In the past, when people complimented me on my skin, I would credit my glowing complexion to my relentless commitment to skincare (three steps: cleanse, hydrate, and protect) and sleep (minimum of seven hours per night). However, there was another “secret” that I wasn’t so keen to share: my bi-annual Botox appointment. As a woman of color, the topic of injectables wasn’t something that came up at brunch on a regular basis. I figured that everyone else who looked like me just wasn’t that into it—or not doing it at all.
According to Carlos Charles of Derma di Colore in New York City, he finds that roughly five to 10 percent of his clientele are requesting injectables, but notes they skew older and with lighter complexions.
“This is mainly because of the differences in the pattern of aging in light versus darker skin tones,” he explains. “In lighter complexions, signs of aging such is fine lines and volume loss can occur earlier, since these are likely due to an increased susceptibility to the damaging effects of ultraviolet light. Also, the pattern of aging in darker skin is typically characterized less by fine lines or wrinkles, but more by overall volume loss later in life.”
As a beauty editor, I have written about injectables in the past, however, it started to feel weird to promote something that I actually never tried. After years of avoidance, and now in my early 30s, I finally buckled after seeing a male friend undergo the treatment and come out looking like a new man. After two appointments, I found myself loving the results. I looked like a better, more well-rested version of myself sans crow's feet or a wrinkled forehead (which happens when my stress level climbs).
So, why aren't more women of color talking about getting injectables? Ahead, we hear from dermatologists on the stigma of getting botox or fillers, the procedures themselves, and more answers to burning questions.
Who is the average patient getting injectables?
Michelle Henry, a dermatologist and dermatologic surgeon based in New York City, estimates that roughly 50 percent of her clients are of color, and of that pool, about 25 to 30 percent of them are requesting injectables. “Women of color typically start neuromodulators a bit later than Caucasian patients, because melanin is protective against UV damage that contributes to the formation of fine lines and wrinkles,” she says. Henry adds that she most of her patients still fall within the late 20s and early 30s regardless of ethnicity.
What areas are people getting fillers/Botox?
For those not super familiar with the filler-game, there are a ton of options available, but it can be confusing to understand what they do. To brush up, I caught up with Melissa Doft, a New York City-based, board-certified plastic surgeon to give me the run down on which injectable does what. Consider this your new cheat sheet the next time you go to the derm—or even plastic surgeon.
“Hyaluronic acid-thicker versions (like Voluma or Restalift) are great for adding volume to the cheeks, jawline or chin. Medium thickness injectables like Restylane, Juvederm or Belotero are excellent for around the mouth to fill in the laugh lines and nose for a liquid rhinoplasty,” Doft explains. “More common ‘thinner versions’ like Vobella or Refyne, work well for lips, ear lobes or tear trough—the groove between your lower eyelid and the cheek."
Fran E. Cook-Bolden, a New York City-based dermatologist, cosmetic surgeon and assistant clinical professor at Mount Sinai Health Center says that the areas most commonly treated among women of color include: "the forehead, the area between the eyebrows (known as the glabellar area), the area around our eyes (known as crow’s feet), particularly the area beneath our eyes after years of joyful smiles or squinching to read cell phone messages and lastly, the chin to correct dimpling or a cleft in the middle of the chin."
Will people notice that I got fillers or Botox?
Naturally, when I had my first Botox appointment, I was nervous about what the outcome would be. Despite knowing my administer’s background, I was fearful that I’d look like a weird, altered version of myself versus a more, youthful refreshed one. And, turns out I wasn’t that far off to wonder if people “knew” what I had done.
According to Harold Lancer, a board-certified dermatologist based in Beverly Hills, who counts clients including Beyoncé, Kim Kardashian West and Jennifer Lopez as clients (note: Lancer did not confirm any of the women above have undergone cosmetic procedures), there is a chance that the human mind can subconsciously detect irregularities. “If you look at someone, any body part, and it doesn’t match the rest of the surrounding environment you know something is wrong,” he explains.
“When using injectables, the anti-aging goal is subtle changes that leave patients looking refreshed and relaxed—as if they have just returned from a relaxing retreat or vacation,” Cook-Bolden adds.
Do women of color need to approach injectables differently from other patients?
While most fillers are created equal, those with melanin-rich skin do need to be a bit more mindful about how things are administered. Women of color are often warned they're prone to hyperpigmentation—is it true? “Hyperpigmentation with injections is a function of the artistry and the expertise of the person doing it,” explains Lancer. “It’s not the material, it’s the method in which it’s done. Hyperpigmentation is a result of bruising causing pigment from the blood flow in the skin. Everyone is prone to that; however, it is more difficult to repair in darker skin types because you have competing melanin interfering with treatment protocols,” he explains.
Henry cautions that bruising can also occur on occasion. “If a component of blood called hemosiderin is deposited in the skin, it can leave long-term discoloration. This is much harder to resolve in darker complexions versus those with lighter skin tones.”
Is there a stigma toward injectables in communities of color?
Beyond the logistics of fillers—why is everyone so hush-hush about getting them? You and I both know many of our faves over 40+ who looks suspiciously amazing. Is it their skin care regimen? Does black really not crack? Or do they have a not-so-secret secret that they simply aren’t disclosing?
“I think there is still a lot of stigma around cosmetic procedures in communities of color,” shares Henry. “There is still a sense that in changing one’s appearance, they are rejecting their ethnicity or heritage. However, this is starting to change and women of color are starting to benefit from cosmetic procedures with less guilt and stigma.”
David Shafer, board-certified plastic surgeon and founder of Shafer Plastic Surgery & Laser Center in New York City notes that celebrities are more keen to share who their dermatologist is but not reveal who their plastic surgeon actually is. “Injectables are so popular right not that it seems like everyone—young and old—are requesting treatments,” he explains. "Social media certainly plays a role as well as the improving economy as people have more discretionary spending. Sometimes it can be frustrating as I would love if my celebrity and VIP patients would be more vocal about their treatments and procedures, but I respect their privacy and I think that is why they keep returning for more treatments with me,” he reveals.
What should you be looking for in a practitioner?
Make sure whoever you're going to for fillers has a very customized approach for each patient. Subtle changes versus those that look “over-corrected” is a big concern for all patients, but is often a result of a cookie-cutter approach. “To achieve the most natural result, fillers and neurotoxins must be individualized to meet each patients need,” Cook-Bolden explains.“Just like the practice of medicine is an art and a science, the use of injectables should be defined as a fine art. Opposed to just filling in spaces, we focus on the landscape or palette that we’re working with to restore volume and correct hollowing supporting and restoring ones natural, more youthful bony structure.”
Henry agrees that looking for a doctor who understands ethnic variations in beauty is key. “For instance, the ‘perfect’ proportions for a Caucasian lip is 1:1.6, which allows for a slightly larger bottom lip. On the other hand, in Black and Asian women, we often see 1:1 ratio of the upper to lower lip, which is more common and considered more desirable in women of color.”
Are injectables worth their high price?
While Botox and fillers can be costly—anywhere from $400 to over $1,000 in New York City, for example—the age-old saying “you get what you pay for” comes to mind. “There are too many cosmetic practitioners—and people—looking for price as the determining factor as to who does what. People are looking for a bargain versus a trained professional,” adds Lancer.
Part of what you're paying for are results that visibly flatter, but don't look obvious. “Great work should not be apparent in any ethnicity. The patient should look more youthful but not ‘worked on’—if it is noticeable, it is not good work, in my opinion,” emphasizes Henry. “Most injectors have a consistent aesthetic. Viewing their before and after photos will give you a sense of if their aesthetic is more subtle or natural.”
Bottom line: Aim to look like an enhanced-yet-natural version of yourself, prompting people to ask you “where did you vacation?” instead of “what did you get done?”
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