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By Ji Hyun Lim | AsianWeek Staff Writer

The elevator’s lights blink. With a loud tone, it stops at the sixth floor. The door opens to a wide, dimly lit hallway. Light from an office at the end of the hall beckons, somewhat ominously. Proceeding closer, the mellow classical music grows louder.

Stepping into the office, the receptionist smiles warmly and tells me to take a seat on the industrial-design style leather couch. The office is decorated sharply, with Matisse prints on the wall and hordes of fashion and beauty magazines on glass-top tables.

Vicki* — dressed in spandex, chunky shoes, an oversized jacket and sporting a mop of curls, framed by an Oliver Twist cap — walks around the office and decides to take a seat next to me.

“What are you getting done?” she asks curiously.

I laugh a little nervously, and tell her that I’m not here for an operation but waiting to talk to the doctor.

I glance at her heavily made-up, flawless face and curiously ask, “Your face is very nice. What kind of work are you getting done?”

She loses her composure, appears flattered and responds, “Oh, I’ve had some work done,” she says demurely. “I actually had my nose done.”

Our conversation is interrupted when another receptionist — a petite, attractive lady — walks through the door and smiles. Faint stretch marks reveal another visage beneath the pretty smile.

“She’s gorgeous,” she remarks about Vicki. “She’s gorgeous …”

A Perfect Face

With the advent of Leonardo da Vinci’s scientific analysis of beauty in 1492 — which models architecture after the “Vitruvian Man,” whose body is perfectly symmetrical — pages upon pages in medical books have created the foundation of an ideal beauty based on symmetry and balance. Facial beauty has been defined as the achievement of a perfect proportion of vertical thirds, from the crown of the head to the chin, while the width of the face is divided in fifths. Since then, the fascination with achieving beauty has not waned.

With body alteration now a well-accepted procedure in the 21st century, many Asian Pacific Americans are embracing cosmetic surgery as a solution to their bodily flaws. Both surgeons and patients are discovering new techniques for treating APA clients. According to the American Society for Aesthetic Plastic Surgery (ASPS), APAs accounted for 4 percent of all cosmetic procedures performed on minorities.

Vicki’s nose job was among the 8.5 million cosmetic surgical and nonsurgical procedures performed in 2001. From 2000 to 2001, there was a 48 percent increase in the number of cosmetic procedures. The top five surgical procedures were liposuction, eyelid surgery, breast augmentation, nose reshaping and facelift. The top nonsurgical procedures were botulinum toxin injection (otherwise known as botox), chemical peel, collagen injection, microderm abrasion and laser hair removal.

With this growing interest in surgeries and the rising APA population, ASPS predicts that it is just a matter of time before the number of cosmetically altered APAs starts to go up as well.

Before (left) and after photos showing the results of rhinoplasty.

Forty-two-year-old Dr. Corey S. Maas stands tall and confident. His features are distinct and slightly rugged, with slightly graying hair as the only sign of aging. Maas admits that regular injections of botox — to firm the skin — and Intense Pulse Light (IPL) treatments — to remove age spots and blemishes — help him to look young. He points out that for the past 12 years, his cosmetic surgery practice has allowed “inner beauty to show outwardly.”

Maas says that cosmetic surgeons aim to “correct” features that are not in proportion with the rest of the face. He says blepharoplasty, or eyelid surgery, and rhinoplasty are among the most popular surgeries performed on APAs. ASPS confirms that the number of eyelid surgeries performed, which costs between $1,500 and $3,000, nearly doubled between 1999 and 2001. Maas explains that the surgery requires doctors to make an incision, then remove excess fat, muscle and loose skin. The lid is then re-sutured to close the incision. The result is a double lid that opens the eyes and makes them appear rounder.

Dr. Maas manipulating a photograph on his visual imaging computer. Photo by Ji Hyun Lim.

Dr. David L. Kahn has practiced cosmetic surgery since 1978 and has had a significant number of APA patients for the past 15 years. He agrees that plastic surgery has changed with technology and culture. Kahn has discovered that Asian faces have different needs and he employs techniques that are specialized for APA patients.

Rhinoplasty, an operation that reshapes the nose, is a popular operation for many APAs, he said. The surgery costs between $2,500 and $7,000. In the surgery, incisions are made and the skin of the nose is lifted from its underlying bone and cartilage support system. Underlying bone and cartilage are removed or rearranged to provide a newly shaped structure. Kahn uses grafts in the nasal tip and uses an L-shaped implant to create a higher bridge and to narrow a nose that is too flat. Then, he applies “struts” in the nose and a mesh material for the bridge.

“Each nose is treated individually.” Kahn said. “If I do Asian eyelids, I put a stitch in that tightens the lower lid and brings it up, it creates less of a round look. People’s eyes look better with an almond shape.”

Culturally Defined Beauty

Cultural anthropology professor Yoshiko Miko Yamamoto. Photo by Ji Hyun Lim.

“Cute is popular,” Yamamoto said. “The average person is not symmetrical but it’s a natural phenomena not to accept it,” she said, brushing away her salt-and-peppered hair.

Pushing back her glasses and intently studying the photographs, Yamamoto argues that beauty is not strictly defined by anatomical standards but is influenced by culture.

“The contrasting images of old and new ideas of beauty reflect the dynamic nature of human perception of society’s ideal,” she said. Yet, she does point out that “growing need for physical perfection” will continue to make cosmetic surgery a growing industry.

The time period, class, status and environment are the cultural variables that help mold “modern versions of beauty,” Yamamoto said. In Japan, The Tale of Genji — a novel written about courtly life in the 11th century — influenced beauty ideals and aristocratic appearance, creating an emphasis on pale faces, a robust body and flamboyant dress.

“The more roundish body showed affluence,” she said. “It was a symbol or sign of wealth. Today, everyone is getting slimmer and prefers dark skin. Many years ago, farmers use to cover their faces to prevent a dark complexion.”

Yamamoto states that with the economic affluence in modernized countries, people opt to change their lifestyles and image. “Ideals are not necessarily global,” Yamamoto remarked. “Versions of beauty vary from culture to culture. Media influences and the idolization of popular star icons have made a drastic change in contemporary Japan’s version of beauty.”

She theorizes that young people are a “lost generation who seek identity” with a peer group. Standards of beauty are getting more uniform through media, which appeals to young generations.

“Plastic surgery won’t change genetics. But the growing impact of technology and cultural contact with other countries will allow plastic surgery to survive because styles and types will change and human nature will persuade people to go under the knife,” she said.

Still slightly optimistic, Yamamoto sighs, “Pretty won’t get you far though. Creativity and uniqueness is rewarded. Facial modification is not permanent because the face changes and constantly needs to be modified as one ages. It’s also time-consuming and expensive.”

Asian Pacific American Beauty

Dr. Won Hyok Bae contends that culture has redefined techniques — especially concerning blepharoplasty. Ten to 20 years ago, many eyelid surgeries were performed to make the eyes look Caucasian. Bae points out that the anatomical structure of the Asian lid prevents this procedure from resulting in an aesthetically pleasing result.

“The current trend is more natural and Asian-looking eyelid and natural fold,” Bae said.

Bae, whose client base is 90 percent Korean, claims that Korean television and movie stars have a different appearance and that many of the trends in plastic surgery reflect this. Sam Mi Ja, a movie star 10 years ago had a tall, high eyelid fold with a deep-set orbital area which resulted from too much fat removal. Recent Korean icons like Shim Eun Ha have small creases and many of her fans request a similar look.

Bae also points out that Asians tend to have a mesocephalic shaped head — one that is shorter and rounder. He contends that Caucasian heads tend to have a dolichocephalic head — one that is slender and longer.

“Applying the same proportions to the different skeletal frame would be making a huge, horrendous mistake,” Bae said.

Maas agrees that surgical procedures on APAs have changed. “Older western versions of the high lid fold are not as popular,” he explains. “ Surgeons are increasingly becoming more culturally and ethnically sensitive.”

Constant Remodeling

Rita*, a solidly built Laotian woman, walks through the door with a self-assured presence. Her gait is firm and one can’t help but notice her smart clothes, gold accessories, coifed hair and quiet elegance.

“Hello,” she says, as she seats herself on the sofa. “Are you the one I was suppose to speak to?”

Her lips are swollen and she speaks carefully and deliberately.

“Are you here to see the doctor?” I ask.

She explains that she has recently had surgery on her lips. A small, soft piece of synthetic foam was inserted into her lips to give them a fuller effect. She says she feels prettier after having her operation 18 days ago. Though her lips feel tight and are not quite healed yet, her confidence in her surgeon is still strong.

“He’s very good,” she says.

Upon talking to her, I discover that cosmetic surgery has been a part of her life for the past 10 years. At age 42, she admits to having had blepharoplasty, rhinoplasty, breast enlargement, liposuction, scar removal and lip surgery. In five years, she plans to have a facelift. None of her surgery has been covered by insurance and she explains that it has been a costly habit.

“I attract more attention and people say nice things to me,” Rita explains. “I like to dress up and people say I look sexy. I don’t care what people think of me. I feel confident.”

With Rita, plastic surgery operations have been another way of life. Her comfortable income as a business executive has allowed her to continue her operations. Looking at her face, it is hard to imagine what she looked like before the operation. There are no traces of scars; however, her face seems stiff, tight and poreless. She explains that her standards of beauty are not affected by mathematical standards, cultural influences or idol worshipping. She contends that all of the operations were done out of a personal vision of beauty.

Constantly changing her face has been a way to “bring out her confidence” but some doctors say that patients like Rita, with numerous surgeries under their belts, may border on obsessive-compulsive behavior.

“People who overuse cosmetic surgery have a body image disorder,” Maas said. “It’s like anorexia nervosa and bulimia. Treatment can be dangerous to these patients. It’s all about managing expectations and educating people of clear and realistic outcomes. We concentrate on people who want to look good on the outside as they feel on the inside.”

Rita’s name is called by the receptionist and she excuses herself and walks to the front desk.

Shortly afterwards, Vicki returns to the reception area and sits down. She watches Rita walk into the surgeons office, the door closes tightly behind her. The receptionist delivers one last compliment, “That Rita is gorgeous,” she says. “Just gorgeous.”

*Names have been changed.

Reach Ji Hyun Lim at jlim@asianweek.com