| THE MUlTIETHNIC AgEINg FACE | aRTicle patients with mediterranean
ancestry usually do not have special anatomical considerations when planning eyelid rejuvenation procedures. however, they may be a greater risk of having noticeable scars.
Figure 11 Patient of Mediterranean ancestry, Type III Fitzpatrick skin presenting with deep hollow lower eyelid groove, lower eyelid dermatochalasis and pseudohernias of fat
Figure 12 Patient following lower blepharoplasty with fat repositioning and second stage phenol chemical peel
increased fatty content, short columella, wide dorsum, bulbous tip with ptosis, weak projection, diminished nasal height, and horizontal flared nostrils. The Asian nose may exhibit wide intercanthal distance, and thick skin, bulbous and weak nasal tip, flared nostrils, and decreased nasal dorsal height. The latino nose may share many features of both the Asian and African- American nose, such as a depressed or even elevated nasal dorsum, wide nose, poorly defined and supported nasal tip, wide and flared nostrils and thick skin. In contrast to these general descriptions it should be noted as with most generalizations that noses can vary widely from patient to patient, even within an ethnic group. Patient in Figures 5, 6, with Brazilian ancestry presents
with blue eyes, type III skin, a wide nasal bridge, moderate skin thickness, bulbous tip with moderate tip ptosis with midfacial hypoplasia. The patient underwent upper blepharoplasty, rhinoplasty, fat grafting midface with 2-year followup with good improvement. The patient in Figures 7, 8, 9, 10 has Chilean, South American Indian heritage presented for rhinoplasty and facial rejuvenation. Her evaluation revealed brow and facial ptosis, nasal dorsal prominence, and a wide bulbous nasal tip. She underwent a rhytidectomy, endoscopic browlift and rhinoplasty.
Rejuvenating the periorbital region Many patients are interested in maintaining the ethnicity of their eyelids and periorbital region. This is important in planning aesthetic procedures in this region. The upper eyelid drapes from the supraorbital ridge to the lashes, and there is absence of the superior palpebral fold. Anatomic differences in the Asian eyelid include attachment of the levator fibers to the tarsal plate without making attachment to the orbicularis muscle and skin above the tarsal plate, the fat compartments because the lack of preseptal attachments descend anterior to the tarsal plate, and the presence of the epicanthal fold. The goal is to create a palpebral line that divides the eyelid into pretarsal and preseptal components, lighten the eyes by removing some of the preseptal fatty tissue and possibly removing the epicanthal fold. The latter should be discussed and agreed upon with the patient before any surgery is performed. Patients with Mediterranean ancestry usually do not
prime-journal.com | March 2011
have special anatomical considerations when planning eyelid rejuvenation procedures. However, they may be a greater risk of having noticeable scars, or developing hyper- pigmentation after surgery. This patient of Mediterranean heritage presents with deep hollow lower eyelid groove and lower eyelid dermatochalasis with pseudoherniations of fat. The patient underwent lower eyelid blepharoplasty with fat repositioning and a lower eyelid phenol peel as a second stage procedure (Figures 11, 12).
Figure 13 (Below) Patient of Hispanic, Caribbean ancestry presenting with brow ptosis, cheek soft tissue hypoplasia and ptosis with Type IV Fitzpatrick skin
Figure 14 (Below right) Same patient following rhytidectomy, endoscopic browlift and fat grafting to cheek and midface
The lower two-thirds of the face The midface and lower face in the multiethnic population will present a diversity of variables. The midfacial area may vary from a flattened or sunken look to the full, augmented high cheekbone appearance. The presence of high cheekbones and a full midface is a desired youthful feature coveted in patients of most ethnicities. High cheekbones may be found in patients of Northern
European, American and South American Indian and Asian ancestry. Midface flattening may be from a combination of malar bone deficiency and/or loss soft tissue volume. Midfacial volume loss may present with a flattened, hollowed, tired appearance, a deep naso jugal trough, and/or ptotic nasal folds. Midface lift has been advocated as a treatment for the ptosis of this area, but care should be taken in patient
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