| THE MUlTIETHNIC AgEINg FACE | aRTicle
any complications (Figure 17). The frequency of hypertrophic scars and keloids may be diminished by minimizing the tension on the skin flap closure. laser resurfacing and chemical exfoliation may be
complicated by prolonged erythema, hyperpigmentation, dyschromia, infections, scarring, and dermatitis in the multiethnic patient. Resurfacing in darker skin individuals may produce
hyperpigmentation in 17–83% of the cases (12). Most physicians will not perform traditional resurfacing in Fitzpatrick V and VI patients. Hyperpigmentation may be treated with retinoic acid,
glycolic acids, azelaic acid, hydroquinones, sun block, and possible Jessner’s peels (lactic acid 14% and salicylic acid 14%).
Figure 17 Patient of African American ancestry with well healed facelift scars and no evidence of hypertrophic scars or keloids
strengthen favorably the cervicomental angle. Patients with retrognathia and/or type II malocclusion will often have greater visible ptotic cervical changes. A patient of Hispanic heritage presented with
significant lipodystrophy of the neck, and with associated microgenia. She underwent submental, cheek liposuction and chin implant (Figures 15, 16).
Concerns and complications Patients of African American, Mediterranean, and Asian ancestry may present with increased incidence of keloids, hypertrophic scarring and hyperpigmentation. Keloidal scars can occur in all skin types, but its rate
has been shown to be 5–15 times higher in African Americans than in the Caucasian population (10), three times more common in Japanese population, and five times more common in Chinese population.(11) Patients at risk for developing keloids are best followed
closely after any procedures which might put them at risk. Many physicians will start these patients on topical silicone gels or sheeting early in the healing process prophylactically. If they still start to develop in some of the fairer patients, they can be treated with vascular lasers, such as 532, 585, or 595 nm. Since these wavelengths are also absorbed by melanin, there is a risk of dyschromia and should not be used in patients with Fitzpatrick V or VI skin types. Keloids developing in surgical scars may be treated with serial injections with triamcinolone. These serial injections can cause hypopigmentation or atrophy of the underlying subcutaneous tissues. Hypertrophic or keloid scarring in facelift scars is more
common in African American, Asian, and Mediterranean ancestry patients, even though most will heal without
Conclusions Beauty exists in all ethnic and multiethnic faces. The goals of ageing face surgery must be directed at refining ethnic features while attaining a natural, balanced, and harmonious result. Analysis of the multiethnic face continues to evolve and therefore cannot be defined with anthropometric analysis. This analysis requires an artistic sense. The ageing multiethnic face must be understood in three dimensions to assess structural and volumetric changes as well as skin redundancy, changes in the neck, eyes and nose. Perception of the face and its individual features is unique to each individual. It is important to determine areas of priority, and which procedures stand to be of most benefit. Communication is important in establishing an understanding of cultural differences, realistic expectations, risks and limitations of any treatment or surgery. Surgery may involve combining and incorporating both soft tissue and structural bone augmentation with other conventional surgical procedures such as blepharoplasty, rhytidectomy, rhinoplasty, and browlift among others.
References
1. Projections of the resident population by race, Hispanic origin, and nativity: middle series, 2006-2010. Washington, DC: Population projections program, Population division, US census bureau, 2000.
2. Fanous N, Yoskovitch A. New classification scheme for laser resurfacing and chemical peels, Modification for the different ethnic groups. Facial Plastic Surgery Clinics of North America (10). 2002, 405–13.
3. Gonzales-Ulloa M, Flores E. Senility of the face: Basic study to understand its causes and effects. Plast Reconstr Surg 1965; 36:239–46.
4. Coleman SR. Structural Fat Grafting. St. Louis, Missouri: Quality Medical Publishing, Inc., 2004.
5. Fisher GJ, Wang ZQ, , et al. Pathophysiology of premature skin aging induced by ultraviolet light. N Engl J Med 1997; 337:1419–428.
6. Kang S, Fisher GJ, Voorhees JJ. Photoaging: pathogenesis, prevention, and treatment. Clin Geriatr Med 2001; 17:643–59.
7. Herzberg AJ, Dinehart SM. Chronologic aging in black skin. Am J Dermatopath 1989; 11:319–28.
8. Taylor SC. Skin of color: biology, structure, function, and implications for dermatologic disease. Am J Acad Dermatol 2002; 46:41–62.
ACKNOWLEDGEMENTS
This article is an edited excerpt from one of the chapters within Aesthetic Rejuvenation Challenges and Solutions, 1st Edition, edited by Paul J Carniol, MD, FACS and Gary D Monheit, MD. Chapter was written by Stephen C Adler, Eric T Adler and Paul J Carniol. Some details have been edited out to facilitate this condensed entry in the Prime journal. In the published book, multiethnic and multinational authors address how to approach patients with due consideration of their ethnic differences, and how to individually design solutions for patients in order to optimize the results. There are sections dedicated to procedures for patients with African, Asian, Hispanic, Indian, Middle Eastern, and Pakistani heritage. Furthermore, the book presents chapters on dealing with challenging patients who: have limited time for recovery, require revision procedures, have unrealistic expectations, or, are dissatisfied. The book is available from
Informa Healthcare at www.
informahealthcarebooks.com
9. Fitzpatrick TB. The validity and practicality of sun-reactive skin types I through VI. Arch Dermatol 1988; 124:869–71.
1 Kamer FM, Pieper PG.0. Surgical treatment of the aging neck. Facial Plast Surg 2001; 17:123–28.
11. Levine VJ, Lee MS,
Geronemus RG. Continuous wave and quasi continuous wave laser. Lasers and cutaneous and aesthetic
surgery. Arndt KA, Geronemus RG, Dover JS, Olbrichtd SM Lippincott-Raven, 1997, 67–107.
12. McBurney EI. Clinical
usefulness of the argon laser for the 1990’s. J Dermatol Surg Oncol 1993; 18:358–62.
13. Arnold HL, Franer FH. Keloids: Etiology and
management by excision and intensive prophylactic radiation. Arch Dermatol 1959; 80:772.
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