The presence of plastic surgery in our society has never been more

The presence of plastic surgery in our society has never been more apparent. However, while the typical image of the plastic surgery patient in the past was white and elderly, Asian-Americans have slowly begun to take advantage of new techniques available for both reconstructive and cosmetic issues. This comes at a time when there is more acceptance about the universality of beauty. The presence of plastic surgery in our society has never been more apparent. However, while the typical image of the plastic surgery patient in the past was white and elderly, Asian-Americans have slowly begun to take advantage of new techniques available for both reconstructive and cosmetic issues. This comes at a time when there is more acceptance about the universality of beauty. Few would deny that Angelina Jolie, Lucy Liu, Halle Berry, and Aishwarya Rai are all extremely beautiful, for reasons that extend beyond their skin color or the shape of their eyes. However, the topic of surgically enhancing beauty has long been a taboo topic in the Asian-American population.

The taboo against plastic surgery is hardly justified when one considers the long history of Asian contributions to the field. In ancient India, amputation of the nose was a common form of punishment for crimes such as adultery. Reconstruction of the nose with the use of skin and tissue from the forehead was first described in the Sushruta Samhita in the sixth or seventh century B.C., and this technique is still performed today in cases of nasal reconstruction following tumor excision. The double-eyelid operation, in which a natural fold is created in the eyelid crease, was pioneered in 19th century Japan, and remains a very popular procedure.

Despite cultural beliefs about plastic surgery, the American Society of Plastic Surgeons (ASPS) has noted the increasing trend in cosmetic surgery among Asian-Americans. They report that in 2006, Asian-Americans made up 6% of all cosmetic surgery patients in the United States. From 2004-2005 alone, plastic surgery in Asian-Americans increased by 58%. The most commonly requested surgical procedures in Asian-Americans are nose reshaping (rhinoplasty), eyelid surgery, and breast augmentation. The most common non-surgical procedures are Botox, facial fillers, and chemical peels.

Traditionally, Asian-Americans requested procedures to make them look more Caucasian, and this may be what made cosmetic surgery such a forbidden topic for so long. Certainly, no one wants to be labeled as a “cultural sell-out”. However, this trend has changed. Today, most Asian-American patients seeking cosmetic surgery wish to undergo subtle changes which will enhance their existing features, and retain their ethnicity. In fact, specific surgeries are tailored towards retaining those defining ethnic features. For example, eyelid surgery in East Asians can produce a wider, fuller eye which still maintains a pleasing almond shape. Nasal surgery in South Asians can reduce the large dorsal hump and lift the nasal tip, without producing a typically European nose. Breast implants in both East Asians and South Asians provide volume which is still proportional to the Asian patient’s typically smaller body shape.

Non-surgical procedures have also been tailored to the Asian-American patient. While Botox is most often used in Caucasians to reduce wrinkles, it is often also used in East Asian patients to relax the masseter muscle of the jaws and reduce the apparent width of the lower face. One Chinese patient stated that after this procedure, she received many comments that she appeared to have lost weight and that she looked healthier. Facial fillers such as fat, collagen and hyaluronic acid are commonly used to fill in folds on the face, but in East and South Asians, who have fewer folds as they age, these tools are more often used to gently plump the lips or enhance bony contours on the face. Chemical peels are common among all races, but special care needs to be used in East Asians, who have more sensitive skin, and South Asians, who have a tendency towards hyperpigmentation. The key is to recognize that every patient has unique facial and body features, and to avoid applying a Western standard of beauty which might produce an incongruent result.

Most Asian-American patients who have undergone cosmetic surgery report that they have no regrets, and that they do not feel it changes their ethnic identity. While the occasional Asian-American patient does in fact wish to change their identity (witness the gradual increase in rhinoplasty among dark-skinned men since September 11, 2001), most are very proud of their heritage and would rather enhance it than change it. However, the stigma remains for some patients. One South Asian patient informed this author that although she has always wanted to have larger breasts, her conservative Indian mother’s horrified reaction prevented her from proceeding with surgery. Another South Asian patient underwent a facelift, but refused to inform anyone outside of her immediate family for fear that the entire South Asian community would comment upon her choice negatively. A Korean-American patient reports that although she is thrilled with the results of her eyelid surgery, she fears being labeled as vain. Perhaps the reticence towards plastic surgery in our community is more a result of our cultural tendency to keep such matters private. Maybe it stems from a cultural belief that the human body should not be altered. In any case, these concerns seem to keep some Asian-Americans from both reconstructive procedures, such as breast reconstruction, and cosmetic procedures.

When seeking more information about plastic surgery, follow the following recommendations: First, choose a surgeon who is board-certified by the American Board of Plastic Surgery (ABPS). While many states allow a physician with no plastic surgery training at all to label him- or herself as a plastic surgeon, only the ABPS requires that the physician complete an accredited training program in plastic surgery and pass a series of rigorous examinations for certification. Second, ask to see before and after photos of the procedure you have in mind, and specifically some of patients with your ethnicity if possible. Third, while your surgeon does not necessarily have to be of the same ethnic background as you, he or she should have sensitivity towards and an understanding of ethnic beauty and concerns. Consider your own biases about ethnicity and be realistic in your expectations. Fourth, be aware that scarring and pigment irregularities are more common in Asian patients. Finally, while prices vary for surgery, do not choose your surgeon based on price alone.

Nina S. Naidu, M.D. is a board-certified plastic surgeon practicing in New York City. Dr. Naidu received her medical degree from Cornell University Medical College and completed her general surgery and plastic surgery training at New York Hospital – “ Cornell Medical Center. She has authored numerous papers in the field of plastic and reconstructive surgery.

Dr. Naidu is an active member of the American Society of Plastic Surgeons, the New York Regional Society of Plastic Surgeons, the Medical Society of the State of New York and the New York County Medical Society. She maintains privileges at Lenox Hill Hospital, Manhattan Eye, Ear & Throat Hospital and the Center for Specialty Care. Visit www.naiduplasticsurgery.com