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FACIAL FILLERS IN A DIVERSE PATIENT POPULATION

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SUMMARY

  • As the popularity of fillers has increased dramatically over the past several years, appreciating the subtle differences in aesthetics between different sexes and racial backgrounds is of critical importance to the dermatologic surgeon in order to be able to effectively and prudently treat a diverse patient population.

image Beginner Pearls

  • Female temples should be convex, while male temples should be flat.

  • While prominent lips are desirable in women, in men thinner lips are the norm, and therefore replacement rather than augmentation is desirable.

image Expert Pearls

  • When performing zygomatic augmentation, superior augmentation is performed in females, while inferior augmentation is performed in males.

  • Although aging results in general bone loss of the facial skeleton, males experience this loss much later in life than women.

  • The mid face is often one of the first areas to show signs of aging in African-American patients.

image Don’t Forget!

  • A high G-prime volumizing filler such as calcium hydroxyapatite is an excellent choice to rejuvenate and aesthetically enhance a male face.

  • When using calcium hydroxyapatite, consider transferring the product to a 1-cc syringe which allows for easier aspiration.

image Pitfalls and Cautions

  • Do not feminize the male face!

  • Avoid adding volume to the anterior cheek in males.

  • Replace rather than augment the male lip, and avoid the vermilion border.

  • One of the worst pitfalls in aesthetic medicine is mistaking impending necrosis from intravascular injection for a common bruise and subsequently having the patient ice the area, further compromising blood flow.

image Patient Education Points

  • Instruct the patient to massage at home using the “rule of 5’s”—5 minutes, 5 times per day for 5 days.

  • Patients should be instructed to immediately call the surgeon at the first sign of impending tissue necrosis.

  • Taking a few minutes to explain facial aging may help patients better understand their options.

  • Assess the degree of patient motivation before initiating a therapy plan.

INTRODUCTION

Over the past decades, the use of facial fillers has increased dramatically. Among the fastest growing groups in the facial filler market include men and those with skin of color.1 According to a study by the American Society of Aesthetic Plastic Surgery, ethnic minorities accounted for 22% of cosmetic procedures in the United States.2 Moreover, as the ethnic minority population increases, this number is expected to grow accordingly. In order to best serve all patients, it is important to appreciate not only the role of ethnicity and gender in their care, but also the critical differences in ideal filler placement in different ethnic populations.

BACKGROUND

While the cosmetically undesirable signs of facial aging were initially believed to be secondary to the effects of gravity on the skin and subcutaneous fat (with treatments designed accordingly),3–6 there has been a paradigm ...

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