The demand for cosmetic surgery has reached an all-time high in Asia. With the disproportionate influence of the Western media throughout the world, Asian patients often yearn to emulate the Occidental models in their countenance by undergoing plastic surgery. However, Asians who reside in the Orient maintain different aesthetic ideals that only at times converge with Occidental standards. For instance, a fuller upper eyelid and lower malar prominence run counter to Western conceptions of beauty. Furthermore, the Western cosmetic surgeon who elects to operate on the Asian patient may attempt to extrapolate from his anatomic understanding cultivated from experience with Caucasian patients. However, the bony structure, soft-tissue distribution, and skin quality all differ radically from the Caucasian anatomy. If the cosmetic surgeon can understand the unique aesthetic and anatomic features of the Asian patient, he or she can embark on a successful surgical intervention in the Asian patient who seeks plastic surgery. Cervico-facial liposuction and lipotransfer follow the tenets just outlined for the Asian patient. In this article, the cosmetic surgeons will describe a methodology for liposuction and lipotransplantation that is designed for the Asian patient given the anatomic constraints and aesthetic objectives. Liposuction has proven its efficacy as a useful tool for body recontouring and has assumed a prominent role in the plastic surgeon’s armamentarium.
In addition, cervical liposuction has also become integral to facial rejuvenation with or without a concomitant cervico-facial rhytidectomy. Autologous fat transplantation has met with greater circumspection in professional circles. Many plastic surgeons have concluded that lipotransfer is an ineffective endeavor, as all the transplanted adipose tissue is bound for complete resorption over time. Accordingly, many techniques have been advocated for fat transplantation that have sought to maintain the viability of the fat cells after transplantation, including centrifugation, washing, and microinjection, to name a few. However, controversy has persisted, and the popularity of adipose transplantation has waned somewhat. The cosmetic surgeons would like to revive interest in this technique and to expound upon a surgical technique that has demonstrated value after 23 years of clinical experience and to explain the philosophical underpinnings for this method.
The Western cosmetic surgeon must appreciate the subtleties that define the Asian face before he or she undertakes any kind of incision-based surgery or dermatologic resurfacing. The underlying bony structure of the Asian face differs dramatically from that of the Caucasian face. The forehead and brow region exhibit a narrow expanse and flat contour, with a posterior inclination superiorly. The temple region may appear more hollowed owing to the relative protuberance of the zygomatic arch. The orbits are shallower by virtue of both a less recessed bony orbital cavity as well as a fuller eyelid. The midface tends to be flatter, as the malar bone exhibits less convexity. Conversely, the lower face is more convex than that of the Caucasian face owing to the relative maxillary-alveolar projection and lower mandibular recession.
Greater accumulation of adipose is present in the malar region in the Asian patient, which upon descent accentuates the nasolabial fold at times even more prominently than in the Caucasian patient. However, the submental area tends to have less adipose accumulation in younger patients, as compared with Caucasians; but this difference markedly declines as Asians mature and acquire a greater amount of submental fat. Despite this progressive accretion of submental fat, the underlying platysma muscle is half as likely to be dehiscent in the midline and to exhibit the characteristic anterior platysmal banding as in Caucasian patients. The overlying skin is also thicker and more resilient in the Asian patient, which may obviate the need for a concomitant rhytidectomy after liposuction. A predilection for pigmentary discoloration and hypertrophic scarring in Asian skin should make the cosmetic surgeon always wary about any kind of incision. The senior cosmetic surgeon has developed a method of incision camouflage and skin protection that markedly reduces the risk of these adverse outcomes, as will be thoroughly explained.
Although Asians often desire a more open eye, i.e., a wider palpebral aperture, that resembles the Caucasian eye, a hollowed eye may look unnatural or impart an aged appearance. Overexuberant fat resection from a blepharoplasty or double-eyelid surgery may lead to this hollowed orbital appearance. Lipotransfer to the sunken upper lid may restore one’s ethnicity or rejuvenate the upper lid. However, the lower-lid region is generally a poor area for direct fat transfer, as any redundant skin can lead to a herniated lower-lid appearance. The temporal concavity that is accentuated by the relative zygomatic curvature in the Asian patient is also an area that some patients desire correcting. Autologous fat transplantation offers hope to address this problem. Although the malar region is typically hypoplastic in the Asian patient, very high cheekbones may not always be a favorable, aesthetic trait. When convex malar bones are combined with prominent mandibular angles, a prevalent feature in some Asian countries, the patient may appear to have a very boxy face that can be interpreted as masculine and aggressive. However, a very flat midface may communicate a washed-out, expressionless look and reinforce ethnic facial features; therefore, the cosmetic surgeon may elect to undertake liposuction or lipotransfer depending upon the anatomic configuration and the patient’s desires. Both facial liposuction and lipotransfer constitute unusual requests in the West.
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