ABSTRACT
More than 26% of the US population is nonwhite according to 2006 census.(1) The rate of growth in some minority groups is 18 times faster than the caucasian population. It is estimated that by 2056 more than half of the US population will be nonwhite. In fact, California has already become the first state in the United States with “minority” population surpassing 50%. These demographic changes impact surgical considerations in eyelid surgery as well as in many other areas of aesthetic surgery. Modified surgical techniques for application in darker skin types (Fitzpatrick III through VI) as well as linguistic and cultural competencies are needed to meet the increased aesthetic demands of this diverse population. A complete account of cultural issues involving aesthetic surgery is beyond the scope of this chapter; instead emphasis is placed on defining the doctor-patient relationship through which mutual understandings can be achieved across language and cultural barriers. A large part of this relationship can be established at the first meeting when the surgeon and the patient discuss aesthetic concerns and formulate treatment recommendations. From a philosophical perspective, the population of the United States has historically been diverse. Whether this pluralism is framed in lofty political rhetoric or in the harsh reality of discrimination based on one or more of many variables, economic and social pressures push this country towards homogeneity. Perhaps the collective genius of the founding fathers is embodied in the Constitution which provides for and directs us toward inclusiveness. Recognition of ethnic and cultural heritage remains an active pursuit of many, but even the celebrations that ensue are often inclusive, such as St. Patrick’s Day. This process of defining what the population will become genetically and what phenotype will be accepted as the norm is for the foreseeable future a dynamic one. By definition, substantial ethnic diversity will persist. The authors hope that this chapter will provide the surgeon with perspectives that will be useful in understanding the ethnic patient’s objectives. While we will be presenting general considerations, we recognize that each patient must be evaluated as an individual.
