Dermatological Conditions in Skin of Color—Clinical Tips for Non-invasive Cosmetic Procedures in Skin of Color Patients

by Archana M. Sangha, MMS, PA-C

Ms. Sangha is a medical science liaison for Incyte in Wilmington, Delaware. Prior to that, she spent over a decade as a dermatology PA specializing in general, surgical, and cosmetic dermatology. She is a fellow of the American Academy of Physician Assistants in Alexandria, Virginia. She is also Immediate Past President of the Society of Dermatology Physician Assistants.

J Clin Aesthet Dermatol. 2024;17(3–4 Suppl 1):S24–S25.

Funding: No funding was provided for this article.

Disclosures: Ms. Sangha is an employee of Incyte in Wilmington, Delaware.

According to the 2022 American Society of Plastic Surgeons Procedural Statistics Release,1 there were nearly 23.7 million minimally invasive cosmetic procedures performed in the United States (US) in 2022. This article will review a few key tips when treating skin of color (SOC) patients with minimally invasive cosmetic procedures.1

1. Understand cultural beauty preferences. There are a few facial beauty ideals that are universal. They include harmony, symmetry, and balance. However, the way these characteristics present across different ethnic backgrounds varies greatly. It is important to understand that not all patients desire a “Westernized face,” but rather want to optimize their unique ethnic beauty. For example, in Asian cultures, many consider a wide, square lower face to be unattractive. Instead, a contoured, oval-shaped lower face is often desired. Thus, many younger patients (18–30 years of age) seek botulinum injections for masseter muscle reduction.2 In a study looking at beauty preferences in the Middle East, it was found that an oval or round face shape, full temples, and a well-defined jawline were features that were most desired in Middle Eastern women.3 In regard to lip size and shape, a study of cosmetic surgeons across 35 countries showed differences in “ideal” lip shape. The results showed that White surgeons preferred small lip size, while non-White surgeons preferred larger lip size.4 It is always good practice to have each patient describe what their ideal treatment result is during the initial consultation.

2. Minimize the number of skin punctures. The skin interprets a needle stick as a form of trauma. The more deeply pigmented a patient’s skin is, the greater their risk of postinflammatory hyperpigmention (PIH). To minimize the risk of PIH, it is best to use a linear threading approach, inject slowly, and avoid unnecessary needle punctures.5

3. Consider lower doses of botunlinum toxin and modified injection points for Asian patients. In comparison to White patients, Asian patients tend to have a lower muscle mass. Thus, lower doses of botulinum toxin can be considered. The standard five-point injection technique can also be modified depending on the length of the corrugator supercili muscle. Asian patients are more likely to have a shorter supercili muscle, and a three-point injection pattern can be utilized.2

4. Ask a patient what their ethnic background is; do not assume. For example, a patient might present as a Fitzpatrick III phenotype with light eyes and hair color but then experience the complications of a patients with Fitzpatrick type V. Upon treating the patient for their PIH, you learn their ethnic background is Middle Eastern, with several family members who have type IV and V skin types. The unpredictability of a patient’s phenotypic skin presentation and their skin response to treatment can be minimized simply by asking about their ethnic background.6

5. Take a thorough patient history and prepare the skin for the best treatment outcome. Understanding a patient’s medical history is imperative to assessing the risk–benefit ratio of performing a specific treatment. For example, if a patient presents requesting a chemical peel for melasma, it is important to know if they are on hormonal or photosensitizing agents.

In SOC patients, you should always prime the skin weeks prior to a chemical peel to minimize the risk of PIH. This is often done at least 2 to 4 weeks before the peel and consists of applying hydroquinone 4% twice daily or a topical retinoid nightly. If the latter is chosen, remember to have the patient discontinue its use 5 to 7 days prior to the peel, as it increases the depth of the peel and can lead to complications. Also, remember to advise SOC patients to use sunscreen daily.7

In summary, the list of minimally invasive cosmetic procedures for SOC patients continues to increase. While it is exciting to offer new options for patients, it is important to know what steps to take to provide these patients with the best experiences and outcomes.


  1. American Society of Plastic Surgeons. 2022 ASPS Procedural Statistics Release. 26 Sep 2023. Accessed 9 Mar 2024.
  2. Sundaram H, Huang PH, Hsu NJ, et al. Aesthetic applications of botulinum toxin A in Asians: an international, multidisciplinary, pan-Asian consensus. Plast Reconstr Surg Glob Open. 2016;4(12):e872.
  3. Arian H, Alroudan D, Alkandari Q, Shuaib A. Cosmetic surgery and the diversity of cultural and ethnic perceptions of facial, breast, and gluteal aesthetics in women: a comprehensive review. Clin Cosmet Investig Dermatol. 2023;16:1443–1456.
  4. Heidekrueger PI, Szpalski C, Weichman K, et al. Lip attractiveness: a cross-cultural analysis. Aesthet Surg J. 2017;37(7):828–836.
  5. Funt D, Pavicic T. Dermal fillers in aesthetics: an overview of adverse events and treatment approaches. Clin Cosmet Investig Dermatol. 2013;6:295–316.
  6. Roberts WE. Chemical peeling in ethnic/dark skin. Dermatol Ther. 2004;17(2):196–205.
  7. Vemula S, Maymone MBC, Secemsky EA et al. Assessing the safety of superficial chemical peels in darker skin: a retrospective study. J Am Acad Dermatol. 2018;79(3):508–513.e2.