Embracing Diversity in Asian Facial Morphologies: Rethinking Terminology in Eyelid Surgery

Asia, a continent renowned for its vast geographical expanse and cultural richness, is home to a kaleidoscope of ethnicities and races, encompassing 5 regions: East Asia, Southeast Asia, South Asia, Central Asia, and West Asia. Despite this rich diversity, the term “Asians” is often used to homogenize the multitude of facial morphologies found across the continent. The diversity among Asians across various regions underscores the unique characteristics present within different ethnic groups. For example, individuals from West and South Asia, extending from Turkey to India, often display Caucasoid features. Historical plastic surgery literature from the 1950s perpetuated the misconception that all Asians lack an eyelid crease, giving rise to the term “Asian blepharoplasty.”1,2 However, physical traits such as eyelid features are influenced by a complex interplay of genetic, environmental, and evolutionary factors, and should not be construed as indicative of specific evolutionary paths or cultural histories. Therefore, it is essential to move away from blanket terms like “Asian blepharoplasty” and adopt more precise terminology. The term “East Asian blepharoplasty” is recommended to accurately reflect the predominant presence of monolids among East Asians or individuals with Han features, such as those of Chinese, Japanese, Korean, and select Southeast Asian descent. This shift in terminology acknowledges the diverse facial features among different ethnicities and promotes more inclusive language. Precision in language is particularly crucial when discussing facial morphologies, especially in regions with significant ethnic homogeneity like China, where more than 90% of the population is Han Chinese. Advocates for the term “East Asian” blepharoplasty argue that using “Asian” lacks specificity, perpetuates racial stereotypes, and carries ethnic biases. Despite grouping East Asians with Southeast Asians under the Mongoloid category, it is essential to acknowledge the unique facial characteristics that differentiate these diverse groups.3,4 It is important to recognize that diversity extends beyond East Asia. Southeast Asia, for instance, boasts a myriad of ethnicities, each with its own set of cultural standards and physical features. Similarly, South Asia challenges the stereotype of a standardized Asian appearance, with features often aligning more closely with the Caucasian category. Central Asia exhibits a diverse array of appearances shaped by historical interactions and genetic influences. Although not all Central Asians lack an upper eyelid crease, its prevalence is higher in countries with higher East Asian ancestry, emphasizing the need for nuance in our understanding of facial morphologies. West Asia, often referred to as the Middle East, is home to populations with anatomical features that align more closely with the Caucasian category, further underscoring the complexity of diversity within the continent. In conclusion, the blanket term “Asian” fails to capture the rich tapestry of facial morphologies found across the continent. By embracing more precise and inclusive language, such as “East Asian blepharoplasty,” we honor the diversity of ethnicities and cultures that make up Asia. Understanding and appreciating this diversity not only fosters a more accurate depiction of facial features but also promotes inclusivity and respect for the multifaceted nature of the Asian continent. Let us celebrate diversity and reject simplistic stereotypes in our discourse on cosmetic procedures and beyond. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.