aRTicle | THE MUlTIETHNIC AgEINg FACE | The examination must include an assessment of static
and dynamic anatomy; what problems or concerns are present at rest versus what is present during muscle movement of the face. Dyanmic lines and folds that occur with muscle activity in the upper face can be addressed with the available neurotoxins. For example, lines that occur in the lower eyelids during smiling, are likely to respond to neurotoxins, and possibly resurfacing treatments. Treatment of ageing changes involving the skin in
Figure 7 Patient of Chilean and South American Indian heritage with strong facial bone features and midface with soft tissue collapse with brow and lower face ptosis (Frontal view)
Figure 8 Same patient following a rhytidectomy, endoscopic browlift and rhinoplasty
multiethnic patients can be challenging. The evaluation of the skin must extend beyond Fitzpatrick skin type. It must be directed toward the treatment of the condition and the variable potential responses to treatment. The color of the eyes may also provide added information when planning a treatment protocol. A patient with Fitzpatrick type II or III skin and dark eyes may respond to skin treatment like a type IV skin with dyschromia or hyperpigmentation. Interestingly, some patients who appear to be
Fitzpatrick III with hazel eyes, and some with Mediterranean backgrounds, can react to cutaneous procedures as if they have Fitzpatrick type IV skin. A patient with relatively fair skin and some Asian heritage may also respond to skin peels or lasers with hyperpigmentation or other dyschromia. The patient in Figure 1, who has Native American
ancestry, underwent a TCA35% peel and responded with moderate hyperpigmentation. This was treated with Jessner’s peels, topical retinoic acid and hydroquinone creams, with adequate resolution of the problem. (Figure 2) The scars in the preauricular area in the same patients following a facelift showed adequate healing and confined around the curvature of the ear (Figures 3, 4). Combinations of varied level resurfacing, fractional
Figure 9 Same patient pre-operative lateral view
Figure 10 Same patient, post-operative lateral view following rhytidectomy, endoscopic browlift and rhinoplasty
This is an important part of the facial analysis
because it helps prioritize the areas that, when addressed, will provide the highest benefit and improvement. Interestingly, a patient’s perception may differ significantly from the aesthetic surgeon’s. Many of the changes of the ageing face extend across all ethnic groups. Extensive variability of features within ethnic groups
should avert physicians from solely following anthropometric measurements when planning an operation. Anthropometric analysis may apply, but is less relied upon when attempting to formulate a sense of aesthetic balance and beauty in the ethnic and multiethnic patient. A type of artistry is an important part of this analysis.
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resurfacing, or peels may be indicated in a patient with differing skin problems depending on the treated area of the face. An example is a patient with deep rhytids in the perioral and lower eyelid region and may have slight dyschromia and solar lentigos on the cheeks. He or she may benefit from a phenol peel in the periroral and periorbital area and a TCA35%/Jessner’s to complete the rest of the face. Soft tissue and structural examination may reveal the
need for volumetric enhancement via fillers, fat transfer, and/or structural cheek and chin implants. Patients of Asian, American Indian, or Northern European may exhibit prominent cheek bones and soft tissue.
Aesthetic nasal surgery The nose may be one the most ethnic appearing features of the face. When planning nasal surgery it is important to first discuss with the patient whether their goal is to maintain an ethnic appearance or to have a less ethnic appearing nose. Another issue to consider when planning the procedure is keeping the nose in harmony with the rest of the face. The appearance of the nose can be highly variable
both between and within ethnic groups. For example the African American nose can exhibit dark, thick skin,
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