Cosmetic dermatology is the aspect of dermatology that deals with skin conditions which do not cause any significant morbidity or functional disability. These conditions may be left alone without medical consequence or are treated mainly for enhancement of the patient’s appearance. Correct identification and characterization of these conditions are needed for subsequent appropriate treatment. Cosmetic dermatology is a growing and challenging aspect of dermatology with meeting the patient’s expectations being just as important as achieving good and safe treatment outcomes. Better recognition, improved practitioner’s skills, and more effective and safer medical technological advances all contribute to the dermatologist’s ability to enhance the appearance with minimal side effects and reduced downtime.
Cosmetic dermatological conditions in the Asian skin may be classified into several broad categories:
Lumps and bumps
Wrinkles and skin laxity
Pigmentary changes especially hyperpigmentation are a major cosmetic concern of Asian patients (Figures 23–1, 23–2, 23–3, 23–4, 23–5, 23–6, 23–7, 23–8, 23–9, 23–10, 23–11, 23–12, 23–13, 23–14, 23–15, 23–16). The Asian skin (Fitzpatrick skin types IV and V) develops pigmentation both constitutionally and reactively. The common acquired cosmetic pigmentary problems encountered include freckles, solar lentigines, melasma, and Hori’s nevus. Patients with pigmented birthmarks such as café au lait macules and nevus spilus often seek laser removal. Nevus of Ota and Ito are harmatomas of dermal melanocytes that occur almost exclusively in Asians of Chinese/Japanese descent.
Freckles are small tan-brown macules occurring over sun-exposed areas only. They are generally present during childhood and get progressively more and darker over the years in relation to the cumulative amount of sun exposure. Histologically, there is hypermelanization in the basal layer of the epidermis. The number of melanocytes is normal, but the melanosomes are elongated and rod-shaped.
Solar lentigines (single—lentigo) are small pigmented macules that are found mainly over the sun-exposed areas of the body such as the face, upper chest, and dorsum of the upper limbs. They tend to appear after the age of 30 and vary in color from light-brown to dark-brown. Dermoscopy may show a faint pigmented network or fingerprint structures or uniform pigmentation. They respond better to pigment-specific lasers than to IPLs.
Solar lentigo—left upper cheek
In this photo, the solar lentigo appears as a larger, well-demarcated, tan-brown lesion. Initially flat, it may become a little thickened with time resembling a seborrheic keratosis. Such spots are also known as age spots and liver spots. Histological features include elongated rete ridges, normal or increased number of melanocytes producing increased melanin, and solar elastosis.