African American Cosmetic Surgery
As patients from around the world seek improvements in their appearance through cosmetic surgery, it is important to understand the differences not only culturally but also physically. Psychologists have documented the advantages of a neat, well put- together appearance with achieving personal and professional success. The basic motivation for people of all races to have cosmetic surgery is the same. Some cultures accept cosmetic surgery openly and others may even forbid it. This article focuses on the unique characteristics associated with cosmetic surgery on the African American patient.
The aging process appears to occur more slowly in blacks than Caucasians. The reason for this that is black skin has a much thicker supporting layer of skin called the dermis. This is the skin layer, which has the main supporting elements such as collagen. As a result, more support yields slower aging of the skin. Black patients typically consult with a surgeon for cosmetic surgery evaluation ten years later than patients with thinner skin.
With over one million people a year having cosmetic surgery the breakdown based on race is unknown. However if my practice reflects the national trend, cosmetic surgery among black patients has become much more popular within the last ten years. The consultation with a physician is the first step a patient takes to discuss his or her concerns. In addition to board certification the patient should inquire as to how many black patients-- both male and female--the doctor has operated on and what procedures were performed.
Scarring Concerns
During the consultation, black patients often express concerns over scarring. Due to the thicker dermis, scars can take longer to heal and may thicken. However, this is very unusual on the face. Once the skin is injured, the building blocks of healing are laid down for up to 10-12 weeks; the body winds down and a scar appears.
If the building blocks continue to be laid down at the same rate for several more weeks and then wind down a hypertrophic scar may occur. These are commonly found on the stomach or back after surgery where the scar is raised and wide.
Some patients may be prone to a type of scarring called keloids.This third type of scarring-- a keloid-- occurs when the body continues to lay down more and more building blocks and the scar grows and can actually invade some of the surrounding tissues. This is commonly seen on the earlobe where some reaction occurred at an earring hole and a ball of scar tissue has formed. Fortunately keloids generally do not occur on the face.
Ethnicity Enhanced
The goals of surgery are generally not to make African-American features look more Caucasian. Generally patients are looking for refinement and enhancement while preserving their ethnicity. The computer imager is a wonderful tool, which allows the patient to see potential changes from different procedures. Before and after pictures can also help demonstrate possible effects and the surgeon's technique. These are not guarantees of surgery but great educational tools to allow the patient and surgeon to have a common understanding of the goals of surgery.
Due to the slower aging process, many black patients will come in for minimally-invasive procedures such as Botulinum Toxin (Botox ) injections to hyperactive facial muscles. In addition, softening of the line between the cheek and mouth can be accomplished with Cymetra, Dermologen or Juvederm .
A Variety of Options
Skin care is important for black patients to help reduce possible dark spots and premature wrinkling of the skin. Sunscreen is a daily must as well. While skin cancers are rare they can occur.
Microdermabrasion and glycolic peels are generally well tolerated. If deeper treatments such as dermabrasion or laser resurfacing are to be performed the patient should be placed on a bleaching agent such as hydroquinone for 4-6 weeks prior to the procedure to help reduce pigmentation changes afterwards. These procedures can successfully soften scarring from acne, fine wrinkles or dark circles under the eyes.
Physicians not familiar with pretreatment of the skin will often not resurface black skin or be aware that this is possible. Tattoo removal can be very challenging due to the minimal contrast between the tattoo pigment and the black skin. However certain laser treatments can yield improvement.
Eliminating that Tired Look
Aging around the upper eyelid area can be treated with a blepharoplasty. This procedure involves the removal of excess tissues with a small scar along the upper eyelid crease. The eyelid skin is the thinnest skin on the body and heals very quickly. Puffiness underneath the eyes can be treated by removal from an incision on the inside of the eyelid with no external incision. If excess lower eyelid skin is present an external incision will allow tightening both the skin and removal of the puffy fatty tissue.
Rhinoplasty or cosmetic surgery of the nose in the black patient often involves narrowing the tip to reduce the rounded ball at the end of the nose, as well as building up the bridge. The exact goals of surgery will vary from patient to patient--and the computer imager helps to define them. Typically the base of the nose may require narrowing of the nostrils to help give the patient the desired refinements. The cartilage of the tip of the nose is often soft. This can be evaluated by pressing down on the tip and watching it move. The surgeon can help to reinforce the tip during the surgery to help prevent drooping later in life.
A beautiful face is one in which all features are in proportion and balance. For this reason the position of the chin is important. A week chin can be strengthened with a chin implant or a genioplasty (sliding the chin bone forward). Chin implants are very popular and can be placed through a small incision on the inside of the mouth or under the chin. Many of the implants are made of a hard silastic material.
Fullness of the face under the chin and along the jaw line may be treated with facial liposuction. A small incision about a centimeter long is placed behind each earlobe and under the chin. The fat may be fibrous or thick requiring direct excision under the chin to achieve the desired look. Because the black skin is thick, liposuction may be a viable alternative for some patients in their late forties. When there is a definite excess of skin a facelift will help soften the tired look. To help soften a round face a small incision can be made on the inside of the mouth and the buccal fat pads can be removed.
Cosmetic surgery of the lip generally involves making them smaller, however augmentation may be appropriate for some. Prior to reducing the lip it is important to look at the position of the chin. If the chin is weak the lips may appear too overpowering. However with a balanced chin the lips may look appropriate. If the lips are too large a reduction can be performed by removing a portion of the lip. The incision is in the inside of the lip and is generally not visible after healing is complete. Patients may experience tightness of the lip area for four to six weeks after the procedure.
Black Hair Restoration
Loss of hair on the top of the head can be treated medically with Rogaine or Propecia. If the patient is considering surgical hair restoration a technique called follicular transfer will probably provide superior results. With this technique a strip of hair is removed and the individual follicles are removed under magnification. This is important because the black hair follicle has a curl to it that extends under the skin. The magnification allows the technician to identify and preserve the follicles. The follicles are then placed in the desired area with micro slits. Scalp reductions can be used to remove areas of thinning on the top of the head. Follicular transfer techniques can also be used to help restore fullness to the top of the head. Postoperatively, patients should be aware not to let astringents over-dry the naturally dry scalp area.
Plastic surgery treatments for the body including liposuction, tummy tucks, breast augmentation and reduction can generally be performed in a traditional manner.
Cosmetic surgery is becoming more and more popular amongst patients of all skin types. Black skin has many unique qualities which, when identified, can be enhanced through cosmetic surgery to help patients achieve their goals.
Maloney Center for Plastic Surgery- Atlanta,GA
© Copyright 2000 American Academy of Facial and Reconstructive Plastic Surgery
More Information Coming Soon
