Filler Injections in Asians: 4 Key Treatment Areas & Techniques
The global rise in aesthetic injectables emphasizes the need for culturally sensitive approaches tailored to diverse patient anatomies. While injectables for Western patients often focus on enhancing pronounced features or adhering to "golden ratios," treating Asian patients demands nuanced techniques that respect their unique anatomy and cultural beauty ideals. This article draws upon the work of Fabi, Park, Ho, Vachiramon, and Dayan (2023) in the Journal of Cosmetic Dermatology, providing insights into the anatomical and procedural differences essential for achieving optimal outcomes in Asian patients.
Distinctive Features of Asian and Western Facial Anatomy
1. Skeletal Structure and Projection
Asian Patients: The skeletal morphology is characterized by flatter contours, including a retruded forehead, shallow orbital rims, and less chin projection. The low nasal bridge and wide bizygomatic and bigonial widths contribute to a more rounded facial shape.
Western Patients: More prominent skeletal projections, including pronounced nasal bridges, deeper orbital rims, and sharper jawlines, result in angular facial structures.
2. Skin Quality
Asian Patients: Thicker dermis with dispersed melanosomes provides resilience against fine wrinkles but makes them more susceptible to post-inflammatory hyperpigmentation (PIH). Hooding or heaviness in the upper eyelids is common due to a combination of thick skin and shallow orbits.
Western Patients: Thinner skin that ages more visibly, with a focus on wrinkle reduction and texture improvement. Treatments often address volume loss more aggressively.
Asian Specialised Injection Techniques for 4 Different Treatment Areas
1. Eyes and Brows: Refining Expression and Shape
Usual Treatment for Western Patients: Western eyelid rejuvenation focuses on volume restoration in the orbital hollow, reducing wrinkles, and lifting the brow. Techniques typically involve deep filler placement under the brow and into the tear trough to open the eye and improve symmetry.
Why This Doesn’t Work for Asian Patients:Asian eyelids often have thicker skin, shallow orbits, and retruded orbital rims, leading to hooded or heavy eyelids. Applying Western techniques risks bulging or exaggerated results that distort the balance of the Asian eyelid. Moreover, lifting the brow too aggressively can look unnatural.
Technique for Asian Patients:
Objective: Open the eyes, enhance brow projection subtly, and create harmony without over-Westernizing the features.
Fillers: Inject small volumes (0.2–0.5 cc) into the retro-orbicularis oculi fat (ROOF) and preseptal space using a cannula. These areas are ideal for creating a more open and rounded eye shape.
Brow Adjustment: Support the lateral brow with filler injections into the ROOF above the preseptal space. Combine with microfocused ultrasound (MFU-V) to lift the lateral brow (~1.9 mm).
Botulinum Toxin: Apply small doses to enhance brow elevation and smooth dynamic lines in the glabella and forehead.
Outcome:A more youthful and inviting expression with subtle eye opening and brow elevation. The hooding is minimized while maintaining ethnic characteristics.
2. Forehead Augmentation: Balancing Flat Contours
Usual Treatment for Western Patients:Western patients often seek restoration of youthful volume to address hollowness or wrinkles. Higher filler volumes are used, with injections at multiple depths for prominent contouring.
Why This Doesn’t Work for Asian Patients:Asian foreheads are naturally flatter, and excessive volume can result in unnatural bulging that disrupts the softer facial contours. The thicker skin also highlights filler irregularities.
Technique for Asian Patients:
Objective: Achieve soft convexity to address flatness, avoiding overcorrection.
Cannula Injections: Use a 22G cannula to place filler in the subgaleal plane with microdroplet fanning techniques for smooth distribution.
Volumes: Administer 0.5–2 cc per session, staying conservative to prevent an overfilled appearance.
Outcome:A naturally enhanced forehead with gentle convexity, blending seamlessly into the facial structure without altering ethnic identity.
3. Temple Enhancement: Subtle Blending
Usual Treatment for Western Patients:Temple treatments in Western patients often address significant hollowness caused by aging, using high filler volumes and injections at multiple depths.
Why This Doesn’t Work for Asian Patients:Asian patients typically present with mild to moderate temple depressions. Overfilling risks merging the temple with the lateral orbital rim, creating an unnatural “alien-like” appearance.
Technique for Asian Patients:
Objective: Smooth temple depressions while preserving natural transitions.
Filler Placement: Use the one-up, one-over technique or injections along the bone, focusing on blending transitions between the temple and forehead. Watch how to do this technique here.
Outcome:A smooth, natural contour that camouflages mild depressions, enhancing the face's balance and harmony.
4. Lower Face Contouring: Refining the Jawline and Chin
Usual Treatment for Western Patients:Western techniques emphasize angular jawline definition and addressing submental fullness, often with aggressive filler use or liposuction.
Why This Doesn’t Work for Asian Patients:Asian patients typically have broader jawlines and less chin projection. Applying Western techniques can result in overly masculinized or angular outcomes.
Technique for Asian Patients:
Objective: Achieve a smooth oval contour, slimming the jawline and enhancing chin projection.
Masseter Reduction: Botulinum toxin is used conservatively to slim the jaw without causing excessive thinning or hollow cheeks.
Chin Augmentation: Place fillers deep on the bone to subtly enhance anterior projection without widening the face.
Prejowl Blending: Use a cannula to blend fillers into the prejowl and marionette areas for a seamless lower face transition.
Outcome:A refined and balanced lower face with a softer jawline and harmonious chin projection.
Key Safety Considerations
Vascular Safety:
Asian patients often require injections in high-risk areas, such as the tear trough or medial maxilla. A precise understanding of arterial pathways is critical.
Western patients with thinner skin may experience visible filler migration if overfilled.
PIH Prevention:
Asian skin is more prone to PIH after laser or energy-based treatments. Pre- and post-procedure care with topical steroids or antioxidants is essential.
Avoiding Overcorrection:
Asian aesthetics prioritize subtlety and harmony. Excessive volume or overly dramatic changes can disrupt ethnic identity.
Conclusion
As aesthetic medicine evolves globally, understanding the anatomical differences and cultural beauty standards of Asian and Western patients becomes paramount. For Asian patients, treatments emphasize subtle enhancements, harmony, and ethnic preservation. For Western patients, the focus is on restoring prominent features and addressing aging. Tailored techniques ensure optimal results that respect each patient's unique beauty and expectations.
References:
Fabi SG, Park J-Y, Ho WWS, Vachiramon V, Dayan S. Aesthetic considerations for treating the Asian patient: Thriving in diversity international roundtable series. J Cosmet Dermatol. 2023; 22: 1805-1813. doi:10.1111/jocd.15787
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