Rejuvenation of the African American Periorbital Area: Dynamic Considerations

ABSTRACT

The rejuvenation of the African American periorbit is rooted in select modifications of traditional techniques. The African American patient presents with dynamic considerations and needs. Whereas this subset is at risk for pigmentation and scar concerns, the natural resistance to actinic damage makes rejuvenation efforts rewarding. We will review the composite that makes up the periorbit, the brow, upper eyelid, lower eyelid/lateral canthus, and the midface unique. Specific indications and presurgical and postsurgical considerations will be presented in addition to technical considerations to manage periorbital aging that spares the skin. Common pitfalls and succinct ways to avoid them without compromising on the ultimate end result will be presented. Ultimately, periorbital rejuvenation can be done completely without jeopardizing one's ethnic identity.

KEYWORDS

African American - periorbital - blepharoplasty - midface lift - brow lift - canthoplasty

REFERENCES

• 1 American Society for Aesthetic Plastic Surgery .Cosmetic Surgery National Data Bank. Garden Grove, CA; American Society for Aesthetic Plastic Surgery 2007: 1-20
• 2 American Society for Aesthetic Plastic Surgery .Cosmetic Surgery National Data Bank. Garden Grove, CA; American Society for Aesthetic Plastic Surgery 2004: 1-20
• 3 Fitzpatrick T B. The validity and practicality of sun-reactive skin types I through VI.  Arch Dermatol. 1988;  124 869-871
• 4 Volpe C R, Ramirez O M. The beautiful eye. In: Kellman RM, Strong EB Facial Plastic Surgery Clinics of North America, 13. Philadelphia, PA; Elsevier 2005: 493-504
• 5 Hillebrand G G, Levine M J, Miyamoto K. The age-dependent changes in skin conditions in African Americans, Asian Indians, Caucasians, East Asians and Latinos.  IFSCC Magazine. 2001;  4 259-266
• 6 Grimes P, Edison B L, Green B A, Wildnauer R H. Evaluation of inherent differences in ethnic skin types and response to topical polyhydroxy acid (PHA) use. American Academy of Dermatology Poster Exhibit Washington DC; March 2001
• 7 Grimes P E, Hunt S G. Considerations for cosmetic surgery in the black population.  Clin Plast Surg. 1993;  20 27-34
• 8 Odunze M O, Reid R R, Yu M, Few J W. Periorbital rejuvenation and the African American patient: a survey approach.  Plast Reconstr Surg. 2006;  118 1011-1018
• 9 Flowers R S, Nassif J M, Rubin P A, Hayakawa T, Lehr S K. A key to canthopexy: the tarsal strap. A fresh cadaveric study.  Plast Reconstr Surg. 2005;  116 1752-1758 discussion 1759-1760
• 10 Mathes S, Hertz V. Plastic Surgery, Vol. II, The Head and Neck, Part 1. Flowers RS, Nassif JM. Aesthetic Periorbital Surgery. New York; Elsevier pp.77-126
• 11 Jelks G W, Glat P M, Jelks E B, Longaker M T, Longaker M T. The inferior retinacular lateral canthoplasty: a new technique.  Plast Reconstr Surg. 1997;  100 1262-1270 discussion 1271-1275
• 12 Hester T R, Codner M A, McCord C D et al.. Transorbital lower lid and midface rejuvenation.  Oper The Plast Reconstr Surg. 1998;  5 163
• 13 Odunze M, Rosenberg D S, Few J W. Periorbital aging and ethnic considerations: a focus on the lateral canthal complex.  Plast Reconstr Surg. 2008;  121 1002-1008
• 14 Llorente O, McCallum J C, Few J W. The transconjunctival midface lift: a six-year experience working under the muscle.  Plast Reconstr Surg. 2008;  122 3
• 15 Lorente O, Few J W. Transconjunctival deep plane midface rejuvenation. In: deCastro C, Boehm KA Midface Surgery: Techniques in Aesthetic Plastic Surgery Series. Philadelphia, PA; Saunders 2009: 161-172
• 16 Harris M O. The aging face in patients of color: minimally invasive surgical facial rejuvenation-a targeted approach.  Dermatol Ther. 2004;  17 206-211
• 17 Reid R R, Said H K, Yu M B, Haines K G, Few J W. Revisiting upper eyelid anatomy: introduction of the septal extension.  Plast Reconstr Surg. 2006;  117 65-66
• 18 Odunze M O, Alvin M C, Few J W. Restylane and people of color.  Plast Reconstr Surg. 2007;  120 2011-2016
• 19 Grimes P E, Few J W. Injectable filler in skin of color. In: Carruthers J, Carruthers A Soft Tissue Augmentation. 2nd ed. Philadelphia, PA; Saunders Elsevier Publishers 2008: 143-150
• 20 Matarasso S L, Carruthers J D, Jewell M L. Restylane Consensus Group . Consensus recommendations for soft-tissue augmentation with nonanimal stabilized hyaluronic acid (Restylane).  Plast Reconstr Surg. 2006;  117(3 Suppl) 3S-34S
• 21 Lowe N J, Maxwell C A, Lowe P, Duick M G, Shah K. Hyaluronic acid skin fillers: adverse reactions and skin testing.  J Am Acad Dermatol. 2001;  45 930-933
• 22 André P. Evaluation of the safety of a non-animal stabilized hyaluronic acid (NASHA—Q-Medical, Sweden) in European countries: a retrospective study from 1997 to 2001.  J Eur Acad Dermatol Venereol. 2004;  18 422-425
• 23 Nordlund J J, Abdel-Malek Z A. Mechanisms for post-inflammatory hyperpigmentation and hypopigmentation.  Prog Clin Biol Res. 1988;  256 219-236
• 24 Neuhaus R W. Anatomical basis of “senile” ectropion.  Ophthal Plast Reconstr Surg. 1985;  1 87-89
• 25 Yaremchuk M J. Restoring palpebral fissure shape after previous lower blepharoplasty.  Plast Reconstr Surg. 2003;  111 441-450 discussion 451-452