Black Skin, Injectables, and Stigma: A Deep Dive

Let's dispel the myths.

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Whether you're comfortable discussing our treatments or not, there's no denying that the world of aesthetics has become more attainable. Just like how in the past you would purchase your eye serum or face cream, injectables—otherwise known as tweakments—are now more commonly found on the skincare shopping list.

Tweakments are non-surgical aesthetic procedures that can soften lines and wrinkles, improve pigmentation, tighten sagging skin, increase volume, adjust the proportions of facial features and rejuvenate the skin.

It's not surprising that more women are opting for treatments as a way to turn back time, or just maintain. But for the Black community, injectables like Botox and filler are still considered hush-hush and slightly taboo. Whether it’s through skincare myths, a lack of targeted marketing, or the perpetuated ideals of the Western gaze, many Black women are still reluctant to embrace the world of aesthetics, whether they would like to admit it or not.

Let's start with marketing. An initial place to start and understand why Black women are reluctant or uncomfortable when it comes to tweakments is the marketing that is created by these aesthetic brands. Many, if not all, adverts and images feature white women, with very little targeted marketing focused on Black women. Aesthetic doctor and co-founder of the BAAB (Black Aesthetics Advisory Board) Dr Amiee Vyas explains, “Aesthetic brands are known for using Caucasian faces in their advertising–if you don’t see yourself in the advertising, you won’t know that the service is suitable for you”. 

Another thought to consider: the most popular filler treatments include lip filler and cheekbone filler, which are two features Black individuals may naturally already possess. Dr. Amiee Vyas highlights, “Black individuals often already possess these features naturally and in my experience, patients automatically feel that injectable treatments are not for them." As a result, they might feel that aesthetics treatments in general are not geared towards their needs.

There's also a misconception that because lasers should be treated with caution when it comes to deeper skin tones, the same applies to Botox and filler. “It is a common conception that individuals with dark skin feel as though treatments aren’t targeted or suited for them and this is in some ways comes down to how the skin may react to treatments," says cosmetic surgeon and director of 111 Harley St., Dr Yannis Alexandrides. "With increased pigmentation, there is a risk with hyperpigmentation, especially with chemical peels and laser treatments. However, injectables or treatments that require an increased ultrasonic energy are often safe and recommended on darker complexions”. 

And, of course, there are the generational myths—i.e. ‘"Black don’t crack"—that many Black individuals hold in high regard. “Research has shown that Caucasians show signs of aging, such as wrinkling, decades earlier than African Americans," LA-based dermatologist Dr. Onyeka Obioha MD shares. "However, black can certainly crack—African Americans are more likely to display hyperpigmentation and textural irregularities rather than wrinkling with early aging”.  As we age, our skin naturally loses volume and there is a significant decrease in collagen production, which supports the skin’s elasticity. While aging can appear much later in life compared to Caucasian women, it still happens, and signs of aging like sagging skin and wrinkles can still be treated the same way with Botox and filler.

These beauty myths lead to a lot of misinformation and misconceptions, which can make Black individuals less likely to feel empowered to seek out aesthetic treatments. “The most common myths about dark skin is that it doesn’t need protection from the sun, which is so damaging because sun damage contributes to and creates problems with aging and pigmentation," says Dr. Yannis. Many of these myths come from a lack research provided by the industry and a lack of education being passed down from generation to generation. Dr. Amiee shares, “I have certainly seen a generational difference with older patients being very concerned about the safety and validity of these procedures, while the younger generations are more educated on the safety of aesthetic procedures for their skin tone."

Personally, trying to share with my own mother that I would happily get Botox or filler in areas scares her into thinking that I don’t love or appreciate my features. Within the Black community, there has and still is friction between accepting and loving our Black and natural features vs. the Western beauty ideals. The point that fair and even skin, a contoured nose, thinner lips and sharper cheekbones is what is considered to be "accepted" and "beautiful" is why many Black individuals strive for a European perfection.

Although we're in a time where embracing our beauty is encouraged, the deep-rooted anxiety, tension and trauma still exists, even if the conversation has shifted. So much so that women who are comfortable with having cosmetic treatments often keep it to themselves, or find it taboo to talk about amongst their own. "There are concerns that traditional ‘ideals of beauty’ and treatment outcomes are tailored to a Caucasian face–this simply doesn’t relate to them and feels like a betrayal of their culture," says Dr. Amiee. "I have seen that even if the treatment they are receiving doesn’t dramatically change their appearance, my Black patients are less likely to tell their friends about what they have had done”. 

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This element of secrecy and fear of judgement reflects in the stats. Dr. Onyeka notes, “The American Society of Aesthetic Plastic Surgery reported that out of the 10 million procedures performed in the USA in 2010, 19% were performed on ethnic minorities (8% Hispanic, 6% African American, 4% Asian and 1% non-Caucasian)”. More recently, a case study that was carried out by the Black Aesthetics Advisory Board over the summer of 2020 highlighted that the diversity of their patients’ databases with skin of color defined as Fitzpatrick Skin Types III-IV. 62% of respondents said that 30% or less of their patients had skin of color and of these respondents, 36% (over half) said less than 10% of their database had skin of color. 

With these numbers, it's hardly surprising to see such a small percentage of non-Caucasian individuals leaning into cosmetic procedures. On top of western beauty ideals, cultural tension and skincare myths, trusting practitioners and the aesthetics industry with Black skin plays a pivotal role, too. “Unfortunately, education on how to treat Black skin is significantly lacking in medical school and further training for doctors," says Dr. Amiee. "Although it is slowly improving in the aesthetics setting there is more work to be done”

So, what concerns are Black women facing? “My African-American patients may not express their concerns with their peers, but they most certainly express their aging concerns and interest in cosmetic procedures with me” Dr. Onyeka says. “The main aging-related concerns in my patients are textural irregularities, hyperpigmentation, frown lines and prominent nasolabial folds”. 

This can safely be treated through aesthetic procedures like Botox or fillers. As Dr. Amiee states, “While extra care is needed to prevent post-inflammatory hyperpigmentation, aesthetic procedures are very much a safe and recommended option to improve skin health and confidence in Black skin." It is recommended amongst many practitioners to take a slow, yet steady approach to tweakments. “Injectable treatments such as Botox and dermal filler like hyaluronic acid fillers have excellent safety standards and have been found to be just as safe and effective on Black skin," says Dr. Ifeoma Ejikeme, medical consultant and founder of Adonia Medical Clinic.

Tweakments aren’t something to be afraid of and as the industry advances, so does the knowledge that comes along with it. It’s time to shake off stigmas, myths, and tension and allow everyone to feel empowered to make informed skin decisions that feel right for them, regardless of your skin tone.

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