Cosmetic procedures are increasingly popular in the United States, as the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) surveys continue to show year after year.1,2 Patients seeking cosmetic procedures are recommended to visit a board-certified dermatologist or plastic surgeon. However, many will seek treatments at non-dermatology locations, such as medical spas and salons.
In an interview with The Dermatologist, Cheryl M. Burgess, MD, discusses common cosmetic concerns among patients with skin of color in particular, as well as the importance of all dermatologists recognizing adverse reactions from cosmetic procedures in this patient population. She presented on this topic at the Skin of Color Update, held from September 7 through 8 in New York, NY.3
Dr Burgess is the founder, medical director and president of the Center for Dermatology and Dermatologic Surgery in Washington, DC. She is also an assistant clinical professor at Georgetown University Medical Center and George Washington University Hospital.
The Dermatologist: What are some common cosmetic concerns and procedures among patients with skin of color? Are there any particular procedures that pose a challenge for this patient population?
Dr Burgess: There are approximately 5 main concerns that dermatologists see in patients with skin of color. First, and foremost, is discoloration, or dyschromias. While dyschromias can appear minor, it is one of the major concerns among patients with skin of color. It can present as light or dark discoloration on the skin, in any age group, and any gender.
Another common concern is scars, such as keloids, atrophic scars, and scars from cystic acne, which can be treated with various scar revision techniques.
Benign growths, which include seborrheic keratosis, or dermatosis papulosa nigra (DPN), are another common concern. These growths, particularly within the skin of color population, can make many patients look older because they are associated with age. In my practice, we have had patients who look 10 years younger just by removing DPNs.
Volume loss is a more common anti-aging concern among patients with skin of color. Patients don’t have a lot of wrinkles, per se, but aging is associated with volume loss, as I call it—more sinking and sagging. Anti-aging corrections involve more skin tightening and volume replacement. In addition, hyperkinetic lines are another concern, particularly in the glabellar area, which can cause individuals to be perceived as being angry, mean, or unapproachable.
The Dermatologist: Prior to performing any procedure, are there any techniques or complications dermatologists should consider?
Dr Burgess: First, dermatologists should assess a patient’s heritage, and what I mean by that is that they may have a patient who looks Caucasian, because they have light skin, but really that patient isn’t Caucasian as far as their hereditary lineage goes. I also recommend examining the scars on a patient’s body because this can give a good indication of how they will heal.
When treating dyschromias or pigmentary changes, I use a Wood lamp and colorimeter (or maximeter) to determine the depth of the pigment. It’s a more quantitative measurement of how to assess whether a treatment is working or if it needs to be changed. I use this with patients during their follow-up visit to determine where we are with therapy and to objectively determine if their treatment is working because they sometimes return and tell me the therapy is not working. I’ll do a meter reading and remind them, “it’s working but it’s slow. Let’s add a medium chemical peel,” or, “let’s add something else.”