The aging face in patients of color: minimally invasive surgical facial rejuvenation-a targeted approach

Abstract

We are in the midst of exciting times from a demographic standpoint as the population of darker-skinned people grows exponentially in the United States. Although there is a growing demand for facial cosmetic procedures amongst people of color, the total number of individuals undergoing surgical facial rejuvenation is dwarfed by the current Caucasian market. In order to provide optimal options for facial rejuvenation, cosmetic surgeons must have an underlying appreciation for the dynamic interplay among ethnicity, facial morphology, and the progression of aging. The purpose of the present article is to outline the minimally invasive surgical options for facial rejuvenation best suited for the patient of color. Although the population of individuals with darker-pigmented skin is quite vast, the present paper will focus on individuals of African descent, with whom the author has the most experience. Preferred surgical techniques include blepharoplasty, autologous facial fat transplantation, percutaneous cheek lift, and submental liposuction. Cutaneous surgeons familiar with soft-tissue surgery and facial anatomy should feel comfortable performing these techniques.

Periorbital Aging and Ethnic Considerations: A Focus on the Lateral Canthal Complex

“…Consequently, upper face aging in African Americans is most commonly localized to the periorbital area. 4,5 Of the numerous periorbital changes that transpire with age, we propose that African American women have a greater relative descent of the lateral canthal complex than their Caucasian counterparts. Our study demonstrates that although Volume 121, Number 3 • Periorbital Aging and Ethnicity there is no statistically significant interrace difference of the lateral canthal complex position for both the gross and age-matched data in those aged 45 years or younger and older than 45 years ( Table 2) (p Ͼ 0.05), there is a statistically significant intrarace difference of the lateral canthal complex position in African American women for both the gross and age-matched data (Table 1).…”

“…As a result, upper face aging in African Americans is most commonly localized to the periorbital area. 4 There are several features that make the African American eye ethnically unique. 5 We believe that relative aging changes to the lateral canthal complex are often underappreciated.…”

Aesthetic Dermatology for Aging Ethnic Skin

“…20 Brow ptosis and crow's feet tend to occur later in patients with skin of color than in their fair-skinned counterparts. 5,13 In addition, among the multitude of offlabel indications for BT-A detailed by Carruthers and colleagues, 21 the use of BT-A in the treatment of masseter hypertrophy is becoming increasingly popular, particularly in Asian populations, as preferences shift from surgery to less-invasive methods. 27,28…”

“…Intrinsic changes occur as the skin and subcutaneous tissues age over time and are due to soft tissue volume loss from fat atrophy, gravity-induced soft tissue redistribution, and a reduction in facial skeletal support. 4,5 Extrinsic skin aging results from chronic sun exposure and typically manifests in the form of wrinkles, lentigines, keratoses, mottled pigmentation, telangiectasia, loss of translucency, decreased elasticity, textural roughness, and sallow color. 6,7 The main determinant of skin aging is not intrinsic changes but photodamage, 6 but not all aging skin is equal.…”

“…13,14 In addition, some authors have noted that premature aging may also occur in skin of color, typically manifesting as midfacial aging instead of photodamage, whereas the opposite is true for those with fair skin ( Figure 1A and B). 5,7 Although lighter-skinned individuals typically develop seborrheic keratoses with age, populations with darker skin, particularly African Americans, are more prone to develop dermatosis papulosa nigra over time.…”