For many years, the cosmetics industry as a whole has been primarily targeted towards white people, with treatments marketed as addressing predominantly Caucasian skin concerns. By doing so, there was an underlying assumption that Black people don’t want or need injectable treatments like dermal fillers and Botox and as a result, they were largely left out of the conversation.
Not only that, but the white-centric messaging of the cosmetics industry has created a negative association between aesthetic treatments and the pursuit of Eurocentric beauty standards among the Black community. “There’s still a few overriding opinions that ‘if you get injectables, you don’t love yourself’, or ‘we already have full features'” explains Dr Ewoma Ukeleghe, founder of SknDoctor. “There’s a lot of pride in Black beauty, which has so often been shamed and appropriated.”
“That’s starting to change now,” says founder of the Black Skin Directory and expert aesthetician Dija Ayodele. “The cosmetics market is starting to realise they’ve missed a trick by excluding Black clients. There are so many other benefits to treatments like Botox and fillers that are relevant to Black people and Black skin, but it’s about reeducation and breaking the misconceptions of the past.”
“Fillers can add definition and symmetry, not just volume”
One such misconception is that fillers and Botox can only offer benefits sought by white clients, like fuller lips or fewer wrinkles. “There is some truth in that Black skin doesn’t have the exact same concerns as white skin,” says Dija. “Compared to white women of a similar age, Black women tend to show signs of ageing about ten years after white women do,” explains Dija. “Black skin has tighter collagen bonds and the elastin is much more secure, meaning that wrinkles do not form as early or as easily, and the presence of melanin defends the skin against the damage caused by the sun. That’s where the phrase ‘black don’t crack’ comes from but it manifests in this misconception that black women don’t require or desire Botox or filler.”
The truth is that injectable treatments can have a number of different benefits. Dermal fillers can be used to add definition and fill areas of shadow (for example, under the eyes) as well as disguise scarring and balance out any asymmetry in the facial features. Botox has a roster of benefits, from treating teeth grinding and headaches to sweat prevention. In fact, the before and after results of Botox can be quite transformative both medically and aesthetically.
“There needs to be more education around the potential for these treatments and how they can benefit all skin colours. For example, filler for the chin is one of the most popular treatment with my Black clients,” says Dr Ewoma. “We typically don’t have very pronounced chins, and often have concerns regarding lack of jawline definition. A defined chin, instantly improves an undefined jawline and dermal filler is a great way of achieving that.”
“Occasionally, my Black clients also ask for lip filler – but it’s usually to create more definition around the lip line or balancing out the shape of the lip to make it more symmetrical rather than to add volume.”
Another popular use of filler among Black people is treatment of the under eye area. “I often use filler in the tear trough to improve darkness around the eye, which is very much seen in skin of colour,” says Dr Ewoma. Dija agrees, saying, “treatment of the under eyes is one of the most popular treatments among my Black clients, simply because dark circles tend to be more prominent in darker skin.”
As for which type of filler is the most popular, Dr Tijion Esho, founder of The Esho Clinic says there’s a clear favourite. “Most common filler brand requested by my black patients is Juverderm dermal filler,” he says. “Unlike other brands, Juvederm has a much more consumer-led approach to advertising, which makes it more easily recognisable by a larger demographic of patients.” Juvederm offers a range of different fillers, all of which are based on the naturally occurring hyaluronic acid, but have different consistencies to suit different treatment areas.
“An experienced practitioner can reduce the risk of scarring or hyperpigmentation”
But what about scarring and hyperpigmentation, both of which are common skin concerns in Black skin? “There’s no denying that it is easier to have post inflammatory pigmentation and scarring in Black skin,” explains Dija. “The skin has larger melanosomes and more active melanocyte cells, which creates dark marks if the skin is pierced or damaged. That’s just the nature of injury and the healing process but if you are supporting the skin with good skincare regime, that mark isn’t going to hang around very long.”
Dija recommends always visiting an experienced practitioner, who is used to treating Black skin. “There are certain things they might try to reduce the risk of scarring or pigmentation. Some doctors use a cannula [a little tube that is inserted into the skin at one specific point allowing filler to be administered underneath the surface] to avoid multiple injection sites, and therefore reducing the potential for hyperpigmentation. They might use a lower, more gentle setting on any equipment like skin lasers. They might inject deeper to bypass the melanocytes that are placed towards the surface of the skin. They might meticulously plan all entry points so there’s no mistakes made and therefore no need for re-entry into the skin surface.” All of these factors can help to significantly reduce any risk of adverse side effects.
“Always tell your practitioner if you get keloid scarring”
Keloid scarring is a certain type of scarring, which is more common in darker skin. A keloid scar is an enlarged or raised scar that can be pink, red, skin-coloured or darker than the surrounding skin and can occur as a result of very minor skin injury, like an injection or a piercing.
“We always take a very careful history and ask patients if they experience keloid scarring,” says Dr Esho. “But you can’t just assume that all Black patients will have this problem, or else you will deny them many treatments that may be perfectly suitable for their skin type.”
“Everything starts with a good skincare regime”
As with all skin conditions, the best first step is a comprehensive skincare regime. “Have a consultation with your practitioner first, who can ensure you are doing the relevant steps to take care of your skin,” recommends Dija. “You should be exfoliating, hydrating, using sunscreen and a good antioxidant, Vitamin A for at least six months prior to treatment.”
While this may seem like a long time to wait before receiving treatment, there’s good reason to do so. “Some skincare ingredients, like Vitamin A take months to have an effect. If your skin is in good condition, you will know what really needs to be done to it. For example, if you skin is dehydrated, you might inject 2ml of filler, but if it’s hydrated and healthy, you may only need 1ml. Which is cheaper for you and less work for your skin.”