“For one thing, Asians typically age “better” than Caucasians. Asians have thicker skin with more elastic fibres.”

Beauty For All Faces

Sure, everyone looks a little different from everyone else. But did you know there is a world of difference between Caucasian and Asian faces? Not just in how they look, but how they are structured and respond to ageing as well? When seeking non-surgical facial reshaping or rejuvenation, look for a practitioner who understands these differences. Failure to understand can mean less than desirable outcomes for Asian patients.  

Posted: 25 September 13

Although most people believe that cosmetic surgery and cosmetic treatments are pretty standard procedures and practically everyone has a similar outcome, this is not the case. Aside from individual differences, there are also common traits and features that surgeons and cosmetic doctors have to respect when treating people of different ethnic backgrounds. According to Louisa McKay, this message came through loud and clear at the 2013 Non-Surgical Symposium in Sydney from 28 to 31 August. It was organised by the Australasian Society of Aesthetic Plastic Surgery (ASAPS) together with the Society of Cosmetic Physicians of Australasia (CPSA).

The differences in treating Caucasians and Asians were highlighted in many instances, including the sessions on facial aesthetics. Total facial reshaping sessions for Caucasians and Asians had similar time allocations, lasting an hour each. Assessment and treatment for focus areas such as non-surgical rhinoplasty also saw separate sessions for Asians and Caucasians. In the session dedicated to pigments, there was a general one on managing melasma by topical creams, and a separate one offering the Asian perspective. Treatment differences in acquired pigmentary conditions in Asians—who are rather vulnerable to pigment issues—and the use of light devices in Asian patients, were discussed as separate topics. The sessions on treating capillaries and visible redness also had a separate session addressing treatment of vascular lesion in Asians.

Are there a lot of differences between Asian faces and Caucasian faces?

Yes there are, and not just in appearance. The differences have multiple aspects, including skin and its qualities; facial features; the shape of bones and facial structure; variations in the underlying facial tissue, including connective tissue and muscles; and how all these come together to form facial features. These differences can affect both surgical and non-surgical treatments and their outcomes.

As more and more Asians and those with Asian ancestry seek cosmetic surgery and non-surgical treatments, the many cosmetic options that have been developed mostly for Caucasian populations need to be changed and adjusted in varying degrees to bridge the differences. Let’s look at some of the differences and try to understand how cosmetic physicians and other practitioners approach them to produce good outcomes in both Caucasian and Asian patients.

Asian skin vs. Caucasian skin

For one thing, Asians typically age “better” than Caucasians. Asians have thicker skin with more elastic fibres. Because of thicker connective tissue, Asian skins do not develop laxity and fine wrinkling as Caucasians do. They do not lose facial volume as quickly or in the same way Caucasians do. But the different and slower ageing process can lead to deeper, more dramatic lines in Asians, especially in the nasolabial area.

Thicker skin makes Asians prone to hypertrophic scars, so plastic and cosmetic surgeons need to take extra care to conceal incisions. Special considerations come into play when considering injectables and non-surgical treatments.

There’s also the need for further fine-tuning, because not all Asians have thicker or more pigmented skin than some Causasians. Those from Northeast Asia—including Koreans, Japanese and Northern Chinese—tend to have lighter skin colours and less pigmentation than those from Southeast Asia. Surgeons and physicians essentially have to sub-classify skin types to enhance results of skin rejuvenation treatments in Asian patients. Such fine classifications also help minimise potential complications.

Facial features and ageing

Asian and Caucasian bone structures are not the same. The Asian face is flatter and rounder than the Caucasian, which is more oval in appearance. Caucasian faces are long and narrow because of prominent zygomatic arches and zygomas, which occupy valuable real estate in the midface area. The large masseter muscle that raises the lower jaw and is used for chewing also originates from the zygomatic arch. Non-surgical facial reshaping in Asians makes unique use of this muscle.

Asians have a lower orbital rim and a high zygomatic profile, accompanied by thicker bony structures. Pockets of facial fat are denser and more fibrous, able to hold their shape better than Caucasians’. The ring-like muscle (orbicularis oculi) that surrounds the eye and helps open and close it, and the retaining ligaments from it, weaken more slowly in Asians. This is also the muscle that causes crow’s feet.

Asian eyes are different in shape because the eyelids and folds are different. Asian noses tend to be shorter.

Overall, because of multiple differences, ageing appears to affect the Asian face more slowly. Since both Asians and Caucasians experience facial bone loss in a similar way, it is the soft tissue changes that contribute to the significant differences between them. Unless these distinctions are given due consideration, cosmetic procedures, and non-surgical facial reshaping treatments on the Asian face can have less than desirable results.

Different beauty ideals call for different techniques

Most Asians do not wish to westernise their features, to look like Caucasians, or to completely eliminate their ethnic heritage. Instead, the desire of many people with Asian features is to sharpen them, to extend the nose or to resculpt the jaw line. There is a demand for more projected features. Projection is a key concern for younger people. This is one reason for the popularity of rhinoplasty-related procedures among young Asians. But non-surgical rhinoplasty using dermal fillers can also bring about these changes. Augmenting the root of the nose or lip augmentation are also frequent requests.

Asians often seek to convert their relatively angular four-sided or square faces to a more heart shaped or oval one. Mid-face volumising is one way to achieve a heart-shaped face with greater volume and smoother overall contours. Some Asians want to achieve more angular contours, especially in the lower face. Extending the chin can have a significant impact on the Asian face. This can also be achieved non-surgically with dermal fillers. Neurotoxins can soften the masseter muscles, another technique that is growing in popularity. More robust dermal fillers can be used to improve overall facial contours, give a higher cheekbone and improve forward projection of the chin or jaw line, achieving an effect similar to that of an implant.

Asians tend to show flattening under the eye and the central cheek area as they age. Non-surgical reshaping can reverse this effect, because there is plenty of tissue overlying the bone. This tissue can benefit from the use of dermal fillers injected very deep and close to the bone.

Volumising the face is a top priority among older Asian patients, especially in the cheek and the mid face. Again, deep dermal filler injections can bring about an excellent lifting effect in this area. Massaging will help mould and maximise results, provided your injector chooses the correct dermal filler for you. In general, injectors say that volumising the Asian face requires comparatively less filler than Caucasian faces do. However, this can vary by individual.

Filler injections can also help reduce crepiness and folds in the side cheeks—a very difficult area to treat. The flattening and lining that occurs in the lower cheeks give way to accessory smile lines in Asians. They occur because of fat loss. This area too can be treated with dermal fillers accompanied by massaging, unless the lines are very deep.

Asian patients can experience a hollowing at the temples beginning around the age of about 50. Dermal fillers can be used to get rid of the hollows and enhance the forehead area.

Combining dermal fillers and anti-ageing injections for non surgical facial reshaping

Non-surgical reshaping sometimes calls for a combination of dermal filler treatments and neurotoxins. Especially in younger Asians seeking to change overall facial shape, it is important to inject the masseter muscle that helps move the jaws. Using neurotoxins in this way to reshape the jawline is unique to Asian patients. It can go very well with lifting of the upper face or with nose augmentation. The injector’s experience is vital here, because if the injection is made into the wrong muscle the patient may lose the ability to smile.

Sometimes changing the facial shape can come as a surprise. The patient may wait a few days while nothing much seems to happen, then suddenly they experience a change, which is both subtle and effective.

While older Asians may not get wrinkles like Caucasians, they do want their brows reshaped when droopiness occurs. Because the shape of the Asian brow is different, the injection techniques for anti-ageing treatments need to change as well.

Using lasers

When lasers come into the picture, Asians and Caucasians be treated differently. Order is important when treating Caucasians; not so much for Asians. For Caucasians, total rejuvenation can begin or end with a laser treatment, with dermal fillers and anti ageing injections coming either before or after. With Asians the order is less of an issue, since most of the time their skin problems tend to be discrete ones like freckles, spots or vascular issues, rather than whole areas, as is often the case with Caucasians.

Asians have darker skin profiles. To avoid the post-inflammatory hyperpigmentation that Asian skins are rather prone to developing, it is important to use lower energies. Asians can also get small dark spots as post-inflammatory hyperpigmentation following dermal filler or neurotoxin injections.

Whether you are Caucasian or Asian, non-surgical facial reshaping is meant to make you look good. Injectables and non-invasive treatments are the future and offer a viable alternative to surgery in many cases. There is little or no downtime, and in most cases the treatment can be reversed if the patient doesn’t like the outcome.

What more can you ask?

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