aRTicle | THE MUlTIETHNIC AgEINg FACE | Full and
prominent lips are coveted
features in ethnic, multiethnic and caucasian
populations.
Figure 15 Patient of Hispanic ancestry with significant lipodystrophy of the neck and microgenia
selection. lifting soft tissue over a flat malar eminence
may lead to an over-pulled and distorted appearance, and it can exaggerate the flattening of the midface and alter normal facial contour. The patient in Figures 13, 14 is of Hispanic heritage. She
presented with cheek soft tissue hypoplasia, cheek and brow ptosis. She underwent rhytidectomy, endoscopic brow lift, and fat transfer to the midface with excellent improvement. Rhytidectomy in African Americans, Asian, and
Mediterranean patients with thick skin and loss of structural support are approached by standard incisions to allow adequate exposure and tissue mobilization. Often, this cannot be achieved with minimal incision surgery. The greater more traditional surgical exposure will more readily allow for adequate superficial musculoaponeurotic system (SMAS) suspension and anterior platysmal plication as needed. As for all patients the skin flap advancement must be
tailored to the shape of the face and oriented in the appropriate vectors. For patients that require more structural definition, treatment options may include chin, cheek, sub-malar and tear trough implants which provide a structural augmentation of bony regions and/or soft tissue augmentation with fat transfer. When planning a rhytidectomy procedure the patient’s
medical problems should be considered. For example, hypertension, which is common in the general population and is more prevalent in the African Americans, predisposes the patients to hematoma formation and can increase incidence by 2.6 times (13). The lips are considered an important focal point of the face. They also can vary in appearance between
56 ❚ March 2011 |
prime-journal.com
Figure 16 Same patient following a chin implant and cervicofacial liposuction
individuals as well as ethnic groups. Furthermore they are subjected to changes due to photoageing and underlying volume loss. Full lips are considered attractive, sensuous, and
project a youthful quality in the face. Full, prominent, youthful lips are frequently seen in patients with African American, non-white Hispanic, Indian, Mediterranean, and Asian ancestry. Ageing causes degenerating changes in multiple levels of the lips. The upper lip becomes flatter and the phitrum ridges become less prominent. The prominence and outward projection of the vermilion border is lost and decreases in height. The volume of both the dry and wet lip decreases due to the loss of subcutaneous fat, thinning of the epidermis and the oral commissures drop giving the appearance sadness. Full and prominent lips are coveted features in ethnic,
multiethnic and Caucasian populations. lip enhancement may incorporate lip lifting or vermilion advancement for patients with thin lip lines and minimal volume. lip volume augmentation may involve fat grafting, dermal-fat grafting and hyaluronic acid fillers among other options. The goal of any lip rejuvenation must aim at maintaining a natural, soft and voluminous appearance. Any sign of alteration or unnatural appearance will result in a less than satisfactory outcome.
The ageing neck Cervical ptosis contributes to the aged, and tired appearance found in patients of all ethnicities. The underlying osseous support of the lower third of the face makes an important contribution to this process. A strong, prominent and square mandible in conjunction with a high placed hyoid bone may support the soft tissues and
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