aRTicle | THE MUlTIETHNIC AgEINg FACE |
Figure 5 Patient of Brazilian ancestry with blue eyes, Type III Fitzpatrick skin, wide nasal bridge, upper eyelid dermatochalasis, moderate skin thickness, bulbous nasal tip, and midface hypoplasia and malar flattening
When inelastic skin looses the underlying support it
tends to become redundant. Skin redundancy will fold and accentuate areas such as the nasal folds and prejowl sulcus. In the perioral and periorbital area the loss of soft tissue and skin thinning results in the more visible muscle effects on the skin in areas such as the crows feet , forehead and glabella. Over time, these lines, which initiallly are only seen with animation and smiling, will become permanently printed in the skin. Skin ageing is mostly caused by photo damage from
ultraviolet light exposure (5). Aged and photo-damaged skin displays disorganized collagen fibrils, elastin, and fibroblasts (6). Clinically, the ageing skin displays rhytids, discoloration or dyschromia, solar
lentigos, coarseness,
multiethnic heritage of the patients. As there are genetic variations beyond these broad
classification systems, they should only be used as aids in predicting the reactions of patients to skin treatments. Examination of the skin must anticipate the variable potential responses to different treatments including hyperpigmentation, hypopigmentation, scar, keloids, and prolonged redness. For example, although less likely, it is possible for a
skin ageing is
telengiactesias, and dryness. The increase melanin content in African Americans prevents them from displaying many of the typical signs of ageing found in Caucasians (7). However, due to the increased melanin there can be a tendency towards dyschromia. The presence and the production of melanin in the
skin of colour can diminish ultraviolet light induced photo damage caused by ultra-violet radiation. Histologically, aged skin reveals decrease loss of collagen
and elastin in African American skin, to a lesser degree than Caucasian skin (8). Signs of ageing therefore present later in patients of Mediterranean, Hispanic, Asian, and African Americans than in Caucasian skin. Skin classifications have traditionally been determined by the skin complexion or color and the response to sunlight exposure. The Fitzpatrick classification (9) originally developed
in 1975 which groups different skin types by skin color and the reaction to sun exposure is still considered a major reference point in the evaluation of how patients will respond to facial treatments such as chemical peels, lasers, and other minimally invasive skin treatments. Neither Fitzpatrick nor glogau skin classifications take into account the place of ethnic origin and possible
52 ❚ March 2011 |
prime-journal.com
mostly caused by photo damage from ultraviolet light exposure.
faired skinned blue-eyed patient to develop hyperpigmentation or other dyschromia after laser or chemical peel. This may relate to their ethnic heritage or other factors. During the pretreatment medical evaluation, it is important to have some knowledge of the patient’s heritage and ancestry to anticipate possible side effects.
Facial analysis in a multiethnic patient Evaluation of any patient who presents with ageing face changes is a complex process. It requires a detailed assessment of the face in conjunction with a methodical exam. This should include, as possible, consideration of potential genetic factors that can influence the result and affect the recovery process. The interview of the patient is a time of opportunity to learn about heritage, ancestry, and cultural background. Perception of the face involves forming an initial
impression of the effect and appearance of the face. Does the face portray someone who appears tired, sad, worried, happy, older than stated age, age appropriate, younger than stated, or refreshed? Which ethnic features are dominant, such as color of skin, shape of the nose, height of the malar prominence, chin, eyes, and lips? Which features interrupt the flow of the face, or attract undue attention? For example is the nose too prominent or is there a problem with retrognathia, or even a hypoplasia of cheek bone/soft tissue? Does the face appear to be deflated and hollow or have a full and soft appearance?
Figure 6 Same patient 2 years after undergoing upper blepharoplasty, rhinoplasty, fat grafting to midface
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