Understanding the Female African American Facial Aesthetic Patient

September 2019 | Volume 18 | Issue 9 | Original Article | 858 | Copyright © September 2019

Andrew Alexis MD MPH,ª Charles Boyd MD,B Valerie Callender MD,c Jeanine Downie MD FAAD,d Sara Sangha PhDE

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

BBOYD, Birmingham, MI

cCallender Dermatology and Cosmetic Center, Glenn Dale, MD

DImage Dermatology PC, Montclair, NJ

EAllergan plc, Irvine, CA


Background: The patient populations seeking facial aesthetic treatments is expanding in terms of racial, ethnic, and cultural diversity. While treatment of facial aging patterns among white women is well-documented, far less information describes the aesthetic needs of the African American patient.

Objective: An online study was conducted to survey facial aesthetic concerns and treatment priorities among US-based population of African American women.

Materials and Methods: A total of 401 female African American participants ages 30 to 65 years reported their attitudes toward facial aging, current facial conditions, most bothersome facial areas and areas most/least likely to be treated first, awareness of treatment options and their consideration rates, and motives and barriers factoring into consideration of injectable treatments. 

Results: Uneven skin tone/color (57%) and dark circles under the eyes (48%) were the most frequently-reported facial concerns. Other common bothersome facial areas affected by signs of aging were the submental area, periorbital area, forehead lines, and chin. Similarly, areas given greater priority with respect to future treatment included the periorbital area, submental area, and forehead lines. With advancing age, priorities heightened for the mid and lower facial areas, which included the nasolabial folds, chin, and oral commissures. Although the majority of participants would consider injectables, cost, and safety/side effects were cited as frequent concerns. 

Conclusion: For African American women, concerns about facial aging may be less about fine lines and wrinkles caused by increasing skin laxity, and more about pigmentary concerns and shifts in underlying soft tissue volume. 

J Drugs Dermatol. 2019;18(9):858-866. 


As the range of minimally invasive medical aesthetic treatments for facial rejuvenation has broadened over the past decade, so has their safety and applicability across a wider spectrum of skin types. Concurrently, demographic shifts in the U.S. and internationally have increased the racial and ethnic diversity of patient populations seeking aesthetic treatments. Over the past decade, the number of African American/Black patients receiving cosmetic procedures in the US increased by 76%, and in 2017 represented the second-greatest proportion of non-white cosmetic patients (9%) after Hispanic/Latinos (11%).1,2 Among aesthetic treatment options, there is an increasing trend toward minimally-invasive modalities (including injectable modalities) which has now grown to represent over 90% of all cosmetic procedures performed in the US.2 In addition, there is a much stronger emphasis on maintaining naturalness and preservation of ethnic characteristics with procedural outcomes. Racial and ethnic differences in skin type and facial structure impact the rate of photoaging and patterns of facial aging and contribute to different aesthetic concerns.3-5,7 Given that many published treatment algorithms are focused predominantly on facial aging patterns seen in populations of European ancestry, there remains a need to explore the aesthetic concerns and needs of African American/Black patients which are influenced by their skin biology, skin care needs and common anatomical features.3-5

The demographic terms “African American or Black” used by the U.S. Census Bureau encompasses multiple ethnicities, and in addition to African and Afro-Caribbean origins, this demographic may also be represented by a mixture of African, European, and Native American ancestry.6 Importantly, cultural influences also shape an individual’s perceptions of beauty, attitudes toward preserving aesthetic appearance, and the readiness to seek out interventional treatments.7 An understanding of not only the structural and cutaneous signs of aging but also treatment preferences and motivations reported by African Americans may help physicians in their selection of treatment plans focused on the goals and expectations of this patient population.