Cosmetic surgery is becoming increasingly popular throughout the world, and Asia is no exception to this trend. Once regarded largely as a frivolous pursuit of the privileged few in the upper echelons of society, cosmetic surgery has taken off in a big way. All across Asia cosmetic surgery is rapidly gaining acceptance in mainstream society. Several factors have worked in tandem to promote this: improved socioeconomic conditions, shifting cultural norms, and exposure to Western cultures through the media and frequent travel, among other things.

The perspective of Asians seeking cosmetic enhancement is generally quite different from the outlook among Westerners. Asians tend to be more reserved when discussing such procedures, and discretion is an important consideration. Most patients seeking cosmetic enhancements today desire a natural result that is in harmony with their ethnic features. This is in contrast to the Westernizing procedures that were popular in the 1970s and 80s. The so-called natural look is, of course, difficult to define, but most patients would be dissatisfied if friends could spot that they had had cosmetic surgery. They would be most satisfied if friends notice a favorable improvement in appearance but could not pinpoint what was done.

In Asia, as elsewhere, there is a trend toward minimally invasive and non-invasive procedures, because they minimize or even eliminate downtime. The desire for subtle enhancements with minimal or no telltale signs of cosmetic surgery falls nicely within the ability of these procedures to deliver. The use of botulinum toxin (Botox) injections, skin rejuvenation with lasers or IPL, skin tightening with radiofrequency, thread lifts, and fillers has increased exponentially in recent years and has

Rhinoplasties currently performed in Asia usually involve placing silicone implants. It has been widely held that the thicker nature of the nasal skin and the weaker nasal cartilages make suture and nasal grafting techniques less suitable. However, many surgeons are increasingly rediscovering the versatility and advantages of autogenous materials such as Gore-Tex, with excellent and stable long-term results.

Fat injection, either as a primary or an adjunctive procedure, is increasingly being performed for a variety of cosmetic indications. Areas such as the upper eye-lid, nasojugal groove, nasolabial folds, and glabella frown lines are treated, with good outcomes. Contour irregularities in the face and other regions of the body are also treated with success. This renewed interest has followed the favorable long-term results demonstrated by pioneers and advocates of this procedure throughout the world. Fat injections for breast and buttock augmentations are newer, albeit more controversial applications for this technique. Although in-creasingly being done in Asia, wider application will have to await results of long-term follow up of these procedures.

Certain procedures that are virtually unknown in the West are in demand in Asia, such as the procedure used for a deformity known as radish leg, a term used to describe the bulky calves seen in some Asians. This calf deformity is caused by a combination of the shorter bone structure and the more ovoid configuration of the gastrocnemius and soleus muscles in Asians. Many techniques have been attempted to address this problem with varying success. Botulinum toxin type A gives temporary and inconsistent results. Unlike the experience in the West, liposuction in this group of patients is mainly an adjunctive procedure, because the underlying problem is muscle hypertrophy. Muscle debulking has been performed, but it results in unsightly scars in a highly visible area. Recently, excellent results have been obtained through the development of selective denervation of calf muscle by cutting the nerve to the medial gastrocnemius and partially transecting the nerve to the soleus using a 1-cm incision in the popliteal fossa. Another procedure in demand in Asia is bilateral or unilateral dimple creation. A dimple can be created by inducing adhesion between the dermis and deeper tissues of the cheek. This can be accomplished using incision or suture techniques. Such procedures are in demand because of different physical attributes and cultural preferences in Asia.

Facial contouring in Asia has traditionally focused on bony osteotomies. Malar reductions, genioplasties, and mandibular angle reductions remain popular and are commonly performed. Indeed, dramatic and excellent improvement in facial profile can reliably be achieved using these procedures. However, the concept of facial reshaping with fillers, particularly fat grafts, is gaining popularity. Such an approach focuses on balance and harmony of facial parts by selective soft tissue augmentation, without needing to shift bony relations, and it can achieve very satisfying results. Facial reshaping is appealing to patients who are not willing to undergo osteotomies and who want to avoid the prolonged recovery needed after such major procedures. With more experience, facial reshaping may develop into a viable alternative to conventional orthognathic surgery in appropriately selected patients.

Cosmetic surgery is traditionally pioneered and practiced by plastic surgeons. As elsewhere, this lucrative field in Asia has attracted surgeons from other specialties and even from non-surgical specialties. In some less regulated areas, cosmetic surgery is even performed by non-physicians who are clearly unqualified to provide such services. Although this is generally accepted (or tolerated) by local communities, plastic surgeons have a responsibility to safeguard the public against unrealistic claims made by some of these practitioners. We in turn must continue to improve our skills, to be continuously updated on the latest developments, and to occupy a core position in developing these techniques. 

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