How Injectables Are Evolving for Skin of Color

Welcome to Under The Surface,

the series where we explore aesthetics

and how they shape culture.

I'm your host, Dianna Singh, Allure's Features Director.

Today we're diving into a topic that's been underserved

for too long, the role of dermal fillers

and cosmetic injectables in communities of color.

I'm honored to be joined by Dr. Michelle Henry,

a board certified dermatologist and reconstructive surgeon

whose practice and research specialize in skin of color

and aesthetic procedures across ethnicities.

Thank you so much for being here, Dr. Henry.

Thank you for having me,

always a pleasure to chat with you.

Thank you, let's jump right in.

Let's do it.

[upbeat music]

So, Dr. Henry, when you look back

a decade or more across your career, what were you seeing

in terms of people of color requesting injectables

or dermal filler?

Was there demand?

Was there hesitation?

What's that evolution been like?

So, 10 years ago, it was definitely a lot slower.

I always had patients that were interested,

but it was something that was like a little bit more quiet.

They did it in the shadows.

They shared with their friends, they didn't post about it,

they didn't come in asking me if they could film.

That's what we see today.

So it was something that, the early adopters realized that

it is a moment of empowerment to engage the space.

But it was something that I didn't feel

completely confident in owning.

And so I think that's changing a lot.

Yeah, can you pinpoint a shift or a period of time?

I think that media, for better or for worse,

plays a huge role in this.

I think with skin of color, a lot of it is like,

if you see it, you can be it.

And whether that is a job or aesthetics or anything,

patients of color need to feel that it's for them,

that it's made for them, that it's appropriate for them,

that it's safe for them.

And a lot of that comes from word of mouth.

So normalizing that space

really opened up a lot of people of color.

So when they hear celebrities that look like them saying,

you know what, I just got my Botox today.

They're more open, they realize that she had her Botox,

she's still walking, she's smiling, she looks like her.

It's safe for me too.

So I think a lot of the inclusivity

that we've seen in the media and advertising

and the entire aesthetic space has really opened doors

and increased that comfort level for patients of color.

So, safe to say, you've seen a shift

since you began your career here in New York.

Tremendous shift.

So what kinds of cultural

or societal factors do you think contributed to that stigma?

That kind of behind the shadows attitude that you mentioned

around injectables in communities of color?

In communities of color, there's a lot of incorrect

disparaging information that you learn about, how you look,

your unique differences, those unique cultural differences

that are really beautiful.

And I think a form of empowerment and resistance

as a person of color is to claim and own that beauty.

And to proclaim that beauty.

And I think that anything that deviates from that

makes a lot of people question themselves.

Do I love me?

Do I believe that I'm beautiful?

Am I signaling to others that I don't love me,

that I don't believe that black or brown is beautiful?

And I think the shame around that

was something that was really personal.

And I think also the things that they saw

didn't reflect their beauty.

So they think about celebrities and God rest his soul,

but things like Michael Jackson, you know, early surgery

and ethnic patients just really didn't respect

their ethnic uniqueness, right?

And it really was obliterating that.

And so I think that really

had a chilling effect in communities of color.

And so they weren't early adopters

because they were so afraid that subtlety was not a thing.

Doing something that made you look like you,

just better was not a thing.

All that they knew was that, if I have a procedure,

I'm rejecting my ethnicity

I'm gonna look like something different

and people will know.

And I think that really had a chilling effect.

And then safety of course.

I think whenever communities of color

are engaging the medical field,

there have been so many historic injustices

in the medical field that there is a level of fear.

And so I think all of those things had a combined effect of

a lot of communities of colors not being early adopters.

I'm sure the answer to this is yes,

but does representation of both patients and providers

such as yourself play a role in shifting those attitudes?

I think it absolutely does.

I do a lot of education, a lot of teaching.

And I always say my dream is that soon in this world

that patients will walk into any office of any physician,

of any ethnic background and feel completely confident

that they know them, they can treat them.

And I think we're there.

Some of the people who trained me are not doctors of color,

but they're excellent and invested in that.

So, but I do think where we are now that that cultural

identity and resonance is really important to patients.

Not only in terms of the skillset,

but in terms of it is a really vulnerable thing

to walk into an office and tell a physician,

I don't like this face, I don't like this thing about me.

And you want to use language that you're comfortable with.

You don't want to go there and feel like,

if I use this language, are they gonna understand me?

Do they have the right frame of reference?

Can I be me in that chair?

And so I think it is important.

And because as a physician of color,

I self-select for patients of color.

So the volume of patients of color that I treat, it's huge.

Of course I treat all patients,

but I treat a lot of patients of color.

So there's a huge comfort level with

understanding the dynamics of aging,

treating those patients, being able to manage

any complications that might happen, so that's important.

And then for the patients to see themselves

represented in your book.

So I have a book of before and afters,

it's important for them to see that.

It's important for them to see in the advertising.

So they feel confident that

what you're using is made for me,

you have experiences on me

and we're not experimenting on me.

As a beauty editor,

I know that you mentioned having a frame of reference.

In textbooks, skin of color wasn't always represented.

So conditions that would appear differently

on skin of color were perhaps not taught to

to dermatologists in school.

Absolutely, there was a joke in medical school

that if you didn't really know the answer,

but they described the patient as a patient of color,

it was either lupus, sarcoidosis,

some other infectious disease, you know?

And that's unfortunate, and that bias,

if you are not acutely attuned to it,

it's easy to absorb it.

Even well-meaning people to absorb it, right?

And so I think that's really tough.

So even well-meaning people,

unless they seek out an unbiased education

and seek out those tools

and seek out those images, it's hard to get it.

And so you really have to, I always tell people, they say,

Well how did you learn skin of color?

I didn't learn it just because I have it, right.

I don't have psoriasis, I don't have.

I learned it because I had to create my own curriculum.

And I think that a lot of us have to do that

in order to be proficient.

Yeah, is that still the case

or there have been strides made in academic institutions?

I think there are strides made.

So a lot of institutions have a skin of color department.

They're doing research in skin of color.

They have faculty

that have a keen interest in skin of color.

And a lot of the students all of them,

whether they're of color or not,

come to me asking questions.

Like, I haven't seen a lot of this,

I wanna learn from you.

So I teach at Cornell and all of the students come

and want to come to my office to learn more.

And that's really encouraging.

And that hopefully will give us the day that I dream of

that you can walk into any office

and feel certain that they know how to treat your skin.

So from a clinical, anatomical perspective,

are there specific considerations when you're performing

fillers or any aesthetic procedure on skin of color?

Be that, how skin of color ages or pigmentation,

those sort of nuances?

Yes, absolutely, I think we've all heard that old adage,

black don't crack or Asian don't raisin.

But what I tell my patients is, you may not crack,

but you do sink, fade, dull.

So there's of course patients of color age,

it's just different.

The dynamics of aging, it's a little bit different.

And so what you do see is that structurally,

there's a difference.

So we see more in women and men of color

kind of flatness in the midface.

So because of that, as the skin starts to sag

and that skin is often heavier, thicker, and heavier,

we start to see aging around the eyes,

sometimes a bit earlier.

[Singh] Sure.

We may not see that wrinkling on the forehead

that we see in lighter skin, we're just aging differently.

And so being mindful of that.

So in my office, I do a lot of toxin, I do a lot of filler.

But we do a lot of that filler

because of the dynamics of aging.

So if you see patients of color,

you may not use as much toxin,

although you will eventually, right?

But you may even start with filler

because those volume deficits are more pronounced.

If you're using lasers, you need lasers

that can bypass the superficial pigment

but make it to the target that you're trying to treat.

So you need those specific devices.

When you're thinking about doing procedures

where you're breaking the skin using needles,

you want to minimize the injection sites,

you're not getting hyperpigmentation.

And these things have to be really top of mind

because the skin can be exquisitely sensitive

in terms of getting hyperpigmentation,

which can be longstanding and disfiguring.

Yeah, could you unpack that a little bit?

How does hyperpigmentation

tend to manifest in skin of color?

Yeah, so what we call this type of hyperpigmentation

is post-inflammatory hyperpigmentation.

PIH. Exactly, PIH.

So what that means is after any inflammatory stimuli,

you can have inflammation.

So when we think of skin of color,

both dark skin and light skin,

we all have the same number of melanocytes.

So those are the cells that make pigment.

But in darker skin you have more melano zones,

so those are, I always say they're little

bags of pigment inside the cell, right?

So if you have skin of color,

you're carrying more bags of pigment around, right?

And those little bags are distributed

to all of your other skin cells.

And that's how you get this even pigment.

Now when those little bags are everywhere,

they're more responsive to any trauma.

So you have bags evenly distributed throughout your skin

and you have a pimple, you have an ingrown here,

you have a laser that's too strong for you.

Any inflammatory stimulus

is going to cause those bags to leak.

And that's what I tell my patients is that

your skin is exquisitely sensitive

because any trauma

is going to cause those little bags of pigment to leak,

and then you get longstanding hyperpigmentation.

Wow, so knowing all these many nuances.

For someone who couldn't get to you in New York City,

how should someone who wants to seek out a provider

even begin that search

and know that the person they're going to has the training

and the expertise that you do?

Yeah, don't be afraid to ask questions.

The right doctors should not get offended.

I've been doing this a long time,

and every so often a patient says,

Well, how many cases did you do?

And I have to always remind myself,

I know that I do this, but they don't.

This is their one moment,

this is their one moment to protect themselves.

And so you answer that question with humility

and the right doctor for you

should answer that question with humility.

They shouldn't be afraid to say how many cases they've done.

Maybe they don't know, but they know it's a lot.

It's upwards of however many thousands, right?

Or however many hundred, depending on what's being done.

Ask if they have before and afters.

Ask if they have before and afters with patients like

with your skin type.

Because skin of color, again, is not a monolith, right?

We have light skin of color, dark skin of color.

So don't be afraid to ask for that.

Ask them, what happens if you have a problem?

How do you manage it?

Even in the best hands, a mistake can happen.

But everyone who is conscientious physician

should have a game plan.

So they should have a game plan, how to treat you

to prevent that problem.

And how to manage you

if by chance you do have a complication.

So all of these questions are appropriate,

don't feel shy to do it,

that is how you advocate for yourself,

and that's really important.

On the flip side, are there any sort of red flags

or warning signs that you'd advise anyone watch out for?

Especially someone of color at their first visit?

Yeah, so if someone diminishes your questions.

If they push it away and they say, oh, I've done thousands,

you don't have to know about that, I'm the expert, right?

No, someone should answer your questions

directly and clearly.

They shouldn't gaslight you into feeling like I know

more than you know, don't ask me.

That's not okay,

and if that happens, you're not in a safe place.

Speaking of gaslighting,

how do you help a patient of color

set realistic expectations about results, recovery

and ongoing maintenance?

Yeah, so I am a doctor that

under promises and over delivers,

that is always my approach.

So sometimes patients say,

You told me everything bad that can happen,

I just really trusted you and I'm so glad that I did.

But that's important, you want patients to know like

there's a reason we call it medical aesthetics.

That we cannot extract the medical component from it.

And we need to work as a team

to understand what the risk is,

what we're gonna do if,

God forbid you do encounter it, that we have a game plan,

that we're holding hands and walking in this together.

So I am, I over disclose everything,

but I think that's important, patients need to know.

Absolutely, especially if you're someone

who has been burned literally or metaphorically before.

Exactly, exactly, and I think it's really comforting

to patients when I tell them

all of the things that I do to keep them safe.

My pre-treatments, the way I control my settings,

the devices I use in my office.

The demands I have on companies

before they place a device in my office, you know?

And so it's really important to know that

you began this process with them in mind

and that's very important.

So as we close out our time together,

what would you like to see as the next step

in making injectables more inclusive

and better suited for people of color?

Be it research, education, or just cultural shifts?

Yeah, so I think you hit the nail on the head.

We need exclusivity and research

and education in marketing and advertising.

So moments like this are just so critically important

because I say, there's a lot of information out there,

but not a lot of education, it's edutainment, right?

And so understanding who's the appropriate source

to ask these questions.

And so it's difficult

because as a physician, I'm in the know,

when I'm looking for a doctor, I know what to ask,

I know what to look for, I know how to vet someone.

But we want to empower patients

with that same vetting ability.

And it happens in conversations like this.

And then inclusivity in research is so important

because it's not fair to patients of color

to become our lab rats.

After we've marketed this.

Right, laser didn't work.

Yeah, or we're so sorry,

the settings weren't right for you.

And so I always tell a lot of these brands, like you need,

your settings need to include this.

Because there's someone out there who may not have

the same understanding as we do.

And they may just try something

and not realize how devastating those results can be.

And so I think that's so important.

So education, research, sharing if you can,

I never like to out anyone about their procedures,

but if you ask me, I'll tell you.

Patients will ask me, did you have Botox?

I'll tell them exactly where and how many units.

Do you have filler?

I'll tell them exactly where and how much I used

because it's a moment of empowerment for me.

And I think sharing that helps to let people know that

if you don't like something about yourself,

it is empowering to fix it.

There's no power in living a life that you don't like

because you want to feel like I stayed true.

What does that even mean?

Staying true to your desires, right?

And so like I think just empowering women

to make the decision to do it or not to do it

is how we make things better.

Dr. Henry, thank you so much

for joining us today.

On behalf of the beauty industry,

thank you for all the work you do

to make aesthetic care more inclusive

and for pushing us forward.

Thank you so much for having me,

it's always an honor and a privilege to speak with you,

and I'm always here if you need.

Thank you.

And for our viewers, if you're a person of color

who's curious about injectables,

we hope this episode gave you some of the language

to ask questions at your next consultation.

Thank you so much for watching.