Ethnic and Gender Considerations in the Use of Facial Injectables

Abstract

The United States is becoming increasingly more diverse as the nonwhite population continues to rise faster than ever. By 2044, the US Census Bureau projects that greater than 50% of the US population will be of nonwhite descent. Ethnic patients are the quickest growing portion of the cosmetic procedures market, with African-Americans comprising 7.1% of the 22% of ethnic minorities who received cosmetic procedures in the United States in 2014. The cosmetic concerns and natural features of this ethnic population are unique and guided by differing structural and aging processes than their white counterparts. As people of color increasingly seek nonsurgical cosmetic procedures, dermatologists and cosmetic surgeons must become aware that the Westernized look does not necessarily constitute beauty in these diverse people. The use of specialized aesthetic approaches and understanding of cultural and ethnic-specific features are warranted in the treatment of these patients. This article will review the key principles to consider when treating African-American patients, including the average facial structure of African-Americans, the impact of their ethnicity on aging and structure of face, and soft-tissue augmentation strategies specific to African-American skin.

Characteristics and management of Asian skin

“…In relation to cosmiatric procedures, Asiatic countries are showing an increasing interest. However, the desire for a westernized appearance is not necessarily sought or appropriate for all . In Asia and Southeast Asia, for example, many women prefer extremely fair skin to tanned skin, and the cosmetic procedures reflect this attitude …”

“…Patients experience greater stimulation of collagen by these procedures and histologically show less thinning of collagen bands and elastic tissue at baseline and after treatment. Therefore, they should require less treatment than Caucasian patients …”

“…It is recommended to abstain from or minimize the use of multiple puncture techniques when injecting soft tissue fillers in patients with ethnic skins to prevent postinflammatory hyperpigmentation (PIH). When HA is used, slower injection rates decrease the incidence of PIH and clinical bruising with occasional subsequent hemosiderin deposition in patients with higher phototypes . Although keloid formation has not been generally reported with the use of injectables, it is a necessary caution in patients with a history of hypertrophic scars and keloids …”

Lip and Perioral Enhancement with HA Dermal Fillers in Individuals with Fitzpatrick Skin Types IV-VI

“…• Individuals with skin of color request lip enhancement treatments, often to restore lip volume lost through aging, 3,4 as well as, in our experience, to further enlarge lips. However, there are minimal effectiveness or safety data for individuals with skin of color…”

Universal and Ethnic-specific Considerations on Facial Rejuvenation: Where Do You Inject Your Fillers?

“…5 However, aging black patients may seek to restore the youthful fullness of their lips. To this end, injectable products are placed only in the upper lip, as the lower lip usually maintains its volume.…”