In dermatology, providing safe and effective cosmetic treatments for patients with skin of color requires a deep understanding of their unique needs and challenges. We are fortunate to have experts like Dr. Cheryl Burgess, founder of the Center for Dermatology and Dermatologic Surgery, who has dedicated her career to advancing cosmetic dermatology for diverse populations. In her compelling and informative talk at the Skin of Color Update 2024, Dr. Burgess shared essential pearls for delivering effective treatments while minimizing complications. The session emphasized the importance of understanding both the biological and cultural nuances to minimize risks and improve outcomes for this patient population. Her discussion covered key factors such as histological differences, cultural beauty ideals, and the safe use of cosmetic technologies.
Cultural Beauty Standards
Dr. Burgess explained that, while everyone has the same number of melanocytes, the difference in skin color is due to the number and size of melanosomes. This distinction makes patients with darker skin more susceptible to conditions like hyperpigmentation. Cultural variations in beauty ideals were also discussed, illustrating how beauty preferences can vary widely based on region and culture. For example, Southeast Asian beauty standards prioritize light skin, small faces, and large eyes, while West African cultures celebrate fuller body figures as a sign of health and beauty.
In addition to these cultural considerations, Dr. Burgess highlighted important histological differences in skin of color. Patients with darker skin exhibit characteristics such as larger and multi-nucleated fibroblasts, lower skin pH, increased melanosomal dispersion, and unique blood vessel reactivity. These differences make the skin more susceptible to conditions like scarring and post-inflammatory hyperpigmentation (PIH), making it crucial for dermatologists to adapt their approach during cosmetic procedures.
Diagnosing and Treating Hyperpigmentation
Hyperpigmentation is a prevalent concern among patients with skin of color. Dr. Burgess emphasized using tools like the Wood’s lamp to assess the depth of pigmentation—whether it’s superficial (epidermal) or deeper (dermal)—which can guide treatment strategies. A colorimeter can also help quantify changes in pigmentation over time, providing an objective measure of treatment efficacy. When treating hyperpigmentation, it’s essential to perform test spots on less visible areas, such as behind the ears, to avoid further pigmentation issues. Low-concentration chemical peels are generally safe, but precautions are always necessary to reduce risks in these patients.
Safe Cosmetic Procedures for Skin of Color
Dr. Burgess provided a detailed overview of the cosmetic procedures that are safe for patients with skin of color. Superficial and low-concentration chemical peels are generally suitable, but test spots should always be performed before treatment. The Nd:YAG 1064nm laser remains the gold standard for treating hyperpigmentation and for hair removal in patients with darker skin, thanks to its longer wavelength, which targets deeper skin layers without damaging the epidermis.
However, Dr. Burgess warned that Intense Pulsed Light (IPL) should not be used on patients with skin of color, as it can cause first-degree burns and worsen pigmentation. In her presentation, she also covered various skin-tightening technologies, including radiofrequency, radiofrequency combined with microneedling, and micro-focused ultrasound. These techniques, when used appropriately, can help address skin laxity without the adverse effects seen with other energy-based devices. Photos demonstrated adverse events such as mild erythema, edema, and thermal burns that can occur if treatments are not carefully administered.
Cultural Considerations in Cosmetic Enhancements
Cosmetic desires are often deeply influenced by cultural preferences. For instance, while traditional White beauty standards suggest a 1:3 upper-to-lower lip ratio, Black patients typically prefer a 50:50 balance between the upper and lower lips. As patients age, their lips may lose volume, creating a 1:3 appearance, which drives many Black patients to seek cosmetic enhancement to restore a fuller look.
In regions such as West Africa, body image plays a crucial cultural role, and many women seek fuller figures to align with beauty ideals. This may involve force-feeding practices or even the use of illegal drugs meant to fatten livestock, underscoring the extreme lengths to which some individuals go to meet societal beauty expectations. Dr. Burgess emphasized that understanding these cultural nuances is vital for practitioners, allowing them to offer treatments that align with the patient’s cultural values and personal aesthetic goals.
Conclusion
Dr. Cheryl Burgess’ presentation underscored the importance of a tailored approach when performing cosmetic procedures on patients with skin of color. Dermatologists and cosmetic professionals must be aware of the biological risks—such as hyperpigmentation and scarring—and the cultural desires that may influence a patient’s cosmetic goals. Safe treatment options, such as the Nd:YAG 1064nm laser, radiofrequency technologies, and superficial peels, should be used with careful consideration to avoid complications like burns or pigmentation issues. By integrating both medical expertise and cultural awareness, practitioners can provide safer, more effective, and
This information was presented by Dr. Cheryl Burgess during the 2024 Skin of Color Update conference. The above session highlights were written and compiled by Dr. Nidhi Shah.
Did you enjoy this article? You can find more here.
