Myths and Knowledge Gaps in the Aesthetic Treatment of Patients With Skin of Color

July 2019 | Volume 18 | Issue 7 | Original Article | 618 | Copyright © July 2019

Andrew F. Alexis MD MPH,a Julius Few MD,B Valerie D. Callender MD,c Pearl Grimes MD,D Jeanine Downie MD MA,E Charles Boyd MD,f Conor J. Gallagher PhDg

aIcahn School of Medicine at Mount Sinai, New York, NY

BThe Few Institute for Aesthetic Plastic Surgery, Chicago, IL 

cCallender Dermatology and Cosmetic Center, Glenn Dale, MD 

DThe Vitiligo & Pigmentation Institute of Southern California, Los Angeles, CA

EImage Dermatology, Montclair, NJ

fBoyd Beauty, Birmingham, MI 

gAllergan plc, Irvine, CA


Background: Misperceptions about facial aesthetic treatments in individuals with skin of color (SOC) may influence treatment selection. 

Objective: We aimed to identify knowledge gaps and myths concerning facial aesthetic treatment in individuals with SOC. 

Methods: A PubMed search identified articles concerning patients with SOC receiving facial aesthetic treatments. The experience of experts in aesthetic treatment of patients with SOC was also considered. 

Results: Knowledge gaps included not seeking injectable filler treatment of lips, risk of developing keloids with injectable filler treatment, risk of hyperpigmentation precluding surgical procedures and nonsurgical injectable filler treatment, melasma being a minor cosmetic concern with limited treatments, and racial/ethnic groups being homogeneous with respect to facial characteristics and aesthetic concerns. Dispelled myths included perceptions that: individuals with SOC do not need sunscreen; dermal fillers and neuromodulators are not necessary or useful for patients with darker skin; laser treatments cannot be used on darker skin; facial products are unnecessary; and only medical providers with SOC can understand how to treat patients with SOC. 

Conclusions: Knowledge gaps and myths concerning facial aesthetic treatment in individuals with SOC exist. These patients may undergo various facial aesthetic procedures safely and effectively, as long as nuances in treatment approaches are recognized. 

J Drugs Dermatol. 2019;18(7):616-622. 


The number of surgical and nonsurgical cosmetic procedures performed in the United States increased by more than 30% between 2010 and 2016, with the percentage of procedures performed in non-Caucasians increasing from 19% to 25%.1,2 Despite substantial and increasing interest in aesthetic procedures from individuals with SOC, only a few treatment guidelines or recommendations touch on race or ethnicity in discussions of safety and efficacy.3-7 Dermatologists and plastic surgeons may thus be hesitant to treat patients with SOC, based on inadequate guidance for that population. A national survey of Australian dermatologists found that 75% were not confident in performing cosmetic procedures for patients with SOC, and a majority expressed a desire for more training on medical conditions and surgical and cosmetic issues in SOC, emphasizing the need for education on treating these patients.8 Further, widespread and often unsubstantiated anecdotal information regarding treatment preferences and outcomes in people with SOC has encouraged myths about skin care and aesthetic treatment that may prevent this population from receiving the best possible care.This paper aims to examine knowledge gaps that may exist in the medical community and to dispel patient-held myths associated with skin care and aesthetic treatment in SOC.


Based on their clinical experience, the authors, who are experts in the aesthetic treatment of individuals with SOC, identified and reached consensus on myths and knowledge gaps in the aesthetic treatment of individuals with SOC. PubMed searches were conducted on these areas and the results were reviewed for relevance to individuals with SOC.


Gap: Darker-Skinned Patients of African Descent Do Not Seek Injectable Filler Treatment of the Lips


Darker-skinned patients of African descent may be less likely to undergo enhancement of the lips, but they do request restoration of lip volume lost through aging, generally presenting at an older age than Caucasian patients seeking lip enhancement (Figure 1).9