important, was interpreted as an area easily enhanced with cosmetics versus areas that are more structural in nature and may not have cosmetic solutions. Among all participants, the 2 primary structural areas that were most bothersome were sagging underneath the chin/double chin and the under-eye/tear trough, followed by other areas of the upper face (CFLs, FHLs, GLs) and areas of the mid and lower face (chin, OCs, and NLFs) to a lesser degree.
For the younger group (ages 30 to 44), the under-eye/tear trough and CFLs were the top 2 priorities. The periocular area has been suggested as a common concern among African American women, primarily due to age-related changes in the position of the lateral canthal angle complex which contributes to rounding of the lateral canthi, increased laxity of the lower eyelid, increased scleral show, and infraorbital shadowing.19,20 While under-eye/tear trough was a top treatment priority for both 30 to 44 and 45 to 65 age groups, sagging underneath the chin /double chin took precedence over other areas among the older age cohort. In addition, NLFs and the chin were elevated in priority for this group. An elevation in priorities for the lower midface is somewhat expected as it reflects the increasing structural changes and midface ptosis that accompanies aging. In agreement with observations previously reported among African American women, the primary signs of facial aging tend to be more associated with gravity-induced soft tissue redistribution of the midface and submental area opposed to fine lines and wrinkles of the upper face that women with lighter skin phototypes report first.5,14,20
Midface ptosis and volume loss play a pivotal role in the effects of facial aging, and because its structural integrity supports numerous adjoining tissues. The lower eyelid complex is the “roof†of the midface and therefore the results of aging that affect midface concomitantly affect the under-eye area.21
For both groups (ages 30 to 44 and 45 to 65), the under-eye/tear trough was selected a higher priority than CFLs. This also agrees with previously reported aesthetic concerns common among African American women, who only report moderate-to-severe CFLs 1 to 2 decades later than age-matched white women.5 While these observations highlight the under-eye area as a key treatment area for this patient population, it’s important to note that participants were not given the option to differentiate between “under-eye†and “tear troughâ€. In the absence of a tear trough, under-eye issues may be due to dark circles which involve a vascular or pigmentary etiology.22
An underlying anatomical theme for the midface in this patient population may also include a negative corneal vector attributable to a hypoplastic malar eminence.14,20 With agerelated gravitational descent of a prominent malar fat pad paired with a tendency for orbital fat pad pseudo-herniation,
For the younger group (ages 30 to 44), the under-eye/tear trough and CFLs were the top 2 priorities. The periocular area has been suggested as a common concern among African American women, primarily due to age-related changes in the position of the lateral canthal angle complex which contributes to rounding of the lateral canthi, increased laxity of the lower eyelid, increased scleral show, and infraorbital shadowing.19,20 While under-eye/tear trough was a top treatment priority for both 30 to 44 and 45 to 65 age groups, sagging underneath the chin /double chin took precedence over other areas among the older age cohort. In addition, NLFs and the chin were elevated in priority for this group. An elevation in priorities for the lower midface is somewhat expected as it reflects the increasing structural changes and midface ptosis that accompanies aging. In agreement with observations previously reported among African American women, the primary signs of facial aging tend to be more associated with gravity-induced soft tissue redistribution of the midface and submental area opposed to fine lines and wrinkles of the upper face that women with lighter skin phototypes report first.5,14,20
Midface ptosis and volume loss play a pivotal role in the effects of facial aging, and because its structural integrity supports numerous adjoining tissues. The lower eyelid complex is the “roof†of the midface and therefore the results of aging that affect midface concomitantly affect the under-eye area.21
For both groups (ages 30 to 44 and 45 to 65), the under-eye/tear trough was selected a higher priority than CFLs. This also agrees with previously reported aesthetic concerns common among African American women, who only report moderate-to-severe CFLs 1 to 2 decades later than age-matched white women.5 While these observations highlight the under-eye area as a key treatment area for this patient population, it’s important to note that participants were not given the option to differentiate between “under-eye†and “tear troughâ€. In the absence of a tear trough, under-eye issues may be due to dark circles which involve a vascular or pigmentary etiology.22
An underlying anatomical theme for the midface in this patient population may also include a negative corneal vector attributable to a hypoplastic malar eminence.14,20 With agerelated gravitational descent of a prominent malar fat pad paired with a tendency for orbital fat pad pseudo-herniation,
the tear trough is exposed, surface shadowing becomes more obvious, and deepening of the NLF occurs.14,20,21 Amplifying these structural changes, is the contribution of a thicker skin (likely from less photoaging related atrophy in black skin) as it becomes more redundant with aging.14,20,23
The increase in priority for the submental area also agrees with previously observed aging patterns reported among African American patients, of which, signs of aging in the lower face were less pronounced (less jowling) except for the submental area.14 As laxity of the platysma increases and subplatysmal fat descends, the added consequence of a thicker, heavier skin overlying this area exacerbates the effect of blunting of the cervicomental angle.20 This is opposed to the lower facial aging of white women, in which the soft tissue descent is accompanied by more skin laxity and more distinct jowling.20,23 In addition, the softening of the cervicomental angle may be worsened by agerelated resorption of the mandible.24
Here again, it is important to note that participants were not given the option to select between “sagging underneath the chin†or “double chinâ€. A higher body mass index (BMI), which was not assessed here, plays more of a role in excess submental fat (double chin) as opposed to submental skin laxity or sagging. And may be the basis for the results observed here since “double chin†was reported as an existing condition by 32% while “sagging facial skin†was only reported by 21% of participants.
The mid-to-lower facial areas (MLs, jawline, and cheeks) that were lower priorities but did increase in importance for the older group may reflect that these areas benefit from a thicker skin type with greater integrity which may mask the effect of the structural changes occurring. Areas ranked relatively low in bothersomeness and priority by both groups were the perioral lines and lips. This result was not surprising as baseline lip volume may be full and volume loss or perioral lip lines may be less pronounced due to slower photoaging. In addition, perioral lines and lip volume loss has been observed to occur much later in life for African American versus white women.5 Characteristics common among white women include development of rhytides above and below the vermilion border with volume loss. For African American women, rhytides develop more commonly in the body of the upper lip (below the vermilion border); due to volume loss in the upper lip while the lower lip usually maintains its volume.25
Consideration Rates for Future Treatments Including Injectables
The majority of participants were aware of a wide range of minimally-invasive treatments used to enhance skin tightness and quality, which were matched by higher consideration rates. Consideration of treatments involving lasers and light-based procedures were much lower, which was anticipated given the
The increase in priority for the submental area also agrees with previously observed aging patterns reported among African American patients, of which, signs of aging in the lower face were less pronounced (less jowling) except for the submental area.14 As laxity of the platysma increases and subplatysmal fat descends, the added consequence of a thicker, heavier skin overlying this area exacerbates the effect of blunting of the cervicomental angle.20 This is opposed to the lower facial aging of white women, in which the soft tissue descent is accompanied by more skin laxity and more distinct jowling.20,23 In addition, the softening of the cervicomental angle may be worsened by agerelated resorption of the mandible.24
Here again, it is important to note that participants were not given the option to select between “sagging underneath the chin†or “double chinâ€. A higher body mass index (BMI), which was not assessed here, plays more of a role in excess submental fat (double chin) as opposed to submental skin laxity or sagging. And may be the basis for the results observed here since “double chin†was reported as an existing condition by 32% while “sagging facial skin†was only reported by 21% of participants.
The mid-to-lower facial areas (MLs, jawline, and cheeks) that were lower priorities but did increase in importance for the older group may reflect that these areas benefit from a thicker skin type with greater integrity which may mask the effect of the structural changes occurring. Areas ranked relatively low in bothersomeness and priority by both groups were the perioral lines and lips. This result was not surprising as baseline lip volume may be full and volume loss or perioral lip lines may be less pronounced due to slower photoaging. In addition, perioral lines and lip volume loss has been observed to occur much later in life for African American versus white women.5 Characteristics common among white women include development of rhytides above and below the vermilion border with volume loss. For African American women, rhytides develop more commonly in the body of the upper lip (below the vermilion border); due to volume loss in the upper lip while the lower lip usually maintains its volume.25
Consideration Rates for Future Treatments Including Injectables
The majority of participants were aware of a wide range of minimally-invasive treatments used to enhance skin tightness and quality, which were matched by higher consideration rates. Consideration of treatments involving lasers and light-based procedures were much lower, which was anticipated given the
