Cosmetic injections in Asian patients
Skeletal differences, cultural preferences guide where to use fillers and neuromodulators (1,350 words, 6 minutes, 45 seconds)
There is a growing trend of nonsurgical injectable aesthetic facial treatments, including in Asian patients, so there is a need to recognize the unique structural and anatomical features of the Asian face, said Dr. Monica Li.
Dr. Li, a physician in the Department of Dermatology and Skin Science at the University of British Columbia, spoke at the 7th Annual Skin Spectrum Summit on Nov. 6.
Recognizing these features helps dermatologists “deliver results that are effective yet natural for this population,” said Dr. Li. “And of course, attitudes to beauty also differ amongst this group. The primary objective of injectables in Asians is to make sure that we do not westernize the Asian face, but to optimize unique ethnic features that they have.”
Dr. Li said that there will be differences among age groups. “In our younger patients, we are looking to highlight and refine their structural features and achieve proportion. Whereas in older patients, as we see across the ethnic spectrum, there is going to be more descent and deflation. So we are trying to maintain facial structure and also volume.”
She pointed out that there are skeletal differences between Asian and Caucasian features. For example, many Asians have increased bizygomatic width. She said that many Caucasians in their 50s, 60s or 70s see a slimming of their mid-face and seek revolumization of their lateral upper cheeks. Asians still have high and defined cheekbones, but they have lost the buccal fat, so that area is where the revolumization would need to take place.
Many Asian patients have a low nasal bridge, resulting in a flat, short nose, and are seeking augmentation using dermal fillers, or may see a plastic surgeon for rhinoplasty, said Dr. Li.
There is mid-face concavity in many Asian patients, said Dr. Li. Physicians can improve the interior projection and offset this by using dermal fillers to augment the nose, the medial cheeks or the forehead.
Dr. Li said doctors should treat based on anatomical regions. She said many Asian patients have a wide lower face, which can be slimmed using neuromodulators to reduce the bulk of the masseter muscle. Dermal fillers can be used to contour the chin to extend the jawline and increase the vertical length of the face, she said.
Many therapies can have more than one application, said Dr. Li. For example, neuromodulators can reduce lines of facial expression on the upper face. Many Asians, especially younger ones, also want to use neuromodulators to slim their calves. Neuromodulators can be used to reduce the bulk and strength of the gastrocnemius.
Dr. Li said that while dermal fillers are used often to volumize hollowed cheeks and temples, in Asian patients, they can also be used to offset mid-face concavity. She explained that physicians could use dermal fillers to project the forehead to offset that mid-face concavity.
Bottom Line: Asian patients have unique skeletal features, with needs different from Caucasians but also distinct from other Asian patients. Patients from China, Taiwan, Korea, Japan, Malaysia, Indonesia, Thailand or India will have unique differences that should be highlighted or refined.
From the literature on aesthetic dermatology in skin of colour
A study of combined micro-focused ultrasound and hyaluronic acid dermal filler in the treatment of enlarged facial pores in Asians
The authors of this paper compared the efficacy of micro-focused ultrasound with visualization (MFU-V) as monotherapy to a combination of MFU-V low-degree crosslinked hyaluronic acid (L-HA) injection to treat enlarged enlarged facial pores in Asians.
Some 46 participants completed the split-face study. The authors observed a statistically significant decline in the mean pore volume of both sides of the patient’s faces at every visit compared to baseline, with the lowest mean four months post-treatment. The combined technique showed a lower mean pore volume than the single technique throughout the follow-ups. However, a subjective evaluation by a physician showed no statistically significant difference between the two techniques. Patient satisfaction scores were similar to trends in mean pore volume, with a statistically significant difference at four and six months post-treatment.
Target-specific sandwich technique: Facial rejuvenation leveraging CPM technology
This paper presents a technique for restoring, rejuvenating and enhancing Asian faces through small targeted injections of different facial filler products with different rheologies. The method is described, and a case series of 14 patients is included to present outcomes and patient satisfaction with the technique. A total of 3 cc of fillers were used in each patient case.
Consensus recommendations on the use of hyaluronic acid-based fillers for nonsurgical nasal augmentation in Asian patients
The authors of these recommendations note that non-invasive nasal augmentation is growing in popularity, but they note that, without proper training, the complexity of the nasal vasculature makes it a high-risk procedure. To address this issue, they present recommendations for nonsurgical nasal augmentation using hyaluronic acid fillers focusing on the dorsum, tip, and columella.
Their recommendations include a thorough pre-injection assessment and counselling to align the patient's expectations with aesthetic goals completely. The authors also suggest that injections must be deep and at the level of the periosteum or perichondrium to minimize the risk of intravascular injection, and aliquots of hyaluronic acid must be introduced using slow, low-pressure, and low-volume injections. An optimal aesthetic effect is achieved with hyaluronic acid dermal fillers that are highly elastic, cohesive, and with good adaptability to their environment.
Autogenous fat transplantation and botulinum toxin injection into the masseter muscle to create an ideal oval face
Many East Asian patients with wide faces seek removal of part of the mandibular angle or zygoma to achieve a perceived ideal facial contour, note the authors of this paper. Because the procedure is high risk and the recovery period is relatively protracted, the investigators sought to achieve the desired facial contours through autologous fat grafting (AFG) combined with masseter botulinum toxin (BTX) injection for patients with wide faces and masseter hypertrophy.
In a series of 14 patients presented in this paper, the combination of AFG and BTX injection achieved the desired oval face contour in East Asian patients with very few complications. The investigators note that patient recovery was rapid, and their satisfaction was high.
VIDEO: Non-Asian vs. Asian Plastic Surgery Aesthetics | Wave Plastic Surgery
At the intersection of skin and society
As part of CBC’s The Things I Wish I Said series, a Japanese-Canadian family discusses their experience in Canada over the last century and how it led to a disconnect with their culture.
The Things I Wish I Said is “a series that captures intimate conversations among three Ottawa families of Asian descent, as parents and children open up about racism and their identities,” according to the CBC.
In a 10-minute video, members of the Kamibayashi-Staples family talk about their initial settlement in Vancouver in the early 1900s, incarceration by the Canadian government in internment camps during the Second World War, and their experience with racism in the present day.
The video, a partial summary, and links to the two other parts of The Things I Wish I Said series are available on the CBC’s website here:
Vender on Psoriasis: Episode three
The Chronicle Podcast System’s program about psoriasis with Dr. Ronald Vender, based on Dr. Vender’s popular column in The Chronicle of Skin & Allergy, continues. In this third episode, Dr. Vender discusses the effect of alcohol on treatment response, biologic fatigue and treatment changes in biologics. Listen here.
This week
February is Raynaud’s Awareness Month
Feb. 7 is National Black HIV/AIDS Awareness Day in the US
Feb. 11 is International Day of Women and Girls in Science
Something to think about in the week ahead…
Next week
The risk of causing unwanted pigment changes can lead many dermatologists to hesitate to use energy devices to treat skin of colour. In a presentation at the 7th Annual Skin Spectrum Summit, Dr. Vincent Richer provided recommendations on when and how to use energy devices more safely on darker skin. He also describes alternatives for when energy devices may not be the best choice.