Soft tissue augmentation in skin of color: market growth, available fillers, and successful techniques

Journal of Drugs in Dermatology, Jan, 2007 by Cheryl M. Burgess

Abstract

In recent years, people of color have become an increasingly important market force for the cosmetics industry. Product lines have been expanded to accommodate a broader spectrum of skin colors and marketing strategies have been specialized in order to target specific ethnic populations. In addition, it is predicted that people with pigmented skin will eventually comprise a majority of the domestic and international population during the 21st century. Not surprisingly, people of color are increasingly seeking out products and procedures to fight the effects of aging, including an increase in surgical and nonsurgical cosmetic procedures. Among nonsurgical procedures, soft tissue augmentation has experienced dramatic growth. Today, clinicians are performing more and more of these procedures in people of color. As a result of these shifts in the cosmetics industry, clinicians performing soft tissue augmentation require increased expertise in the treatment of ethnic skin. This article reviews the important differences that exist between the appearance of the aging faces of Caucasians and people of color. In addition, soft tissue augmentation strategies and injection techniques that are specific to skin of color are discussed.

Introduction

The domestic and international market for cosmetics, cosmeceuticals, and surgical and nonsurgical cosmetic procedures continues to enjoy record growth. Several factors have been instrumental in this growth, including the continuous flow of newer products and procedures, and the heightened awareness of the effects of aging on facial appearance. However, another emerging market force comes from ethnic consumers who are helping drive the growth of the cosmetics industry in a variety of ways. This is due in part to the expansion of product lines to include cosmetic colors and shades that address the whole spectrum of skin colors. In addition, ethnic consumers are increasingly using cosmetic products specifically designed to address the unique skin care needs of women and men of color. Moreover, the cosmetics industry is using novel mechanisms for marketing directly to ethnic consumers. As a result, the growth of ethnic cosmetic markets has been predicted to reach a record $1.8 billion in revenue. (1) Additionally, the overall number of cosmetic procedures, both surgical and nonsurgical, has increased dramatically. According to recent surveys, 10.2 million cosmetic procedures were performed in 2005--an increase of 11% from the previous year. (2) As the number of cosmetic procedures continues to increase, dermatologists and cosmetic surgeons can expect greater numbers of procedures to be performed in specialized ethnic populations.

Among cosmetic procedures, nonsurgical methods have experienced the greatest increase. Since 1997, the number of nonsurgical cosmetic procedures increased 726%. Surveys of the American Board of Medical Specialists found that in 2005, the top 5 nonsurgical cosmetic procedures were Botox injections ($3.2 million), laser hair removal ($1.5 million), soft tissue augmentation ($1.1 million), microdermabrasion ($1.0 million), and chemical peels ($0.5 million). Of these nonsurgical procedures, soft tissue augmentation experienced the greatest growth--a 35% increase from 2004. (2)

For the dermatologist or cosmetic surgeon, it is becoming increasingly important to acquire a comprehensive understanding of how these cosmetic products and procedures are used within specialized ethnic populations. This is especially true, given the changing demographics in the US. The US Census Bureau reports that current Asian and Latino population growth is surpassing that of black and white populations. (3) Moreover, it is predicted that people with pigmented skin, or skin of color, will comprise a majority of the US and international populations in the 21st century. (4) In addition, people of color are increasingly seeking out products and procedures to fight the effects of aging. According to the American Society for Aesthetic Plastic Surgery, 11.5 million aesthetic procedures were performed in US in 2005. African-American patients represented 5.9% of those patients, or about 680.000. (2)

Because of important differences that exist between Caucasian skin and skin of color, clinicians must be aware of the effects of the aging process that are specific to skin of color, and the resulting differences in aesthetic treatments that are used for patients with skin of color. The following article discusses the use of soft tissue fillers in people of color. The discussion begins with a brief overview of relevant differences in skin composition between Caucasians and people of color and the underlying mechanisms of fat atrophy and hypertrophy that are responsible for the out-ward appearance of an aging face.

Skin of Color

The phrase "skin of color" is often thought to refer primarily to black skin. However, in the US, individuals with pigmented skin come from a variety of racial and ethnic groups. These groups are summarized in Table 1. The diversity of groups yields a broad spectrum of pigmented skin types that defy easy categorization. Although the Fitzpatrick skin phototype classification was originally developed to categorize the skin's response to ultraviolet (UV) radiation, over time dermatologists became accustomed to using the system to classify both UV sensitivity and skin color. White skin is divided into categories I, II, and III; skin of color is divided into categories IV, V, and VI. Skin of color that is olive, beige, or lightly tanned is typically classified as type IV; brown skin is classified as type V; and black skin is classified as type VI. (4) Although the Fitzpatrick skin phototype system has assisted dermatologists in the classification of skin types, the system has limited utility for patients with skin of color. New systems of classification with greater utility are currently being proposed to include pigmented skin. For example, patients with skin of color might benefit more from a classification system based on the propensity of the skin to scar and/or become hyperpigmented--a unique characteristic of pigmented skin with obvious use to these patients.