Aesthetic Plastic Surgery , 14 (1990): 215-221

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Aesthetic Plastic Surgery , 14 (1990): 215-221

  1. 1. 221Aesthetic Plastic Surgery, 14 (1990): 215-221The Development of Aesthetic Facial Surgery in Japan: As Seen Through a Study of JapanesePictorial ArtYukio Shirakabe, M.D.Tokyo,JapanAbstract. A study of pictorial art in Japan reveals a basic approximately 270 years-from the 17th century to the midconcept of beauty which is very much related to the de- 1800s. During this period a distinctive feudal culture andvelopment of aesthetic surgery for the Japanese face. The eyes, lifestyle was established and quickly flourished.nose, and mouth in a round-to-oval face are traditionally Art is often a good subject by which to study the culture andexpressed in a unique manner that is based on the Buddhist history of a poeple. Therefore, it may be interesting to analyzeideas of harmony and universality. The common facial the development of aesthetic facial surgery in Japan through acharacteristics of the Japanese were idealized in a manner that study of Japanese art.was best seen in the oblique view. The key to effective An 8th-century drawing entitled "Ladies under a tree,aesthetic surgery for such facial features is suggested in the decorated with bird feathers in screen panels" reveals the basicauthors ideas for enhancing facial expression and concept of Japanese beauty: a round-to-oval face with gentleindividuality. This can be seen in the double-eyelid operation facial lines, and a straight nose and straight eyes (Fig. 1). Theand augmentation rhinoplasty, which are the two aesthetic flat, broad eyelids and small, receding chin, which were signs,surgery procedures that are more popular in Japan than in the of beauty in this period, expressed the peacefulness and charityWest. of the human spirit. A small mouth with well-shaped lips enhanced the graceful appearance. The most sophisticatedKey words: Japan - Aesthetic surgery - Artistic values - example of this idealized concept of Japanese facial beauty-aTraditional art - Blepharoplasty - Augmentation rhinoplasty sort of "Venus of the Orient- idealization-can be seen in the drawing "Kichijo Ten (Mahasri)" (Fig. 2). The same concept isBecause of the distinct differencs between Caucasian and revealed in a more conventional form in the Printed Scroll ofJapanese facial features, aesthetic facial surgery for the the Tale of Genji, drawn in the l2th century (Fig. 3).Japanese face often puzzles plastic surgeons in Western The well-known ukiyoe art form of the Edo period providescountries. In fact, however, many of the unique techniques us with a variety of examples of facial expressions, all ofused for Japanese faces owe their development to the which are based on the same ideals of beauty-straight eyes andmodernization/westernization and in particular the nose, flat, single eyelids, and receding chin-that typify theAmericanization of Japanese culture over the past 100 years. Japanese face (Fig. 4). These ideals can also be seen in In ancient Japan, the concept of beauty was based on the portraits of beautiful Japanese women who representedBuddhist ideas of harmony and universality. These ideas were traditional spiritual values of obedience, gentleness, andinternalized during the Edo period, when Japan closed its devotion (Fig, 5). The eyes, nose, mouth, and chin in thesedoors to the world for portraits reveal a basic ideal of Japanese facial beauty that has remained the same since ancient times. Strong or unique fa-
  2. 2. 222 Fig. 1. Enlarged detail of the face of "Ladies under a tree, decorated with bird feathers in screen panels," one of the Shoso-in Treasures, drawn in the 8th century Fig. 2. Enlarged detail of the face of "Kichijo Ten (Mahasri)" in Yakushi Temple, drawn in the 8th century Fig. 3. Enlarged detail of a womans face in Illustration 1, Azumaya Chapter, in the Printed Scroll of the Tale of Genji, drawn in the early 12th century Fig. 4. Ukiyoe faces in "Three Beauties of the Kansei Era" by Utamaro Kitagawa, drawn in the 1700s (Edo period) Most Japanese faces are generally wide and flat with a lowcial characteristics, which might represent individuality or projection of the nasal bone and a remarkable protrusion of theself-assertion, were not prized in a society that was zygomatic bones. The flat appearance is further enhanced bygroup-oriented. As a result, one seldom sees signs of the flat, broad upper eyelids and the small, straight eyes. Theindividuality in the faces of women in Japanese art. small, receding chin further exaggerates the wide appearance A closer examination of these portraits, especially the older of the face. The front-maxillary bone is usually prominent andones, reveals that Japanese faces are almost always expressed features thick lips.in half or three-quarter frontal views, never a direct front view A half or three-quarter view of the Japanese face emphasizesor profile. This suggests that the artists of ancient Japan were the projection of the nasal root and mentomandibular line andvery aware of how to best express Japanese facial de-emphasizes the prominent malar areas and mouth, yet stillcharacteristics. permits full
  3. 3. Fig. 5(A) Enlarged detail of the face of the "Wife of Nagamasa Asai,- drawn in the 16th century, (B) enlarged detail of the face of "Maiko" by Seiki Kuroda (1983), (C) enlarged detail of the face of "Kinuta" by Shoen Uemura (1938), (D) enlarged detail of the face of "Hydrangea" by Shinsui Ito (1954)expression of the eyes. In short, because of the morphological low projection of the nasal bone makes the distance betweencharacteristics of the Japanese face, these features are best the medial canthi seem wide and the protruding malar bonesshown in oblique-angle frontal views. totally dominate the width of the face. In the full-side view, the The pre- and postoperative facial characteristics of a patient low nasal projection disrupts the profile line while thecan be compared from three directions-full-frontal, half-frontal expression of the eyes is barely noticeable.and full side-in order to understand more clearly the artistic This patient subsequently underwent a double-eyelidideals of Japanese beauty (Fig. 6). Of all the preoperative operation plus augmentation rhinoplasty with tip contouring.views, the half-front view best shows the patients facial Her postoperative facial characteristics show dramaticfeatures. In the preoperative full-frontal view, the contour of improvements in every view. In the full-frontal view, theboth eyes is clearly shown, but the modified eyes and nose produce a narrowing effect across the width of the
  4. 4. Fig. 6. Pre- and postoperative views of apatient who underwent a double-eyelidoperation and augmentation rhinoplasty
  5. 5. Fig. 7(A) Enlarged detailof the face of "Woman in aRed Dress" by SeikiKuroda (1912), (B) enlargeddetail of the face of "AWoman in Oriental Dress"by Takcji Fujishima (1924),(C) enlarged detail of theface in "Hokei" by TakejiFujishima (1926), (D)enlarged detail of the faceof "Portrait of a Woman"by Saburosuke Okada(1936)face, while the full-side view reveals a profile with much more to Japanese aesthetic surgery as most Caucasians are born withcharacter. clearly delineated eyelid folds. Thus, from a modern Japanese point of view, aesthetic facial Historically, the modernization of Japan began in 1853 atsurgery should enhance the individuality and expression of the the end of the Edo period when Commodore Matthew Perryface, especially in profile. In this regard, the keys to successful opened the country to the rest of the world. The Japanesesurgery are double-eyelid and augmentation rhinoplastic people were astonished by Western civilization, and for theoperations plus careful consideration of the morphological next fifty years, modernization was Westernization, supportedcharacteristics of the Japanese face, perhaps the biggest by a strong admiration for Western things and ideas. Thesource of puzzlement for Western plastic Surgeons who Japanese learned to appreciate individuality and self-deal primarily with Caucasian faces. The double-eyelid expression not only in their way of living and thinking but alsooperation is particularly unique in their appearance. The Japanese
  6. 6. Fig. 8(A) Pre- and postoperative views of a female patient who underwent the double-eyelid operation introduced by Mikamo in 1896. (B) Pre- and postoperative views of a female patient who underwent an augmentation rhinoplasty introduced by Nishihata in 1923 summarized in Figure 9. Note that there is an enormous demand for the double-eyelid operation and for augmentation rhinoplasty. This supports my theory regarding that the intent of aesthetic facial surgery on Japanese patients is to improve the facial expression and emphasize that persons individuality. Rejuvenative facial surgery for Japanese patients should also emphasize the advantages and de-emphasize the disadvantages of Japanese facial characteristics and thus create a youthful appearance as well as improve the individual characteristics and expression of the face. As an example, we can consider the case of an elderly female patient for whom five different surgical procedures were required to repair the ravages of aging and to create a new and more youthful look (Fig. 10). At the age of 51, the patient underwent an upper blepharoplasty as well as double-eyelid and augmentationFig. 9. Totals for the seven major aesthetic operations rhinoplastic operations. Some time later, she underwent a faceperformed at the Shirakabe Clinic from 1981 to 1986 and neck lift as well as a lower blepharoplasty and chin augmentation. In her final postoperative view, her clearlyconcept of beauty was accordingly influenced by this new defined double eyelids and augmented nose and chin havecultural environment. Thus, in modern portraits showing given her a new facial expression. Taken together, theprofiles of beautiful Japanese women, there is clearly an operations effectively removed the signs of aging and created aevolution in the ideals of beauty toward clearly delineated more youthful looking face by improving the patientsdouble eyelids, well-projected noses, and prominent chins morphological features and individuality. The double-eyelid(Fig. 7). operation and augmentation rhinoplasty, therefore, have In 1896, Mikamo [1] published the first paper on the considerable potential for enhancing the faces of both thedouble-eyelid operation, and in 1923, Nishihata and Yoshida young and the elderly.[2] wrote the first paper on augmentation rhinoplasty using a Some morphological aspects of the Japanese face canforeign material (Fig. 8). These surgeons understood that the actually emphasize the aged appearance of many elderlyeyes and nose were the keys to enhancing the individual patients: The protruding malar prominence can result in ancharacteristics and expression of the Japanese face, and a uneven and hollow malar contour, the protruding maxillaryschool of aesthetic surgery for the Japanese face was bone may cause the nasolabial folds to become moreestablished through their innovative techniques. The prominent, and the receding chin can often distort the lowercombination of Westernization with the morphological facial contour. In Japanese eyes, the amount of orbital fat incharacteristics of the Japanese resulted in a new branch of the upper eyelids decreases with age and results in droopingaesthetic facial surgery based on the Western concept of eyelids due to the low projection of the supraorbital rim. Inbeauty. The demand for a "Western look" led to the addition, rings in the lower eyelids often accompanydevelopment of new techniques [3] for creating double eyelids protruding malar bones. Sunken eyes, due to the hollowness ofas well as for augmentation rhinoplasty and augmentation the upper,mentoplasty. The seven major types of aesthetic surgery performed at myclinic over the past five years are
  7. 7. Fig. 10. Pre- and postoperative views of a female patient who underwent five different aesthetic surgerieseyelids, is a special concern because fatty, broad eyelids are Referencesconsidered a sign of youthfulness. Through my long experience in dealing with the Japanese face 1 . Mikamo K: A technique in the double--yelid operation. JI have come to believe that the Japanese beauty ideals of Chugaishinpo, 1896gentleness and tranquility should always be the goal of aesthetic 2. Nishhata T, Yoshida A: Augmentation rhinoplasty usingfacial surgery for Japanese patients who wish to enhance their ivory. Clin Photo 7:8, 1923facial expression, individuality, and youthfulness. 3. Shirakabe Y, et al: The double-eyelid operation in Japan: Its evolution as related to cultural changes. Ann Plast Surg 15:224, 1985

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