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INTRODUCTION

The Latino population, comprising Hispanics and Latin Americans, is the fasting growing minority population in the United States. Latin Americans descend from the countries of the Western Hemisphere, south of the United States, that predominantly speak Spanish, Portuguese, or French while Hispanics are defined as persons of Spanish descent. Together, Latinos represent a beautiful and ethnically diverse population who are presenting in record numbers to dermatologists and plastic surgeons throughout the country for a variety of cosmetic procedures.

Over the past 10 years, the rate of cosmetic surgery procedures in ethnic patients has risen dramatically. Hispanic patients lead all ethnic groups in this trend and represent a sizable share of the market. In 2006, according to the American Society of Plastic Surgery, Hispanic patients had 932410 cosmetic procedures performed, a marked increase from 552638 procedures in 2004.1 Hispanic patients accounted for 8.6% of total cosmetic procedures in 2006, an increase from 6.3% in 1999. The most commonly requested noninvasive cosmetic procedures among Hispanics were Botox®, injectable fillers, and chemical peels. With respect to invasive cosmetic procedures among Hispanics, breast augmentation, nose reshaping, and liposuction were the most frequently requested. The American Society for Aesthetic Plastic Surgery published similar statistics. In 2006, there were approximately 11.5 million surgical and nonsurgical cosmetic procedures performed in the United States, compared to 2.1 million in 1997.2 Hispanics led all racial and ethnic minority groups undergoing 9.7% of the 11.5 million procedures, an increase from 6% in 1997.

Pigmentary disorders represent the predominant disturbances for which Latino patients seek cosmetic consultation.3,4 Hyperpigmentation and facial melasma were among the top 10 most common skin diagnoses in a group of 2000 Latino patients treated in a hospital-based clinic.4 The incidence of pregnancy- induced facial melasma among Mexican women has been reported to be as high as 50%.4 Additionally, the mandibular type of melasma, associated with papillary dermal melanin accumulation, predominates in middle-aged females.5

Cosmetic consultation should be the prerequisite visit before any aesthetic procedure is considered. In addition to the standard medical and dermatologic history, a thorough understanding of the patients' concerns and expectations should be elicited. For example, pigmentary disorders particularly melasma and postinflammatory hyperpigmentation (PIH), cause significant psychosocial distress among Latinos, affecting their quality of life.1,2 They often present at consultation hoping for immediate treatment and resolution. Additionally, Latino patients are presenting more frequently requesting the latest cosmetic treatments for photoaged skin including laser and light source therapies. The greatest risk posed to these patients would be a rush to treatment. Often times, the best and most cost-effective treatment options are time and observation. Patient education on their skin type and perioperative care is important component of the cosmetic consultation. This typically includes a discussion on the increased risk of dyspigmentation with even the mildest irritation in darker skin types (Figure 23.1). In ...

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