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  • With rising populations of skin of color, dermatologic surgeons must understand and recognize the particular issues and needs relevant to those with darker skin.

  • Among all patients of color, the most frequently performed cosmetic procedures are soft tissue fillers, botulinum toxin injections, microdermabrasion, and chemical peels. Additionally, hair transplantation is becoming increasingly popular.

  • Although the exact number of hair transplant procedures performed in persons of color is unknown, it is clear that as the awareness of alopecia in men and women grows, the numbers of hair transplantations in this group of patients will increase.

Cosmetic procedures are becoming increasingly more popular, and over the past 5 years, the number of cosmetic procedures performed has increased by approximately 2 million.1 The most common nonsurgical procedures performed in 2012 were botulinum toxin injections, hyaluronic acid fillers, laser hair removal, microdermabrasion, and chemical peels.1 Caucasian patients typically desire cosmetic procedures that diminish signs of photoaging: fine lines, rhytides, dyschromia, telangiectasias, and keratoses. In contrast, patients of color most often request cosmetic procedures for disorders of pigmentation, primarily postinflammatory hyperpigmentation (PIH).2,3,4,5 Two of the most common nonsurgical cosmetic procedures being performed in the United States, which address disorders of pigmentation, are chemical peels and microdermabrasion,1 and these procedures and techniques may require modifications and special considerations when performed in patients of color. Of note is the fact that sought after cosmetic procedures, such as sclerotherapy, may result in the complication of PIH.

Alopecia occurs commonly in skin of color populations, leading to demand for hair transplantation surgery. Racial differences in hair and hair follicle morphology may necessitate differences in surgical instrument selection and surgical technique.

With rising populations of skin of color come increasing demands on cosmetic dermatologic surgeons, who must understand and recognize the particular issues and needs relevant to those with darker skin. Because the bulk of published data on cosmetic procedures thus far has focused on the Caucasian population, performing aesthetic procedures on patients with skin of color remains a challenge. Clearly, the medical community must expand its knowledge of the cosmetic issues relevant to this growing patient population. In this chapter the safety and efficacy of the following procedures in skin of color will be reviewed: chemical peels, microdermabrasion, hair transplantation, and sclerotherapy.


Chemical peeling is the process of applying one or more chemical agents to the skin for the purpose of exfoliating the epidermis or dermis, thus creating a wound that subsequently reepithelializes. Chemical peels are performed using superficial, medium-depth, or deep peeling agents. Superficial peels, with agents such as glycolic acid (GA), salicylic acid (SA), lactic acid (LA), Jessner’s solution, trichloracetic acid (TCA) in concentrations of 10% to 30%, and lipohydroxy acid (LHA) in concentrations of 5% to 10%, penetrate the stratum corneum to the papillary dermis. Medium-depth ...

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