Does Ethnicity Matters in Cosmetic Jaw Surgery in Singapore?

Corrective jaw surgery serves to correct dentofacial deformities. But how do we diagnose dentofacial deformities in the first place? What is the basis of saying that a particular look is a deformity? To answer this question, we first have to define what is normal. The norm is a mathematical entity. It is quantifiable and measurable. To establish a norm, we take a random sample of the population and measure certain features and get an average figure or a range of figures. For the purpose of corrective jaw surgery, we typically made measurements of the face as well as on x-ray films. A patient’s measurements compared against the normal values will give an indication of where the problem lies. In this respect, it is a bit like a blood test; eg if your hemoglobin is too low, you are anemic and may need treatment. However, unlike a blood test, the normal values in such facial and radiographic measurements are significantly different across ethnic lines. The measurements of a random sample of people from China are going to be very different from those from Africa. So, the scientific literature is full of publications documenting the normal values for different ethnic groups. However, is achieving normal looks the main objective of most patients who undergo cosmetic jaw surgery?

The norm is not necessarily aesthetic. In fact, the norm is most probably not aesthetic. If you just walk around town and look at the faces you see, how many would you consider as a pretty face. Chances are it is the minority. So, do most patients seek surgery to have a pretty face or do they just want a normal face. I would venture to say that if given a choice, most would choose to have a pretty face over a normal face. There are also many studies done to document measurements of beauty contestants instead of a random sample of the population.  Usually these studies are done along racial lines as well. If it is not measureable, it is not Science. Having these measurements render Surgery a Science. However, Surgery is also an Art. And in today’s globalized world, the ethnic lines are blurred and along with that, the cephalometric and arthropometric measurements.

We are all influenced by the popular media’s portrayal of aesthetics. It is not uncommon for patients of one race to seek surgery to look like another race. There are no scientific studies that can document whether surgically changing the jaw to conform to a set of measurements of a different race will achieve a better or worse result. Aesthetics depends a lot on personal preference as well, for beauty lies in the eye of the beholder. It is also a evolving concept that changes with time. Sometimes, a certain kind of look is preferred while a generation later, it may be the diametric opposite that is all the rage. 

To understand a patient’s aesthetic preference, I often use media personalities as examples. I would often ask a patient, regardless of ethnic origin, whether they prefer the sharp prominent facial features kind of look ala Angelina Jolie, or the rounded and softened facial features exemplified by the typical Korean actress.  When I ask this question, I have to be very careful not to mislead the patients into thinking that I can turn them into a Hollywood superstar or a K-pop sensation. It is just to get a sense of their aesthetic taste. This is the Art part of orthognathic surgery.  I think today’s orthognathic patients are exposed to a very global culture and we can no longer apply the supposed normal values strictly, including the normal values of beauty contestants.

However, the measurements are still important, especially in diagnosis. They tell us where the discrepancies lie e.g. is it the upper jaw that is too short or is the lower jaw too long, or a combination of both, compare with ethnic norms. However, when I plan the surgery, the objective is not to move the jaws to a position where I can get normal values when I make the measurements. They serve as a guide only. The treatment objective is to achieve a facial appearance that the patient likes. I use simulation software to show the patient the planned outcome and see if they like it. If not, we work together on the surgical movements to achieve the desired facial appearance. If that outcome results in physical and x-rays measurements that differ from the racial norms, I am not concern.

Fortunately, there are some universal values, things like a well proportion face where the face can be divided into equal thirds, general symmetry of the face and good alignment of the jaws., that are timeless and transcend racial differences. With a globalized economy, there is greater confluence across different ethnic groups of what constitute an aesthetic face. The more cosmopolitan the society, the greater the degree of confluence. In a city-state like Singapore, I find that treatment objectives have significantly deviated from racial norms towards a more international outlook. While the Science of orthognathic surgery can be learned systematically, the Art of jaw surgery in SIngapore requires in-depth understanding of each patient as a unqiue individual with unique preferences, that is influenced by his or her own historical background and life experiences.