Chapter 20: Special Considerations in African American Skin

INTRODUCTION

People of color are increasingly seeking out products and procedures to fight the effects of aging, including surgical and nonsurgical cosmetic procedures. In fact, a survey by the American Society for Aesthetic Plastic Surgery (ASAPS) found that cosmetic procedures performed on racial and ethnic minorities represented 22% of the 11.5 million surgical and nonsurgical cosmetic procedures performed in the United States in 2006.¹ According to the survey, this market segment consisted of Hispanics (10%), African Americans (6%), Asians (5%), and other non-Caucasian individuals (1%). In addition, racial and ethnic minorities had a 2% increase in cosmetic procedures from 2005 and are among the fastest growing segment of the cosmetic procedures market. Consequently, a thorough understanding of the aging process in ethnic skin and nonsurgical treatment options for patients of color is required of dermatologists and cosmetic surgeons who will treat these patients.

Of the 11.5 million procedures in 2006, nonsurgical cosmetic procedures made up 83% of the total.¹ Not surprisingly, new products in this market continue to emerge at a brisk pace—all the more reason for clinicians to take a proactive approach to education and training. The following chapter provides an overview of differences between Caucasian skin and ethnic skin, focusing on structural and pathophysiologic differences, and corresponding treatment options for ethnic patients.

UNDERLYING MECHANISMS IN THE AGING FACE

In order to make the appropriate selection and application of cosmetic procedures, clinicians must acquire a thorough understanding of the underlying mechanisms in the aging face. As the face begins to age, fat atrophy and hypertrophy cause hills and valleys to develop, producing demarcations between the cosmetic units. Features become concave, characterized by loss of volume in the lips (mainly the upper lip), sunken temple and cheek, scalloped mandible, and increased shadowing among the resulting hills and valleys. With aging, the most significant change in appearance is the sagging of excess skin, which causes the conversion of primary arcs to straight lines. Reversing the effects of fat atrophy/hypertrophy cannot be adequately accomplished through conservative techniques. A comprehensive approach, that considers the entire face and all the underlying causes of aging is necessary. Volume must be restored in regions experiencing fat atrophy and excess fat, must be removed from regions where fat has accumulated. Correcting the distribution of volume throughout the face can help restore homogenous topography, eliminate demarcations between cosmetic units, and restore the primary arcs.²

STRUCTURAL AND FUNCTIONAL DIFFERENCES BETWEEN CAUCASIAN SKIN AND ETHNIC SKIN

The most evident difference between ethnic skin and Caucasian skin is epidermal melanin content. While no differences exist in the number of melanocytes, variations do exist in the number and size³ and packaging and distribution⁴ of melanosomes. Moreover, the epidermal melanin unit in skin of color contains more melanin overall and may undergo slower degradation.³ These differences in melanin and melanosomes ...