Cosmetic fillers and Asian facial anatomy
Understanding common facial forms and cultural preferences is key to improved patient satisfaction (1,500 words, 7 minutes)
Asian patients have unique aesthetic considerations based on anatomical differences, Dr. Monica Li told the 9th annual Skin Spectrum Summit in Toronto on Oct. 21, 2023. Injectable treatment options can be customized for Asian patients, she said, based on those anatomical considerations.
Dr. Li is a cosmetic and medical dermatologist in practice in Vancouver and Surrey, B.C. She is also a clinical instructor in the Department of Dermatology and Skin Science at the University of British Columbia.
“Our approach when we are treating the Asian patient is not to westernize their faces, but to optimize their unique underlying ethnic features,” said Dr. Li.
Many Asians have increased bizygomatic width, or a wider mid-face, said Dr. Li. As a result, dermal fillers should not be used in the apex or upper lateral cheeks because it will make patients look chubby, she said. Instead, dermal filler should be used in the anteromedial cheeks to project those areas that tend to be flatter.
Patients of Asian descent also often have a retruded, or flattened, forehead said Dr. Li. Younger Asian patients want to anteriorly project the region, to offer better support in the upper face and more harmony with the rest of the face.
Also, many Asian patients have a low nasal bridge, which can make it difficult to wear glasses without nose pads. They may wish to augment the site by using dermal fillers, she said. Many Asian patients also have bimaxillary protrusion or a hypoplastic mandible, which often translates to a retruded chin. Again, dermal fillers may be used to improve both horizontal and vertical microgenia, said Dr. Li.
Bottom Line: For Asian patients, using injectables is not intended to westernize their faces, but to optimize their unique ethnic features. Because there are skeletal differences between Asian and non-Asian features, the concerns may be different, and treatments may be used for different purposes.
From the literature on aesthetic dermatology
Effectiveness and safety of resilient hyaluronic acid (RHA) dermal fillers for the correction of moderate-to-severe nasolabial folds in people of colour: Post hoc subgroup analyses of U.S. pivotal clinical data
This study was conducted to assess the safety and effectiveness of a new line of dynamic HA fillers (RHA) for treating moderate-to-severe nasolabial folds (NLF) in people of colour (POC) versus non-POC.
The authors conducted a post hoc subgroup analysis to compare the efficacy and safety of POC versus non-POC subjects treated with three filler products (RHA2, RHA3, or RHA4) for correction of moderate-to-severe nasolabial folds in 217 patients from two clinical trials. Participants were classified by Fitzpatrick skin type (FST I to III, vs FST IV to VI) and by subject-reported race (White or non-White). Outcomes were evaluated relative to baseline at six, nine, 12, and 15 months.
Investigators found POC consistently showed greater improvement in wrinkle severity and higher responder rates compared to non-POC, which reached statistical significance at several measured time points. Global aesthetic improvement scores (GAIS) and subject satisfaction were similar for POC and non-POC and remained high throughout the course of the study. Treatment-related adverse event rates were generally lower for FSTs IV to VI versus FSTs I to III, with no reported cases of keloidal scarring.
Cosmetic enhancement updates and pitfalls in patients of colour
In this article, the authors examine the risks of cosmetic enhancement procedures in patients of colour, as well as best practices to prevent adverse events.
Procedures covered include light-based devices, body contouring, skin tightening, neurotoxins, and soft tissue augmentation.
The authors discuss the importance of counselling patients on appropriate cosmetic procedures, patient selection, adjusting treatment parameters to maximize safety for each patient, the value of “test spots” before treating a full area to determine potential adverse events, and the potential need to conduct more treatment sessions with more conservative parameters to achieve desired outcomes.
Lasers for the treatment of eyebrow microblading and cosmetic tattoo pigment: A review of the literature
This literature review examines the use of laser for the treatment of complications of eyebrow microblading and cosmetic eyebrow tattoos, taking into account Fitzpatrick skin type and race. Specifically, the authors compare q-switched and picosecond lasers in these indications.
The researchers summarize the results of 11 studies evaluating the use of laser for cosmetic tattoo removal, with 129 patients treated specifically for eyebrow pigment. Most studies (8/11) reported Fitzpatrick skin type or race. Seven studies utilized q-switched (QS) neodymium-doped yttrium aluminum garnet (Nd:YAG), alexandrite or ruby lasers, three used picosecond (PS) Nd:YAG or alexandrite, and three used carbon dioxide (CO2) laser. They report laser energy, spot size, pulse duration, treatment outcomes, and adverse events.
They write that the review findings demonstrate that PS Nd:YAG was quicker and more effective than QS Nd:YAG in the treatment of eyebrow tattoos. Additionally, the paradoxical darkening seen with QS lasers was less common with PS lasers. The authors also demonstrate that CO2 laser may be a helpful adjunct to QS or PS laser. This review provides a unique perspective on the use of laser treatment in skin of colour, which often poses an additional treatment challenge, they conclude.
Efficacy and safety of 595-nm pulsed dye laser treating port wine stains in Vietnamese patients: Analysis of 124 cases and optimal treatment regimens
Researchers included 125 patients who underwent 595-nm pulsed-dye laser treatments to treat port wine stains, and retrospectively analyzed data from 124 of those patients in this study. They collected data on demographic characteristics, treatment regimens, and clinical improvement.
Overall, they observed an overall response rate in Vietnamese patients with Fitzpatrick skin types III and IV of 73.4%. Age, gender, treatment sessions, and lesion positions were generally not associated with the response rate. Instead, lesion grade was the sole element that affected the clinical improvement.
Grade 1 lesions had the best response (100%) even after a short duration of treatment (six to ten treatments). Grade 4 lesions required more than 16 treatments to reach better than 60% improvement.
Lesions of grades 1 and 2 could be blanched with fewer than 10 treatments. The authors note that for lesions of grade 3, regimens exceeding 15 treatments should be carefully considered after evaluating associated conditions. They found grade 4 lesions required 16 or more treatments to reach acceptable outcomes.
VIDEO: How to avoid aesthetic dangers when treating skin of colour
Aesthetic physician Dr. Chris Croley and Jerry Drinkard, Advanced Practice Nurse Practitioner, co-owners of the Skin & Tonic clinic in Pace, Fla., discuss the intricacies of ensuring safety and success when providing aesthetic treatments for individuals with diverse skin colours.
At the intersection of skin and society
Findings from a recent study by a University of Alberta graduate student in psychology show that negative stereotypes about Indigenous Canadians persist among many non-Indigenous Canadians, according to a press release from the university.
For the survey, conducted by Plains Cree graduate student Lakota Wood, participants were asked to rate identifiers commonly used to describe Indigenous people in Canada—Indigenous, Aboriginal, Native, First Nations, Métis, Inuit, Indian, and North American Indian. Respondents were asked to rate how “typical Canadians” perceive those identifiers, rather than how they might perceive the labels themselves.
The findings show participants rated them all as conveying less warmth and competence than those describing other ethnic groups.
“Our results align with the premise that even if individuals do not personally endorse prejudicial values, they may still be aware of those stereotypes and, as a result, respond negatively,” said Wood, who designed her survey in collaboration with the university’s Indigenous Students’ Union, the City of Edmonton’s Indigenous Relations Office, and the First Peoples’ House community.
“This indicates that in the face of stereotypical associations, continuing to change and update Indigenous labels may not be sufficient, as we are only changing the label, not the stereotype content.”
With the help of the Indigenous Students’ Union, Wood recruited 402 non-Indigenous introductory psychology students to complete her survey online. Participants ranged in age from 18 to 37, all born in Canada with diverse backgrounds.
According to the release, Wood’s findings rely on a theoretical approach in social psychology known as the stereotype content model, which stipulates that “all cultural group stereotypes and personal impressions form according to qualities of warmth (friendly, likable, trustworthy) and competence (intelligent, efficient, capable).”
These survey findings reinforce previous studies showing that Indigenous groups rate lower on perceptions of both competence and warmth than English Canadians, French Canadians, Chinese Canadians, and South Asian Canadians, according to the release.
The survey revealed little difference in rating for warmth and competence among the Indigenous terms.
“This was an unexpected finding, as we hypothesized that preferred terminology— especially Indigenous, which is viewed as more inclusive and respectful — would be rated higher to reflect those connotations,” said Wood.
This week
Dec. 12 is International Day of Neutrality
Dec. 12 is International Universal Health Coverage Day
December is Seasonal Depression Awareness Month
Something to think about in the week ahead. . .
—Carl Friedrich Gauss, German mathematician (1777-1855)
Next week
For the final 2023 edition of Skin Spectrum Weekly, we look back at the top three posts of the year.
If you like Skin Spectrum Weekly, why not check out Chronicle’s other publications, podcasts, and portal?
Established in 1995, The Chronicle of Skin & Allergy is a scientific newspaper providing news and information on practical therapeutics and clinical progress in dermatologic medicine. The latest issue features:
Drs. Irina Turchin (Fredericton, N.B.), Ron Vender (Hamilton, Ont.), and Ashley O’Toole (Peterborough, Ont.) discuss advances in psoriasis treatment.
Dr. Joel DeKoven (Toronto) details the most common contact allergens based on North American Contact Dermatitis Group data.
An essay from Dr. Fabian Rodriguez-Bolanosi (Toronto) submitted to the 2022 Dermatology Industry Taskforce on Inclusion, Diversity and Equity (DiTiDE) short essay contest. Dr. Rodriguez-Bolanosi wrote about his experience working with Black women in the hair clinic.
Plus regular features, including the popular column “Vender on Psoriasis” by dermatologist Dr. Ron Vender
Read a recent digital edition of The Chronicle of Skin & Allergy here. To apply for a complimentary* subscription or to receive a sample copy, please email health@chronicle.org with your contact information.
The Women in Dermatology e-newsletter updates new findings concerning dermatologic issues that affect women and the female dermatologists who care for them. Read the current issue here.
Season three of the Vender on Psoriasis podcast with Dr. Ron Vender has begun. Listen to the new season here. In episode four, Dr. Vender discusses psoriatic skin lesions, methotrexate and nonmelanoma skin cancer, and face-to-face time between patients and physicians.
And if you’re looking for a web destination for all things derm, visit derm.city, “Where Dermatology Lives.” Please like, rate, review, and share it with your colleagues.