Ethnicity influences cosmetic outcomes

Key Points

Los Angeles - Dermatologists are well aware of the complications that can arise following a rejuvenation procedure in lighter skin-type patients, including post-inflammatory dyschromias, keloids and hypertrophic scarring, among others.

These same complications occur more frequently in darker skin types, and can be significantly more devastating for the patient when they arise. One expert offers her years of experience on the characteristics of darker skin types, how the aging process differs from that of lighter skin types, and what tools are available and work best in rejuvenating procedures.

Pigment disorders rule

"One of the manifestations of the aging face in darker racial ethnic groups is dyschromia, and it is a central characteristic of photoaging for darker skin types. If you look at how the face ages in darker skin types versus skin types I, II and III, one of the major differences is that in darker skin types, you don't really have a lot of coarse and fine wrinkles. Gravity, however, sets in, and what you do see is prominent nasolabial folds and jowls," Dr. Grimes tells Dermatology Times.

She says that aging is characterized by midface aging. In darker skin types, Dr. Grimes corrects the unevenness in the skin with the use of topical bleaching agents, chemical peels and microdermabrasion. She also uses Botox (Allergan Medical) for the forehead and various fillers for nasolabial folds and marionette lines, to recontour the cheek and for teardrop deformities.

Using light with caution

"Due to the problems that lasers pose, and especially overzealous treatments with lasers in darker skin types, aesthetic physicians must be wary of the choices they make for rejuvenating procedures.

"Injectables such as the fillers make a tremendous difference in darker skin and play a major role in treating darker racial ethnic groups," Dr. Grimes says.

Rejuvenating lasers are readily used in cosmetic dermatology for the treatment of wrinkles and fine lines. These cosmetic issues, however, are much more of a central issue in lighter skin types.

Dr. Grimes says that rejuvenation lasers used to tighten the skin can also be used in darker skin types. However, the physician cannot be as aggressive with most of the laser modalities because of the substantially greater risk of postinflammatory hyperpigmentation or hypopigmentation in darker skin types compared with lighter skin types.

"When I perform a tightening rejuvenation procedure in darker skin types, I have seen much success with the long-pulsed Nd:YAG laser as well as with Thermage®. Cosmetic outcomes in my patients are better, with less unwanted side effects of dyspigmentation," Dr. Grimes says.

Dr. Grimes also says that laser hair removal is a popular procedure in darker skin types, and she prefers to use a Nd:YAG laser for optimal cosmetic results.

Overcoming fear

According to Dr. Grimes, many dermatologists are very uncomfortable with treating patients of darker skin types, as the risks of dyschromias and scarring are significantly higher in this group.

Additionally, many physicians may be reluctant to treat darker-skinned patients because of the legal nightmare they may potentially face if complications arise.

A symposium at the 65^th Annual Meeting of the American Academy of Dermatology (AAD) "was long overdue because it was the first time in the history of the AAD where a symposium was held that specifically addressed cosmetic surgery in dark skin," Dr. Grimes says. "As there are significant differences in the way darker and lighter skin types age, there are different ways to treat each skin type, giving special attention to the needs and nuances of each."