Mobile Procedures for Ethnic Patients
Aesthetic Surgery in African Americans
The most common aesthetic surgeries in African Americans are the same surgeries that are the most common in everyone of course. These include facial rejuvenation, breast enhancement, and body contouring and have all of the same goals, risks, benefits, and concerns that all patients have. But there are certain nuances worth mentioning as it relates to aesthetic surgery in African Americans.
African-American facial aging tends to be less dramatic and skin laxity and wrinkles tend to be less of a problem, but deeper folds still develop, which are best addressed surgically. The nasolabial fold and jowls are treated with a mid-face and facelift. Neck laxity can be addressed with a lower face-lift, liposuction, or direct excision of skin. Lower eyelid bags without skin excess, can be treated with a transconjunctival blepharoplasty, avoiding the need for a skin incision. Skin excision is performed when necessary. Facial skin is unlikely to develop keloids or hypertrophic scars.
Excessively full African Americans lips can be corrected with surgical removal of mucosa inside the lip and/or a V-shaped wedge excision. Dr. Park and Dr. Rebowe perform a conservative reduction since it is possible to reduce the lip further, but difficult to replace.
The African American nose is characteristically flatter, shorter, and wider with flaring of the nostrils, which are oval in shape. While many patients seek a refined nasal appearance with its ethnic characteristics, others desire removal of their ethnic features. Although the specific techniques are similar to a standard rhinoplasty, the planned interventions require a plastic surgeon ,who is experienced in aesthetic surgery of the African American nose such as Dr. Park and Dr. Rebowe, and understands the patient’s desires and concerns. The nasal dorsum or roof of the nose is often flat, short, and broad and needs augmentation with cartilage (septum or ear) or bone (skull or rib). Significant nasal tip work requires an open rhinoplasty through an incision inside the nose and across the columella, the skin bridge between the nostrils. This has the potential for visibility, but generally heals with an imperceptible scar. The nasal tip is corrected with suture and cartilage grafts. Flared nostrils (ala) can be corrected by mobilizing the cartilage or excision of skin in the nostril floor or at the alar cheek junction. Thorough preoperative evaluation and precise surgical technique can prevent airway compromise and asymmetry.
Since African Americans are prone to keloids, hypertrophic scars, and altered pigmentation, they must always be respected in planning elective and/or cosmetic procedures where the result could suffer. Prevention of keloids and hypertrophic scars is the best treatment and is maximized with atraumatic surgical technique, pressure dressings, and scar injections. Once formed, re-excision and prophylactic treatment may be indicated but can also make things worse. Skin grafts can be used for large keloids or recurrent keloids and in difficult cases, postoperative low dose radiation can be used to control the lesions.
Aesthetic Surgery in Asian Patients
Asian patients also seek the same, common procedures that all patients seek with similar issues. The largest variable is figuring out the ideal goal of the asian patient, which may include preserving the Asian ideals or westernizing. Most Asians seeking cosmetic procedures of the eyelid and nose are not looking to westernize their features, but seek a change to satisfy their sense of aesthetics and beauty.
Westernizing Asian eyelid surgery is often directed at the web (Mongolian fold) of skin at the inner aspect of the eyelid or the absence of a supratarsal / palpebral crease with lid fullness due to descent of fat under the eyelid skin. The Asian upper blepharoplasty is often referred to as the double-eyelid operation, and it can be done under local anesthesia in an outpatient setting. The procedure can be done with removal of excess skin and fat or it can be done with quilting sutures without an incision. In either case, an adherence between the skin and underlying levator muscle is created. The web on the inner aspect of the eyelid can be corrected with local tissue rearrangment, in the form of a w-v plasty procedure.
The typical Asian nose is characterized by a flat nasal dorsum, low projection of the nasal tip, and thick nasal skin. An emphasis is placed on thinning the soft tissue envelope, strengthening the nasal tip, and augmenting the nasal dorsum. The removal of fibrofatty tissue below the skin at the tip reduces the thickness of the skin envelope. Nasal tip projection is achieved with cartilage sculpting and cartilage grafts. Minor dorsal augmentation can be obtained with an onlay cartilage graft, but major augmentation requires rib cartilage, rib bone, bioprosthetic, or synthetic implants. Rib cartilage or bone harvest obviously requires a major additional surgical site. Synthetic implants, especially silicone, are commonly used in Asia, but the risk of postoperative complications is greater with the use of synthetic materials (infection, exposure, extrusion). Bioprosthesis are products that are manufactured from human or animal tissue and the risks are lower than synthetic implants.
Aesthetic Surgery in Hispanic Patients
Common procedures desired by Hispanic patients include restoring a more youthful figure, correcting the changes of aging and pregnancies on the breasts and abdomen, and facial surgery. Buttock Augmentation is more common in the Hispanic population and can be completed with an implant, flap, or fat injection. The risks of hypertrophic scarring, keloids, and loss of pigment must be considered prior to cosmetic surgery or skin resurfacing in the Hispanic population. A Hispanic nose is typically characterized by thick nasal skin, a broad nasal base, and decreased projection and adding grafts to the nasal tip or dorsum can achieve the goals of many patients.