ORIENT: Artistry On The Oriental Face

Artistry On The Oriental Face
by Dr. Harry V. Eisenberg, Plastic and Reconstructive Surgeon

Ever since Cleopatra first dabbed eye make-up on--- perhaps even long before that--- women all over the world have been struggling to do everything they could to enhance their looks.
For instance, women have been known to slather hot mud packs on their faces, wallow in hot milk baths, suffer through painfully tight corsets to "slim down", and in certain Asian countries, wrap their feet in steel to stunt growth--- all to achieve some feminine ideal of beauty.
Down through the ages, the concept of beauty has been determined pretty much by the culture and eye of the beholder. It has evolved, however, into a noble notion that the old can grow young and housewives can become glamour girls, if they try hard enough. Today, the consuming preoccupation for both men and women is to retard the inevitable aging process and hold on to youth as long as one can. This led to their compelling fascination to not only ignore their body limitations and defy their natural body structure but seek repair and reconstruction.
Sagging eyebrows, excess skin on upper eyelids, bags under the eyes, skin wrinkling, too much abdominal fat, reshaping the nose, the chin or cheeks, diminishing prominent ears, body contouring, breast enlargement, breast reduction, face lifts, tummy tucks--- these are only some of the reasons one seeks a cosmetic surgeon, who must be, on top of it all, also a consummate artist who will re-define one's facial features and re-contour one's body.
How about such artistry on the oriental face?
Dr. Harry V. Eisenberg, head of the Maitland Cosmetic Surgery Center in Maitland, Florida and past president of the Florida Society of Plastic and Reconstructive Surgeons, is both a cosmetic surgeon and a reconstructive artist.
"Culturally", he notes, "Asians are not as concerned with the aging process as Caucasians. Thus, facelifts among Asians are rare. They seem, however, to be more interested in changing their features--- eyes and nose. Asians want some fold or crease in the eyelids. Often this is to correct vision impediments caused by overhanging upper eyelid skin. Also, typically, they have a flat and broad nose which they want to enhance to achieve a profile. Or to correct some breathing problems."
"Elective cosmetic surgery is primarily female-dominated, especially in facelifts. Males account for only fifteen percent of the total. It's more acceptable, it seems, for men to look older. There are different expectations. A fifty-year old man who looks good, looks fifty. A fifty-year old woman who looks good looks thirty."
Instead of a facelift, which is more for tightening skin, Asians favor a face peel which is more for wrinkles. The function of a skin peel is to create an evenly controlled shedding of several layers of damaged cells. This exposes a fresh layer of skin with a more even color and a smoother texture. In addition, the peel stimulates new cells to grow, thereby tightening the skin, which decreases wrinkling.
There are several kinds of peels, he said, each using a different chemical to create a peeling effect. Light and medium peels use TCA or "trichloroacetic acid", which is a non-toxic chemical in use for more than 30 years. TCA peels have the added advantage of creating a fresh, natural-appearing complexion, while preserving the normal skin color. That's why they are often referred to as "freshening peels". They effectively improve conditions such as dull, weathered skin, freckling, blotchy pigmentation, sun damage, fine wrinkles and shallow acne scars.
Performed on an out-patient basis, TCA peels cause momentary burning or stinging--- so brief that most patients choose not to use any sedation or anesthesia. Most take five to seven days to heal. However, there is no pain during the healing process; it simply looks like a severe sunburn. For awhile after the peel, it's important to avoid strong sunlight and protect the skin with sunscreen and/or a hat.
According to Dr.Eisenberg, many patients fear that the change will be so great that people will notice. Experience has shown, however, that in a few weeks, other people won't remember how you looked before. Those who are not aware of the surgery may not even notice at all.
Dr. Robert S. Flowers, clinical professor of plastic surgery at the University of Hawaii, has performed surgical procedures on more than 20,000 Asians. He has been honored worldwide as a lecturer and educator, and is well known as an author, essayist, medical illustrator, artist and sculptor. In addition, he is also an accomplished musician, composer, and poet--- another artist performing cosmetic artistry on the Asian face.
Most Orientals, he said, have some degree of upper eyelid fold during youth. To avoid the inevitable drooping as the eyelid, forehead, and scalp skin stretches, which requires the individual to constantly raise his or her eyebrows to allow adequate vision, many choose to undergo eyelid surgery or "blepharoplasty" as a teenager. Between one third and one-half of all Oriental blepharoplasties are performed before the age of 20.
"Like Caucasians, Orientals also develop pouches beneath the eye that create a tired look. Due to heavier skin padding, however, this condition is not as prominent. Scarring shows more on Orientals or East Asian skin and, therefore, this requires careful placement of the scars within the newly-created upper eyelid folds. Scars should not extend beyond the crease."
"Some Orientals have deepset, hollowed-out upper eyelids, which can be helped by the surgical transfer of scalp tissue or excess lower eyelid fat to fill in the deficient area. Fat injection has never been a satisfactory solution to this problem", he added.
Once performed, "blepharo- plasty" in the Oriental face alters the eyelid structure permanently. "Because of the removal of skin and fat during this procedure, individuals who have undergone fold-creation procedures on their eyelids have virtually no opportunity to regain their original appearance," says Dr. Paul L. Schnur, assistant professor of plastic surgery, Mayo Clinic Medical School in Scottsdale, Arizona.
Dr. Flowers believes this is seldom a problem, however, when the surgery has been performed well. "I have never seen a patient with an artistically and sensitively created lid fold who wished to have it reversed." He stresses, however, that there is rarely a desire among East Asians--- either here or abroad--- to Caucasianize their appearance. The desire is simply to be beautiful or handsome, consistent with beautiful or handsome people of their ethnicity. Keeping the patient's ethnic identity intact is important, a fact often poorly understood by Western surgeons.
In an article he wrote, Dr. Flowers stated that, "it does not follow that someone who undergoes cosmetic surgery is necessarily going to look better. Nor does it follow that the patient will be happy with the new appearance alteration. For this reason, it is most essential to establish good communication with the patient undergoing surgery. This is sometimes difficult if a language barrier exists. At other times, the patient may believe in some way that the surgeon knows all--- not only how one should look, but how one wants to look."
From one principle the surgeon should never deviate--- he should never create a change that goes against his own aesthetic judgment, he added.
"The motives behind cosmetic surgery differ between Asians and non-Asians. When the Oriental woman comes in, it is usually at the encouragement of her husband, and she does so with the desire to please her mate. On the other hand, it is not unheard of for a Caucasian woman to "surprise" her husband or not tell him at all that she had surgery done," says Dr. Eisenberg.
"The two outstanding features about the Oriental face are the roundness of the face and the high cheekbones. These features you do not want to disturb. They also have characteristically broad noses. The combination of these three factors creates a sense of flatness to the face. The goal is to have three-dimensionality to the face while maintaining the ethnicity within their universally-accepted standards of balance and beauty. The total look must be aesthetically pleasing."
"The change must be subtle, all alterations must be aesthetically accurate, and ethnically correct. Whether it is repairing the upper eyelid (blepharoplasty) or repairing the nose to add additional height to the bridge (rhinoplasty), a surgeon must always be sensitive to the unique aesthetics of the oriental face. To a great degree, he must be an artist. After all, he is performing artistry on a face."
"My wife tells me I was born in the wrong era", relates Dr. Eisenberg, "I belong in the middle ages, and that I am a renaissance man. I love being surrounded by art, and in my own way, I am creating works of art. Because I love the artistry involved in reconstructive and cosmetic surgery."
"I was drawn to cosmetic surgery to be able to have normal and controllable office hours, to give me time to be with my family, enjoy the opera, theater, and ballet. I love to cook and create gourmet recipes for my friends. I dabble in photography, painting and piano. Besides, when I began my surgical training, I started out doing general surgery and found it wasn't enough just removing the gallbladder, that must be performed artistically and aesthetically, too. So I specialized on plastic surgery instead, cosmetic and reconstructive in particular."
"Each case is different. Many times, during surgery, I literally have to devise and "make up" the operation as I go along. You pre-visualize the "look" you want to achieve and must already know the desired outcome. I have performed the surgery in my head before I even get to the table."
"Artists have a high degree of focus and concentration. It is important that a surgeon has this ability, and an artist's drive. Sculpting has helped my skills as a cosmetic surgeon. It gives you a feel for, and sensitivity to, the human anatomy. Particularly in lipo-sculpting, which is sculpting and redesigning the anatomy through fat removal. This is different from lipo-suction, which is removing fat from the thighs and the stomach. These are not indiscriminate procedures, they are specific. While the right hand holds the surgical instrument, the left hand must feel and interpret the process. "
"Aesthetic surgery is not just treating the patient physically. We are really treating his soul, the inner person. I must help him be happy with himself. I don't think there is anything more important than that."
Before considering cosmetic surgery, Dr. Eisenberg advises, locate a board-certified plastic surgeon, call the American Society for Aesthetic Plastic Surgery for a referral, or contact your local hospital. The first step is a consultation, which generally takes upwards of an hour. Don't hesitate to ask the specialist for his credentials. Photographs are taken and the surgeon thoroughly reviews with the patient the steps of the procedure--- how involved it is; how the person will look, and what to expect in post-operative care. In Dr.Eisenberg's center, surgery is generally performed on an out-patient basis, which eliminates a hospital bill. It creates an atmosphere of intimacy and privacy. Most procedures take only an hour, sometimes two.
Patients often experience some apprehension. "Is it going to hurt?" and "what will it look like after?" Surprisingly, Dr. Eisenberg says there's very little pain in any kind of facial surgery. Since patients are sedated, most remember little or nothing about the actual operation. There's some swelling and discoloration of the face and eyelids after the surgery. Occasionally, the whites of the eyes may be bloodshot. This is both normal and temporary. Bruising, especially with nose surgery, occurs most notably on the second and third days. Depending on the type of skin and patient's age, discoloration generally diminishes in about 12 days. The upper lip may feel stiff with some numbness noticed over the tip of the nose for a while.
After eye surgery, bandages are placed on the eyes overnight. Afterward, compresses soothe and reduce swelling. After nose surgery, a restrictive splint is placed on the nose for about 7 days. Additionally, there will be packing inside the nose for a few days, so you have to breathe through the mouth, causing some membrane dryness. A feeling of congestion is also normal for awhile.
Expect to resume normal activities in two weeks or less, a small price to pay for looking and feeling better about yourself.
For qualified cosmetic surgeons in your area, contact the Plastic Surgery Referral Service at (800) 635-0635.

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