Eastern aesthetics in general are different from the traditional dermal filling in Westerners. Some examples of commonly performed dermal filling procedures include-

• Tear trough fillers for dark circles and medial lid-cheek enhancement
• Liquid rhinoplasty to define the nose
• Chin & jawline shaping (most often in combination with facial slimming)
• Fat transfer is another alternative to dermal fillers

Asian aesthetics are unique, namely the aim in most cases is to elongate & slim. Asian women are typically broad faced, with strong jawlines & sharp angles. The aim is to soften facial outlines to more of an oval shape, rather than ‘boxy’.

The most commonly performed method to slim the face is to Botox the masseter muscle just in front & below the ear. This slims the face, whilst dermal fillers to the chin can elongate, giving a nice subtle taper. Chin projection can also be achieved with dermal fillers.

Dermal fillers can reshape the nose, creating a better front & side profile. The most common area to enhance is the nasal bridge. Dermal fillers in this area can give a perception of projection & definition, reducing the ‘flat’ look commonly seen in Asian patients.

Dermal fillers in this area typically last around 12-14 months. For nasal contouring I always use hyaluronic acid fillers for two reasons- safety & reversibility.

It is important to address the underlying causes of dark circles. In Asian ethnicities one of the major contributing factors is tear trough related, coupled with maxillary hypoplasia or lack of anterior projection). By building up & supporting the mid-cheek area, shadows contributing to dark circles can be diminished.

Dermal fillers are the preferred treatment of choice for creating volume, structure & improving aesthetic deficiencies. I occasionally use fat transfer in this area (pros & cons discussed elsewhere).

Other causes of dark circles include vascular, or prominent capillaries & veins. Simple vascular laser or IPL-BBL can help. For increased pigmentation due to melanin or post inflammatory skin colour changes, pico or nano lasers can help.

Cases such as pigmentation demarcation lines & constitutional physiological pigmentation are difficult to treat as these are genetically & racially determined. The use of precise skin care & sun protection can marginally improve these conditions (at best).

Skin care is super important. Hyaluronic acid creams can hydrate, retinol & peptides can increase collagen, whilst ascorbic acid, tocopherol, ferulic acid & green tea can protect from UV & environmental oxidation. Caffeine & tranexamic acid can modify blood vessels that contribute to dark circles. 

The number of pigment cells, known as melanocytes, are the same across all races & ethnicities. They occupy the basal layer of your epidermis. The activity of these cells are controlled by ethnicity, UV exposure & hormones. Asian patients have a higher activity of melanocytes compared to Caucasian counterparts. This increased activity accounts for post inflammatory hyperpigmentation.

Hyperpigmentation can be treated with chemical peels, lasers & prescription skin care. Addressing the cause of pigmentation (most often acne) is paramount in preventing further darkening.

In most cases I combine lasers for skin lightening, and energy devices for skin tightening with injectables on the same day.

Lasers I employ for skin lightening include picolasers, dermal toning laser, Fraxel, Clear & Brilliant as well as vascular lasers. Skin tightening can be achieved with devices such as Ultherapy, Tempsure & Thermage.

Non-surgical skin tightening procedures are more effective in Asian patients as collagen bundles & production is exaggerated in ethnic skin (the flipside is that ethics are more prone to overproduction of collagen, namely keloid & hypertrophic scarring). Treatments include-

• Ultherapy or HIFU: uses high intensity focused ultrasound to tighten.
• Thermage: uses RF or radiofrequency in short bursts.
• Tempsure – Pelleve: uses RF in longer bursts to stimulate collagen production.
• Threads– include monofilament & suspension MINT threads.

In general, Asian patients compared to Caucasian counterparts are less expressive, this means that less muscle relaxants (Botox, Dysport, Xeomin) are required to get the end result. This especially applies to forehead wrinkles & the frown line. 

The flipside is that masseter activity (chewing muscle) is more active in Asian ethnicities, especially in Chinese & Korean patients. This accounts for the wider Asian face. Accurate placement of muscle relaxants can slim down the face, in turn improving facial aesthetics.