Facial soft tissue fillers are an integral part of aesthetic medicine. The majority of clinical trials and reports in the literature suggesting facial plastic surgery are aimed at improving age-related appearance in older Caucasians. In Asian populations, the majority of facial plastic surgery is performed on young adults, and clinical guidelines for the use of soft-tissue fillers for Asian facial plastic surgery have not been reported. So what guidelines should cosmetic surgeons follow when dealing with Asians, who are different from Caucasians? A group of experts from Yonsei University and other institutions in Korea discussed this issue and made recommendations that were published in the journal Plastic and Reconstructive Surgery. Characteristics of fillers Two injectable fillers, cohesive hyaluronic acid and calcium hydroxyapatite, were discussed. Viscosity and elasticity are the main factors affecting the application of fillers, and generally the more viscous the filler, the deeper the injection. Asian Faces Compared to Caucasians, Asian faces are wider and rounder, with a flatter mid-face than Westerners, flat foreheads, smaller and wider noses, oval lips with no three-dimensionality, and a wider jawline without a prominent chin. Age characteristics: Asians have thicker and darker skin, the soft tissue and fat under the face is denser enough to maintain the facial contour for a longer period of time, so their skin sagging and wrinkles will appear later. Aesthetics: Asians mainly want to modify those facial features or contours that are not attractive. The T-zone is the most fundamental and important aspect of Asian facial plastic surgery. Plastic surgery recommendations for the various parts of the face Forehead: For Asians, forehead enlargement is the most important to enhance the three-dimensionality of the forehead. When the forehead is enlarged and fuller than in Caucasians, there is less need to continue to eliminate wrinkles, and the face looks younger. Clinical recommendations are to perform forehead fillers in conjunction with neurotoxin pretreatment. Anatomical recommendations: do not use too much filler and avoid the superior orbital artery, the superior talar artery and the frontal branch of the superficial temporal artery when injecting filler. Temples: For young people, fillers should be harmonized with forehead fillers; for older people, fillers in the lateral brow area should be the main focus. Anatomical recommendations: Avoid the temporal artery and the frontal branch of the facial nerve; the supraperiosteal level is the best injection point. Eye Sockets: Filling in the center of the face improves the appearance of bags and hollows under the eyes, and is also recommended as the first step in a full facial reconstruction. Anatomical recommendations: in some cases excessive fat should be raised before injectable fillers are performed. Expansion of the ocular recesses requires caution, as it can easily cause irregularities in shape, contusion or contamination, and more importantly, contusion of the facial arteries, so injectable fillers in the ocular recesses are not recommended. Midface: The Asian face is wide, short, and flat, and injectable fillers in the deep cheeks can add to the overall fullness of the midface and face. Anatomical Suggestions: To create a three-dimensional hierarchy in the midface, reduce the volume of fat under the eyes, reduce the more prominent lines and folds of the nose and lips, and increase the curve of the upper lip. Asians do not like to have prominent cheekbones and prefer a rounded, apple-shaped face. The cheekbones and cheekbones are made smoother and more defined with fillers. Nose area: Asians have a flatter nose with shorter nasal bones; a lower bridge and prominent nasolabial folds. Filler injections are used to improve the bridge of the nose or to raise the tip of the nose. Since fillers are not easy to perform in the lips, the panel does not recommend routine treatment of the lips, but does recommend the use of additional filler nasal spines to add thickness to the lips in some cases. Anatomical recommendations: The nose has a large number of blood vessels supplying blood, and injections into them should be avoided, as this may result in local ischemia, tissue necrosis or even blindness. Nasolabial folds and maxillary area: Nasolabial folds are filled not only to fill the deeper sulcus but also to increase the three-dimensionality of the maxilla and to support the collapsed midface. Anatomical recommendations: superficial facial injections can easily injure the descending branches of the facial arteries, so slow, deep injections are highly recommended. Chin and jaw area: The chin and jawbone are a whole, some people like inverted triangular shaped chin, some people like narrow and slender chin, what kind of chin you want to make needs to be communicated with the doctor in time. Anatomical suggestion: When injecting, we should avoid all kinds of tiny blood vessels at the tip of the chin, and the injection site should not be too shallow, avoiding overkill, otherwise it will be unnatural. Soft tissue filling should also consider the front and back edges of the jaw, otherwise the smooth line of the jaw will be destroyed. Also consider the incidence of lumps after subcutaneous injection and the location of facial arteries and veins. Perioral area: Asian upper lip is thicker, the golden ratio of upper and lower lip is 1:1.2, a small amount of filler injected into the edge of the lip can form a clear outline of the lip, and a small amount of filler injected into the lip can increase the volume of the lip and achieve a satisfactory ratio of upper and lower lip. Young people only need to thicken the mid-lip and mid-central ridge while older people need to thicken the whole lip and increase the volume of the whole lip to improve wrinkles. The treatment of the marionette lines and the anterior sulcus of the thin lobes are contiguous and generally the marionette lines are difficult to remove, in which case they can be layered with high to low viscosity fillers. Anatomical advice: The movement of the muscles around the lips dictates that calcium hydroxyapatite should not be used for lip fillers. HAND AREAS: Hand injections with fillers are used to increase the visibility of the underlying bones, tendons and, veins are as thin as the dermis. Highly viscous hyaluronic acid and calcium hydroxyapatite are both ideal filler injection sites located between the epidermis and superficial fascia. Anatomical advice: hand injections can be painful and require anesthesia. Restorative Intradermal Injectables: Large injections of small block hyaluronic acid into the dermis can enhance skin fullness and firmness, improve surface smoothness and elasticity, and improve collagen synthesis. Nearly 75% of the panelists use hyaluronic acid for routine injections in the face and neck, and intradermal and subcutaneous injections are recommended. Prevention and management of complications All filler injections are associated with different complications such as redness, swelling and erythema. Non-inflammatory nodules usually occur when the filler injection site is too superficial or overcorrected. Use saline or lidocaine to destroy the nodules or dilute the filler to redistribute the filler; vascular injury is rare but the consequences of injury are serious, once it occurs, the treatment should be terminated immediately and appropriate remedial measures should be taken; injection combined with contamination is prone to produce inflammatory nodules. Due to the special characteristics of Asian faces and the specificity of aesthetic requirements, facial soft tissue filler requires special treatment. When performing multi-regional facial improvement, the first consideration is to fill in the middle of the face, restoring the volume of fat particles in the middle of the face can lift the cheeks and improve the appearance of the eye sockets, nasolabial folds, and the corners of the mouth. Fillers in the forehead, nose, and chin, or T-zone, can be used to give the Asian face a more three-dimensional and three-dimensional profile.