    Google Scholar 

  49. Zhang, X.T., Wang, S.K., Zhang, W., Wang, X.F.: Measurement and study of the nose and face and their correlations in the young adult of Han nationality. Plast Reconstr Surg 85, 532–536 (1990)

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The consensus meeting was funded by an unrestricted educational grant from Allergan; however, the authors are solely responsible for the contents of this article. The authors would like to acknowledge Dr. Kyle Seo, Dermatologist, Korea, for providing the photograph of the Korean woman in Fig. 1. Assistance with administration of the survey, survey data analysis, and editorial preparation of the manuscript was provided by Samantha Santangelo, PhD, of MediTech Media Asia Pacific.

Author information

Authors and Affiliations

  1. Shape Clinic, Sydney, Australia

    Steven Liew

  2. Woffles Wu Aesthetic Surgery and Laser Centre, Camden Medical Centre, 1 Orchard Boulevard, Suite #09-02, Singapore, 249615, Singapore

    Woffles T. L. Wu

  3. Department of Medicine, University of Hong Kong, Pok Fu Lam, Hong Kong

    Henry H. Chan

  4. The Specialists: Lasers, Aesthetic and Plastic Surgery Central, Pok Fu Lam, Hong Kong

    Wilson W. S. Ho

  5. Division of Anatomy & Developmental Biology, Department of Oral Biology, Yonsei University College of Dentistry, Seoul, Korea

    Hee-Jin Kim

  6. Monash University, Clayton, Victoria, and Skin & Cancer Foundation, Carlton, VIC, Australia

    Greg J. Goodman

  7. P-Skin Professional Clinic, Kaohsiung, Taiwan

    Peter H. L. Peng

  8. Regional Medical Affairs, Allergan Asia Pacific, Singapore, Singapore

    John D. Rogers

Authors
  1. Steven Liew
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Woffles T. L. Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Henry H. Chan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wilson W. S. Ho
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hee-Jin Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Greg J. Goodman
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Peter H. L. Peng
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. John D. Rogers
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Woffles T. L. Wu.

Ethics declarations

Disclosure

Dr. Liew sits on advisory boards for Allergan, Galderma, and Kythera and has received honoraria from Allergan and Galderma for delivering local and international workshops and lectures. Dr. Wu sits on advisory boards for Allergan, Galderma, and Merz and has received honoraria from these companies for attending board meetings and delivering local and international workshops and lectures. Dr. Chan has received financial support for travel on behalf of Allergan. Dr. Ho is a consultant for Allergan. Professor Hee-Jin Kim received honoraria from Allergan, Merz, and Galderma for delivering local and international workshops and lectures. Dr. Goodman has received honoraria for delivering lectures from and sits on advisory boards for Allergan, Galderma, Merz, and Leo. Dr. Peng is a speaker and/or consultant for Allergan, Galderma, Merz, Zeltiq, Sanofi, Ulthera, Cynosure, and Valeant. Dr. Rogers was an employee of Allergan at the time of manuscript preparation.

Additional information

Open Access

This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

This article is being reprinted for ISAPS 50th Anniversary Special Issue.

On behalf of the Asian Facial Aesthetics Expert Consensus Group, the members of Asian Facial Aesthetics Expert Consensus Group are given in Appendix

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Liew, S., Wu, W.T.L., Chan, H.H. et al. Consensus on Changing Trends, Attitudes, and Concepts of Asian Beauty. Aesth Plast Surg 44, 1186–1194 (2020). https://doi.org/10.1007/s00266-020-01808-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00266-020-01808-w

Keywords

Search

Navigation