The Stigmas Around Botox and Fillers for Black People Are Changing

“Black don’t crack" is a succinct way of saying that higher concentrations of melanin provide more protection against the physical signs of aging that result from UV rays breaking down collagen and elastin, causing sagging and wrinkles. But a new generation of Black and brown people are embracing Botox and fillers. A recent study conducted by The American Society for Aesthetic Plastic Surgery revealed that Black people, who constitute about 13 percent of the US population, accounted for eight percent of all cosmetic procedures in 2016. Between 2005 and 2013, the rate of cosmetic augmentation in Black patients rose by 56 percent.

Misconceptions that Botox and fillers are unsafe or ineffective on dark skin have been slow to change. “Initial research on injectables was done mostly on Caucasian patients, so it's not uncommon for people to still think that Botox and fillers don’t work on African-American skin,” said Dr. Raman Madan, Director of Cosmetic Dermatology at Northwell Health, suggesting that the early lack of representation of ethnic patients only worked to cement pre-existing suspicions that certain cosmetic procedures were inherently white-facing. “Another misconception is that injectables are not safe for dark skin. They work the same, regardless of skin color,” he said.

In fact, in the hands of an experienced practitioner, dark-skinned patients often see exceptional results simply because their skin ages more slowly and thus tends to be less damaged to begin with. “Injectables should enhance the natural version of oneself,” said dermatologist and UT Austin Professor of Internal Medicine Dr. Adewole Adamson. “Fillers, in particular, work great on darker skin because there’s less UV damage, so you get an extra 'pop' as a result.”

Older generations tended to look upon cosmetic procedures as extensions of Eurocentric beauty standards. For those who came of age in the 60s and 70s, themes of Afrocentricity and Black pride, which were a new bedrock of cultural thought, stood in stark juxtaposition to past understandings of beauty, which were seen as passive acts of assimilation to white beauty norms. Black and brown patients were also historically excluded from critical clinical research and trial studies, leading to a lag in the quality of education around the unique needs (and even beauty and health trends) of communities of color. On top of that, it often takes medical and academic communities years to address new technologies, making the road to inclusivity longer. Social media has come to play an unexpected role in providing visibility and clarity around procedures that once felt taboo. These days, doctors are using platforms to market directly to potential clients (sometimes with the backing of celebrities). In doing so, they’ve lifted the veil of mystery around injectables, which may make them feel safer and more accessible.

Ourian, who owns the medical spa Epione Beverly Hills and counts the Kardashians among his most famous clients, boasts over three million Instagram followers. His feed includes video snippets of procedures (including captions explaining the pain level, cost, and recovery time) on clients like French Montana, and Amber Rose. In a society that places so much emphasis on the cult of personality, the visibility of celebrities of color undergoing cosmetic procedures sells them to a wider demographic. “Marketing for cosmetic procedures is becoming more targeted to people of color, [and] practitioners are expanding to service these demographics,” said Adamson. “The demand has increased as the stigma around these procedures has decreased.”

For social media influencers of color who monetize aspirational lifestyle content, like Alexis Chantelle, the benefits are worth the potential judgement. “I got filler because I had dark circles under my eyes,” said Chantelle, who initially received pushback about the procedures from friends and family. “Everyone kept telling me I didn’t need it. I think we were always taught to love ourselves how we are because we didn’t always have the means to get these procedures…Now you see your favorite makeup artist on Instagram and think, Wow, how are they so beautiful? Since people are finally admitting to getting work done, the attitude has become, If they did it, I can, too.”

Dr. Leif Rogers, who started Blush, a private aesthetic dermatology practice in Beverly Hills, 14 years ago, echoed this. “I saw patients of color from the very beginning, but the ones coming in were lighter-skinned—probably because they showed signs of aging a bit sooner. In the last 10 years, I’ve seen an increase in African-American patients of all shades. Filler has gotten very popular in the last three to four years, as well," he said. "That’s partially because the information is out there more, and people know it can be done quickly and safely.”

Even with more marketing aimed toward people of color and the wider cultural destigmatization of cosmetic procedures in general, misconceptions about injectables and dark skin persist. "The main issue is making sure you that you are the right candidate for injectables,” said Madan. “Anyone who is ready to start reversing the signs of aging is ultimately a good candidate. Patients with very severe volume loss"—this is generally caused by the breakdown of collagen and elastin in the skin—"are not going to get the same results, so it’s important to always set realistic expectations.”

Adamson’s Caucasian patients typically seek preventative Botox to preemptively combat visible signs of aging in their late 20s. He recommends melanated patients seeking Botox start in their mid- to late 30s, as facial volume loss and fine lines usually become apparent much later. Lip fillers have become extremely popular with Caucasian patients in the post-Kardashian universe, but according to Madan, his patients of color most commonly seek to address hollowing in the cheek fat pads, treating prominent smile lines, and concealing dark circles.

The cost of such procedures ranges from a few hundred dollars to several thousands, so for prospective patients looking to maximize their Botox or fillers, it’s important to work with a doctor who has experience with non-white skin. Before even making a consultation, make sure to read reviews from other patients of color about their experience with a potential doctor. Checking a clinic’s marketing materials and social pages can also be very telling; if, for instance, they lack examples of work on non-white patients, it’s a good indicator that they may not have the proper experience.

“You should make sure to see a board-certified physician who is familiar with facial anatomy and how to handle any complications following a procedure,” said Madan. “Patients of color should also see a doctor who understands post-inflammatory hyperpigmentation"—dark spots in areas of previous trauma—"when injecting," he said. (One aspect of having more melanin is a tendency toward hyper-pigmentation, which occurs when the skin produces excess melanin in response to irritations like acne, superficial injuries, changes in medication, or even trying new products.) Because Botox and fillers are administered through injection, there is a small potential for them to cause minor trauma to the skin, which could result in hyperpigmentation at the injection site. "It’s not common, but you should always be aware,” said Madan.

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