African American patients who are in the consultation are almost equally concerned about the formation of keloids. Since most surgeons are aware, the term is often used to describe a slightly raised scar keloids, widened scars or hyper pigmented scar. However unpleasant fear is of great concern. Often, African-American patients on familiarity with African American surgeon surgery. As with Asian patients, these patients are extremely worried abouta natural appearance. Relatively thicker skin in the area subbrow subbrow and fatty lumps are often present when the upper eyelid surgery is performed. Many surgeons extension of the fold of the upper eyelid beyond the lateral canthus area of crows feet in the Caucasian patients. This rule is not ideal in African-American patients, as the scar is probably too obvious.
Assuming that the incision is healed or hyperpigmentation or hypopigmentation is a good wayremembering 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.
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