greater risk of pigmentary alterations and scarring observed in higher FSPs IV to VI.26,27 Awareness of and consideration rates for neuromodulators were higher than for other injectables. Given that sagging underneath the chin/double chin was the most bothersome facial feature and an escalating treatment priority across age groups, it was surprising that there was only a 31% consideration rate for this treatment, and may also reflect a lower awareness of safe and effective treatment options for patients of color.
The strengths of this study are represented by its large participant population, cross-sectional design, and use of the MaxDiff methodology to minimize scale bias. The data presented here characterize the priorities, treatment awareness, and opportunities to educate African Americans women naïve to facial injectables. Two case examples of African American patients treated by the authors are presented in Fig. 9. A limitation was a low (18%) representation of individuals with FSPs V and VI.
The strengths of this study are represented by its large participant population, cross-sectional design, and use of the MaxDiff methodology to minimize scale bias. The data presented here characterize the priorities, treatment awareness, and opportunities to educate African Americans women naïve to facial injectables. Two case examples of African American patients treated by the authors are presented in Fig. 9. A limitation was a low (18%) representation of individuals with FSPs V and VI.
CONCLUSIONS
African Americans are a growing patient population for aesthetic practitioners, and their greater consideration rates for minimally-invasive treatments (vs. surgical) is following the overall increasing trend in medical aesthetic treatments. Compared to other racial/ethnic groups, the signs of facial aging among African American women may be less about fine lines and wrinkles caused by UV damage, and more about pigmentary concerns and shifts in underlying soft tissue volume. The key areas of aesthetic concern revealed here include the under-eye/ tear trough, CFLs, and excess submental fat, and with advancing age, priorities heighten for the mid and lower facial areas.
Among those who would consider injectables, a higher proportion reported a desire to “look good for their age†versus wanting to look more youthful. This suggests an overarching level of self-confidence with aging, and that pursuit of aesthetic intervention may be mostly about supporting the projection of that self-confidence. A lower than expected consideration rate for under chin fat reduction treatment may represent an opportunity to counsel patients on a less familiar option to address their primary concerns.
Educating and counseling patients on these barriers may increase patient acceptability of a broader range of treatment options. Many women remain “considerers†for many years before trying treatments they are unfamiliar with, therefore, educating and counseling patients with these “barriers†in mind may help patients become open to a broader range of safe and effective treatment options, including minimally invasive injectable procedures. This study hopes to contribute to a first step in providing physicians with a more patient-centric and culturally-competent approach to the treatment of their African American facial aesthetic patients.
Among those who would consider injectables, a higher proportion reported a desire to “look good for their age†versus wanting to look more youthful. This suggests an overarching level of self-confidence with aging, and that pursuit of aesthetic intervention may be mostly about supporting the projection of that self-confidence. A lower than expected consideration rate for under chin fat reduction treatment may represent an opportunity to counsel patients on a less familiar option to address their primary concerns.
Educating and counseling patients on these barriers may increase patient acceptability of a broader range of treatment options. Many women remain “considerers†for many years before trying treatments they are unfamiliar with, therefore, educating and counseling patients with these “barriers†in mind may help patients become open to a broader range of safe and effective treatment options, including minimally invasive injectable procedures. This study hopes to contribute to a first step in providing physicians with a more patient-centric and culturally-competent approach to the treatment of their African American facial aesthetic patients.
DISCLOSURES
A Alexis serves as an investigator and has served on advisory boards for Allergan plc. C Boyd serves on an advisory board and speakers’ bureau for Allergan plc. V Callender serves as a consultant and investigator for Allergan plc. J Downie has received research support from Allergan plc. S Sangha is an employee of Allergan plc and may own stock/options in the company.
The opinions expressed in this article are those of the authors. The authors received no honoraria related to the development of this article. This study was funded by Allergan, Inc. Writing and editorial support for this article was provided by Erika von Grote, PhD, Allergan plc, Irvine, CA.
The authors would like to thank Garrett T. Shumate of Allergan plc for his invaluable assistance in the interpretation of data and in the development of this manuscript.
The opinions expressed in this article are those of the authors. The authors received no honoraria related to the development of this article. This study was funded by Allergan, Inc. Writing and editorial support for this article was provided by Erika von Grote, PhD, Allergan plc, Irvine, CA.
The authors would like to thank Garrett T. Shumate of Allergan plc for his invaluable assistance in the interpretation of data and in the development of this manuscript.
REFERENCES
1. 2008 ASAPS Statistics: Procedures by ethnicity. American Society for Aesthetic Plastic Surgery. Available from: http://www.surgery.org/sites/ default/files/2008stats.pdf. Accessed October 2018.
2. 2017 ASAPS Statistics: Procedures by ethnicity. American Society for Aesthetic Plastic Surgery. Available from: http://www.surgery.org/sites/ default/files/2017stats.pdf. Accessed October 2018.
3. Vashi NA, de Castro Maymone MB, Kundu RV. Aging differences in ethnic skin. J Clin Aesthet Dermatol. 2016;9(1):31-38.
4. Davis EC, Callender VD. Aesthetic dermatology for aging ethnic skin. Dermatol Surg. 2011;37(7):901-917.
5. Alexis A, Grimes P, Boyd C, Downie J, et al. Racial and ethnic differences in self-reported facial aging in women: results from a multinational study. In peer-review with Dermatol Surg. May 2018.
6. https://factfinder.census.gov/faces/tableservices/jsf/pages/productview. xhtml?src=bkmk#. Accessed March 4, 2019.
7. Talakoub L, Wesley NO. Differences in perceptions of beauty and cosmetic procedures performed in ethnic patients. Semin Cutan Med Surg. 2009;28(2):115-129.
8. Boyd C, Chui A, Montes JR, Narurkar V, et al. Differential facial aesthetic treatment considerations for skin of color populations: african american, asian and hispanic. Poster presented at: The Skin of Color Seminar Series; May 2018; New York, NY.
9. Fitzpatrick TB. The validity and practicality of sun reactive skin types I-VI. Arch Dermatol 1988;124:869-871.
10. https://blog.skincancer.org/2018/09/13/are-you-at-risk-for-skin-cancer/ Assessed February 2019.
11. Ho BK, Robinson JK. Color bar tool for skin type self-identification: A crosssectional study. J Am Acad Dermatol. 2015;73(2):312-3.e1.
12. Fabi S, Montes JR, Aguilera SB, Bucay V, Manson S, Ashourian N. Understanding the female hispanic and latino american facial aesthetic patient. J Drugs Dermatol. 2019;18(7):
13. The MaxDiff System Technical Paper, Version 8. Sawtooth Software 2015. Available at: URL: http://www.sawtoothsoftware.com/support/technicalpapers/ maxdiff-best-worst-scaling/maxdiff-technical-paper-2013. Accessed December 2016.
14. Harris MO. The aging face in patients of color: minimally invasive surgical facial rejuvenation-a targeted approach. Dermatol Ther 2004;17:206-211.
15. Alexis AF, Sergay AB, Taylor SC. Common dermatologic disorders in skin of color: a comparative practice survey. Cutis. 2007;80(5):387-394.
16. Callender VD, Barbosa V, Burgess CM, Heath C, et al. Approach to treatment of medical and cosmetic facial concerns in skin of color patients. Cutis. 2017;100(6):375-380.
17. de Rigal J, Des Mazis I, Diridollou S, Querleux B, et al. The effect of age on skin color and color heterogeneity in four ethnic groups. Skin Res Technol. 2010;16(2):168-178.
18. Alexis AF, Obioha JO. Ethnicity and Aging Skin. J Drugs Dermatol. 2017;16(6):s77-s80
2. 2017 ASAPS Statistics: Procedures by ethnicity. American Society for Aesthetic Plastic Surgery. Available from: http://www.surgery.org/sites/ default/files/2017stats.pdf. Accessed October 2018.
3. Vashi NA, de Castro Maymone MB, Kundu RV. Aging differences in ethnic skin. J Clin Aesthet Dermatol. 2016;9(1):31-38.
4. Davis EC, Callender VD. Aesthetic dermatology for aging ethnic skin. Dermatol Surg. 2011;37(7):901-917.
5. Alexis A, Grimes P, Boyd C, Downie J, et al. Racial and ethnic differences in self-reported facial aging in women: results from a multinational study. In peer-review with Dermatol Surg. May 2018.
6. https://factfinder.census.gov/faces/tableservices/jsf/pages/productview. xhtml?src=bkmk#. Accessed March 4, 2019.
7. Talakoub L, Wesley NO. Differences in perceptions of beauty and cosmetic procedures performed in ethnic patients. Semin Cutan Med Surg. 2009;28(2):115-129.
8. Boyd C, Chui A, Montes JR, Narurkar V, et al. Differential facial aesthetic treatment considerations for skin of color populations: african american, asian and hispanic. Poster presented at: The Skin of Color Seminar Series; May 2018; New York, NY.
9. Fitzpatrick TB. The validity and practicality of sun reactive skin types I-VI. Arch Dermatol 1988;124:869-871.
10. https://blog.skincancer.org/2018/09/13/are-you-at-risk-for-skin-cancer/ Assessed February 2019.
11. Ho BK, Robinson JK. Color bar tool for skin type self-identification: A crosssectional study. J Am Acad Dermatol. 2015;73(2):312-3.e1.
12. Fabi S, Montes JR, Aguilera SB, Bucay V, Manson S, Ashourian N. Understanding the female hispanic and latino american facial aesthetic patient. J Drugs Dermatol. 2019;18(7):
13. The MaxDiff System Technical Paper, Version 8. Sawtooth Software 2015. Available at: URL: http://www.sawtoothsoftware.com/support/technicalpapers/ maxdiff-best-worst-scaling/maxdiff-technical-paper-2013. Accessed December 2016.
14. Harris MO. The aging face in patients of color: minimally invasive surgical facial rejuvenation-a targeted approach. Dermatol Ther 2004;17:206-211.
15. Alexis AF, Sergay AB, Taylor SC. Common dermatologic disorders in skin of color: a comparative practice survey. Cutis. 2007;80(5):387-394.
16. Callender VD, Barbosa V, Burgess CM, Heath C, et al. Approach to treatment of medical and cosmetic facial concerns in skin of color patients. Cutis. 2017;100(6):375-380.
17. de Rigal J, Des Mazis I, Diridollou S, Querleux B, et al. The effect of age on skin color and color heterogeneity in four ethnic groups. Skin Res Technol. 2010;16(2):168-178.
18. Alexis AF, Obioha JO. Ethnicity and Aging Skin. J Drugs Dermatol. 2017;16(6):s77-s80
