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Aesthetic Surgery in African Americans
Since African Americans are prone to keloids, hypertrophic scars, and altered pigmentation, they must always be respected in planning elective, cosmetic procedures where the result could be worse than the original complaint. Prevention of keloids and hypertrophic scars is the best treatment and is maximized with atraumatic surgical technique, pressure dressings, and steroid injections. Once formed, reexcision and prophylactic treatment may be indicated but can also make things worse. Skin grafts can be used for large keloids or recurrent keloids and in difficult cases, postoperative low dose radiation can be used to control the lesions.
African-American facial aging less dramatically and skin laxity and wrinkles tend to be much less of a problem. Deeper folds still develop, which are best addressed surgically. The nasolabial fold and jowls are treated with a mid-face and facelift. Neck laxity can be addressed with a lower face-lift, liposuction, or direct excision of skin. Lower eyelid bags without skin excess, can be treated with a transconjunctival blepharoplasty, avoiding the need for a skin incision. Skin excision is performed when necessary. Facial skin is unlikely to develop keloids or hypertrophic scars.
Excessively full African Americans lips can be corrected with surgical removal of mucosa inside the lip and/or a V-shaped wedge excision. Dr. Park performs a conservative reduction since it is possible to reduce the lip further, but difficult to replace.
The African American nose is characteristically flatter, shorter, and wider with flaring of the nostrils, which are oval in shape. While many patients seek a refined nasal appearance with its ethnic characteristics, others desire loss of ethnic features. Although the specific techniques are similar to a standard rhinoplasty, the planned interventions require a plastic surgeon who is experienced in aesthetic surgery of the African American nose and understands the patient’s desires and concerns. The nasal dorsum or roof of the nose is often flat, short, and broad and needs augmentation with cartilage (septum or ear) or bone (skull or rib). Significant nasal tip work requires an open rhinoplasty through an incision inside the nose and across the columella, the skin bridge between the nostrils. This has the potential for visibility, but generally heals with an imperceptible scar. The nasal tip is corrected with suture and cartilage grafts. Flared nostrils (ala) can be corrected by mobilizing the cartilage or excision of skin in the nostril floor or at the alar cheek junction. Thorough preoperative evaluation and precise surgical technique can prevent airway compromise and asymmetry.
Aesthetic Surgery in Asian Patients
Most Asians seeking cosmetic procedures of the eyelid and nose are not looking to westernize their features as has been suggested by some, but seek a change to satisfy their sense of aesthetics and beauty. Asian eyelid surgery is often directed at the web (Mongolian fold) of skin at the inner aspect of the eyelid or the absence of a supratarsal / palpebral crease with lid fullness due to descent of fat under the eyelid skin. The Asian upper blepharoplasty is often referred to as the double-eyelid operation, and it can be done under local anesthesia in an outpatient setting. The procedure can be done with removal of excess skin and fat or it can be done with quilting sutures without an incision. In either case, an adherence between the skin and underlying levator muscle is created. The web on the inner aspect of the eyelid can be corrected with local tissue rearrangment, in the form of a w-v plasty procedure.
The typical Asian nose is characterized by a flat nasal dorsum, low projection of the nasal tip, and thick nasal skin. An emphasis is placed on thinning the soft tissue envelope, strengthening the nasal tip, and augmenting the nasal dorsum. The removal of fibrofatty tissue below the skin at the tip reduces the thickness of the skin envelope. Nasal tip projection is achieved with cartilage sculpting and cartilage grafts. Minor dorsal augmentation can be obtained with an onlay cartilage graft, but major augmentation requires rib cartilage, rib bone, bioprosthetic, or synthetic implants. Rib cartilage or bone harvest obviously requires a major additional surgical site. Synthetic implants, especially silicone, are commonly used in Asia, but the risk of postoperative complications is greater with the use of synthetic materials (infection, exposure, extrusion). Bioprosthesis are products that are manufactured from human or animal tissue and the risks are lower than synthetic implants.
Aesthetic Surgery in Hispanic Patients
A Hispanic nose is typically characterized by thick nasal skin, a broad nasal base, and decreased projection and adding grafts to the nasal tip or dorsum can achieve the goals of many patients. Buttock Augmentation is more common in the Hispanic population and can be completed with an implant, flap, or fat injection. The risks of hypertrophic scarring, keloids, and loss of pigment must be considered prior to cosmetic surgery or skin resurfacing in the Hispanic population.
All of the descriptions for the various procedures are condensed from the text of the upcoming textbook written by Dr. Christopher Park and Dr. Malcolm Marks and are copyrighted, "The Artistry of Plastic Surgery: Exploring the Experience” . |
