Correlation of Acculturation and Asian Esthetic Preferences Among Asian-American Laypersons

Thursday, October 10, 2013
Yoshi Shen DDS,MS, Department of Orofacial Sciences Div of Orthodontics, University of California San Francisco, San Francisco, CA
William Kim , Department of Preventive and Restorative Dentistry, University of California San Francisco, San Francisco, CA
Jennifer Cai , Department of Preventive and Restorative Dentistry, University of California San Francisco, San Francisco, CA
Aldrich Sy DDS, Department of Oral and Maxillofacial Surgery, University of California San Francisco, San Francisco, CA
Cathy Tao DDS,MS, Department of Orofacial Sciences Division of Orthodontics, University of California San Francisco, San Francisco, CA
James Chen DDS,PhD, Orofacial Sciences, Division of Orthodontics, University of California San Francisco, San Francisco, CA
Janice S. Lee DDS, MD, MS, Oral & Maxillofacial Surgery, University of California San Francisco, San Francisco, CA
Facial esthetics and orthognathic treatment planning are influenced by cephalometric norms, esthetic preferences and the training background of the surgeon.1Ideally, there should be concordance between the surgeon’s treatment plan and the patient’s expectations.  With increasing ethnic diversity in the US and globalization of healthcare, an understanding of the esthetic expectations of non-Caucasian patients and the impact of acculturation (cultural modification of an individual by adapting to traits from another culture) may guide surgical planning and potentially improve patient satisfaction.

The purpose of this study was to determine the correlation between acculturation levels and Asian esthetic preferences of Asian-Americans.

This was an IRB-approved cross-sectional study of Asian Americans between 18-45 years of age. Participants were asked in person at local universities, community centers, or public places, to participate in the study. Participants were given a short survey to rank four facial profile images and complete the validated Suinn-Lew Asian Self-Identity Acculturation Scale survey2.  Facial profile photographs of 2 Asian males and 2 Asian females, with skeletal Cl II and Cl III profiles, were digitized to create a baseline template and then modified using Dolphin imaging software. The skeletal Cl II profiles were modified into two profile images: Cl II camouflage (retrusive) and mandibular advancement (protrusive). The skeletal Cl III profiles were modified into two profile images: mandibular setback (retrusive) and maxillary advancement (protrusive). Participants were asked to rank the baseline and modified profiles of each gender on a scale of 1(most attractive) to 3 (least attractive). Ordered logistic regression analysis was used to determine the association between profile preference and acculturation scores among participants and stratified into: less acculturated, acculturated, highly acculturated. Mean rank score determined the most preferred Asian profile preferences among acculturated and non-acculturated Asian-Americans.

A total of 169 Asian-American laypersons participated in the study.  There were 88 females (52.1%), 81 males (47.9%).  Mean age was 24.4 years (S.D. =5.7). The average years spent in the U.S. was 19.2 years (S.D.=7.5). Over 84.6% of the participants received a college degree. 17.8% were less acculturated, 52.1% were acculturated, and 30.2% were highly acculturated. Acculturated participants found a Cl II female with a mandibular advancement (OR=0.6, S.D.=0.3-0.8, p<0.01), a Cl III female with a mandibular setback (OR=0.6,S.D.= 0.4-0.9, p<0.01), and a Cl III male with a maxillary advancement (OR=0.5, S.D.= 0.3-0.8. p<0.001) most attractive. Acculturated participants found least attractive a Cl II male with a camouflage appearance (OR=1.8, S.D.=1.2-2.7, p<0.01) and a Cl III male with a mandibular setback (OR=3.1, S.D.=1.9-3.2, p<0.01). There was agreement between acculturated and less acculturated participants who found Cl II male with mandibular advancement (OR=0.8, S.D.=0.5-1.2. p=0.242), a Cl III female with maxillary advancement (OR=0.8, 0.6-1.3, p=0.404)attractive and they found a Cl II female with a camouflage appearance (OR=1.3, S.D.=0.8-2.0, p=0.25) less attractive.

In general, both acculturated and less acculturated Asian Americans preferred a fuller profile in both male and female images and found that retrusive profiles were less attractive.  Less acculturated participants were more tolerant of retrusive profiles in both genders.  Acculturated Asian Americans strongly favored fuller male profiles compared to less acculturated participants but they did not have the same strong preference for a fuller female profile.  The gender of the images played a role in the esthetic preferences of the survey participants. 

References:

1.)    Lee LH, June JH, Danganan M, Pogrel MA, Kushner H, Lee JS(2011). Orthognathic surgery for the Asian patient and the influence of the surgeon’s background on treatment. Int J Oral MaxillofacSurg,May, 40(5): 458-63.

2.)    Suinn RM, Suinn RM, Rickard-Figuero K, Lew S, VigilP. (1987). The Suinn-Lew Asian Self-Identity acculturation scale: An initial report. Educational and Psychological Measurement,47(2), 401–407.

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