| THE MUlTIETHNIC AgEINg FACE | aRTicle In the ageing face, there are changes in the facial
Figure 1 Caucasian Patient with Native American Indian ancestry and Type II Fitzpatrick skin following a Trichloroacetic Acid (TCA) 35% chemical peel resulting in skin hyperpigmentation
skeleton, and musculature., fascial changes, subcutaneous fat atrophy,and a decrease in skin elasticity. There are also intracellular changes including such as decreased hyaluronic acid. gonzales-Ulloa has identified fat atrophy as one of the main components of ageing (3). These factors contribute to loss of volume with an associated rela tive increase in the skin envelope with diminished elasticity.. Additionally, bone density and therefore bone loss occur during the ageing process and as a result decrease the structural support for the more superficial soft tissue and skin. Coleman (4) has popularized and expanded the concepts of facial atrophy and the new model of ageing with regards the loss of the third dimension of the face. He has been a strong advocate for the need to replenish soft tissue with techniques of autologous structural fat grafting. When analyzing the multiethnic face, understanding
multiethnic features must include the evaluation of facial bone structure and soft tissue. For example, a person with Native American or Asian heritage may exhibit high prominent cheek bones which project a fuller and more youthful look. Many ethnic groups consider these to be desirable facial characteristics. Alternatively, some Asians may have diminished nasal dorsal projection, along with flattening of midface and chin regions. While respecting the different multiethnic traits, the current trend is to consider volume enhancement as a primary option or as an adjunt to other facial rejuvenation procedures. Clinically, loss of volume is one of the factors
Figure 2 Same patient with resolution of hyperpigmentation following the treatment with Jessner’s chemical peel in combination with topical retinoic acid and hydroquinone treatment
accelerate the visible ageing process. The signs of facial
ageing including wrinkles, skin dyschromia, skin laxity, loss of volume, malar fat pad descent, and/or skeletal changes vary among patients depending on multiple factors Although these factora are applicable to all groups, the extent and type of visible changes can vary between ethnic groups Ageing is not limited to the skin, but also to its supporting
structures. The paradigm shift in facial plastic surgery has changed from a two-dimensional perspective, where surgeons are mainly focused on lifting, pulling, and removing tissue, to a three- dimensional perspective, where in addition, bone structure and soft tissue loss are recognized and treated with volume enhancement procedures. During the past 5 years, the aesthetic field has witnessed an exponential growth in volume-enhancing agents and fillers. According to recent surveys, and trends, soft-tissue augmentation is increasing in popularity to the point of revolutionizing the cosmetic surgery market. Furthermore, the use of neurotoxins such as Botox (Allergan, Irvine, California), Dysport (Medicis, Scottsdale, Arizona) continues to be an important option in the treatment of hyperactive muscle lines in patients of all ethnic and multiethnic backgrounds.
prime-journal.com | March 2011
responsible for descent of the brow-forehead and eyelid complex, descent of the lower lid-midface tissues and descent of the lower cheek, jowl and neck skin. Over time with changes in the orbit and periorbita the upper and lower eyelid skin becomes redundant, and hollowing of the eyes is revealed. Thinning of the lip and collapse of the perioral and submalar structures contribute to the formation of nasolabial folds, marionette folds, and prejowl sulci.
Figure 3 (Below left) Same patient, as figure 1 & 2, following a rhytidectomy with well healed post-auricular scars
Figure 4 (Below) Same patient with well healed pre-auricular scars
it is
important to thoroughly explain the surgical procedure, anticipated results and variation of these results.
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