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INTRODUCTION

Patients of African descent, like those of Asian and European descent, are interested in corrective aesthetic procedures to improve the appearance of their skin and hair. Facial aesthetic problems of concern for this population include dyspigmentation, benign facial growths, rhytides, laxity, and aging. Alopecia and facial hypertrichosis are additional aesthetic problems for which these patients seek treatment.

Many widely performed aesthetic procedures are appropriate for individuals of African ancestry. However, given the increased propensity for many of these patients to experience adverse events such as pigmentary alterations or keloidal scarring after aesthetic procedures, knowledge of proper techniques, selection of appropriate tools, agents and/or devices is critically important to achieve successful outcomes in this population.

Microdermabrasion and chemical peels may be used safely and effectively for the treatment of dyschromias, scarring, acne, and textural changes in skin of color (SOC) patients. In general, superficial and medium depth chemical peels are appropriate for individuals with darker skin tones, but deep chemical peels should be avoided. Among superficial and mid-depth peels, careful selection of appropriate peeling agents and concentrations as well as slow titration upward, when appropriate, are important to avoid postinflammatory hyperpigmentation (PIH) or hypopigmentation.

A variety of modalities exist for the removal of facial dermatosis papulosa nigra (DPN), common benign growths of aesthetic concern that commonly occur in African American women. Whereas light electrodesiccation, curettage, scissor excision, and laser may safely remove the lesions, cryotherapy should be avoided in darker skin, as it may produce hypopigmentation or depigmentation of the skin.

The selection of appropriate lasers for the SOC patient is critically important to avoid adverse events. For example, selection of the long-pulsed 1064 nm Nd:YAG for hair removal or the 1550 nm erbium-fractionated lasers for acne scarring can lead to success in individuals of color with appropriate treatment settings. In contrast, hair removal with the alexandrite laser or with intense pulsed light will likely lead to pigmentation problems, given the stronger selectivity for pigment of these devices.

Neurotoxins and fillers can be used to ameliorate the signs of aging in darker-skinned patients. Minimizing cutaneous trauma during injection by keeping the number of entry points to a minimum and delivering dermal injections is important to avoid pigmentary changes.

For hair transplantation, an understanding of the curved structure of the African hair follicle, the propensity for keloidal scar formation and the selection of appropriate tools for graft preparation is important for transplantation success in this population.

Being armed with the proper knowledge, skills and tools for the execution of aesthetic procedures in individuals of African descent will lead to success.

MICRODERMABRASION

Microdermabrasion is a treatment that was first introduced to the United States in 1996 and is primarily used for skin resurfacing.1 Its noninvasive approach makes it a safe procedure to use in all Fitzpatrick ...

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