Preface

More than half of the population of the United States will soon be non-Caucasian. Further, much of the currently burgeoning demand for cosmetic dermatology emanates from Latin America, the Middle East, and the Far East. Fortunately, improvements in technology have made the treatment of pigmented skin more feasible. For instance, long-pulsed Nd:YAG lasers can be used to safely remove hair in darker-skinned patients, and gentler fractionated lasers can resurface the skin of Indian, African American, and Asian persons without a high risk of pigment change.

The purpose of this book is to collate information about cosmetic procedures in pigmented skin. We define “pigmented skin” or “ethnic skin” as any skin darker than the fair Caucasian skin of blondes and redheads. Thus, pigmented skin includes the darker skin of the Mediterranean; of Africa; of indigenous ethnic areas such as those populated by Native American aboriginal peoples; of India and the Near East; of the Middle East; and of the Far East. Of course, many patients have mixed ethnic heritage. Both genetic endowment and environmental factors will influence an individual patient's suitability for certain cosmetic procedures.

To make the text more useful, we have subdivided it into small parts. Most chapters are only 1000 to 2500 words in length and hence can be easily digested in a single, brief sitting. Chapters are organized in categories so that the reader can easily find what is needed.

The first cluster of chapters defines the concept of ethnic skin and clarifies the approach to evaluating and treating cosmetic patients with darker skin. Significantly, a detailed discussion of common adverse events is included in the initial part. Prevention and improvement of such unwanted outcomes is a crucial part of a successful cosmetic practice.

The second part of the book is its heart. This part includes discussions of common cosmetic treatments for skin color and tone in patients with ethnic skin. Primary organization of this material is by the depth, location, and type of skin structure treated rather than by the device or procedure used. We chose this paradigm because, in actual clinical practice, we are confronted with patients who would like the best outcome for their problem, regardless of the technique used. We begin by considering superficial textural and color imperfections. Then we consider treatment of the deeper dermis, including nonablative and ablative resurfacing for improvement of wrinkles and scars. Lastly, we address problems that can occur in areas other than the face, such as excess hair, body contour irregularities, and sagging of the skin. So as not to complicate chapters unnecessarily, when widely divergent modalities are employed for similar indications, we have discussed these in consecutive chapters. For example, in the realm of color improvement, successive chapters examine the use of chemical peels and microdermabrasion for color and texture; lasers and lights for vascular lesions; and lasers and lights for pigment excess. In each chapter in this section, procedures are described in general and then the specific elements relevant to skin of color patients are highlighted. In this manner, readers learn the procedure in its entirety, including techniques that are the same for all patients regardless of ethnicity.

No book on cosmetic dermatology would be complete without a section on cosmeceuticals. Because these constitute a gentle form of noninvasive therapy and because certain cosmeceuticals may be better suited for patients with skin of color, we include a chapter on such topical therapies as a transition to the last part of the book.

In the third section of the book, experts discuss treatments of specific conditions and diagnoses that are likely to afflict those persons with skin of color. Among these problems are melasma, dermatosis papulosa nigra, acne scarring, and postinflammatory hyperpigmentation. The reader who is more interested in a patient's particular condition than in global improvement of skin color or texture can consult these chapters rather than the more general chapters in the second part of the book. Once the reader chooses a particular treatment approach, it may be appropriate to refer to an earlier chapter that provides a detailed explanation on how to proceed step by step.

The fourth and final part of the book summarizes the challenges associated with cosmetic treatments in ethnic skin. The chapters in this section acknowledge that ethnic skin can be separated into subtypes. We asked notable experts in their specialties to consider patients of different ethnic and racial types, including African, Latino, Far Eastern, and Indian patients. Such patients are in some ways similar, and in other ways different, in their cosmetic dermatology needs.

We hope you find this book useful.