African American patients who come in for consultation are almost uniformly concerned about the formation of keloids. As most surgeons are aware, the term keloid is often used to describe a slightly elevated scar, hyperpigmented scar, or widened scar. Nonetheless, unsightly scaring is of major concern. Frequently, African American patients are concerned about the surgeon's familiarity with African American surgery. As with Asian patients, these patients are also extremely concerned about a natural appearance. Relatively thicker skin in the subbrow area and heavier subbrow fat pads are commonly present when upper eyelid surgery is performed. Many surgeons extend the upper eyelid crease beyond the lateral canthus into the crow's feet area in Caucasian patients. This generally is not ideal in the African American patient as the scar will most likely be too obvious.
Assuming that the skin incision will heal with either hyperpigmentation or hypopigmentation is a good way of remembering to design the upper eyelid incisions to remain within the limits of the orbit. It is also important to note that many patients of African descent have epicanthal folds and need special attention to the design of the upper lid creases.
Although the presence of brow ptosis is common, particularly in patients who come in for age-related changes, there is often hesitation to undergo brow surgery - endoscopic or otherwise. I have found that performing limited skin excision in upper eyelids, and resection with prominent eyes and lower lid retration, corneal exposure can be too great and lead to keratitis or ulceration. When a spacer graft is necessary in the lower eyelid, I use biomaterial processed from donated human tissue with success.
Sarcoidosis, which is common in the African American population, will frequently present with lacrimal gland enlargement or prolapse. Many of these patients come in for cosmetic surgery un-aware that they have sarcoidosis or that this is a manifestation of their sarcoidosis.
0 comments:
Post a Comment