🔍 Key Finding

Botulinum toxin (BTX) and dermal fillers are safe and effective in skin of color (SOC) populations, with strong evidence particularly for Asian patients, while providing promising but less extensive data for Black and Latinx populations.

🔬 Methodology Overview

• Systematic literature search of PubMed/MEDLINE (1960-2020) for studies on injectable neuromodulators and dermal fillers in SOC

• Included studies with >20% SOC participants or dedicated content on SOC-specific safety/efficacy

• 88 articles selected from 503 publications, including 50 with level I-II evidence

• Total of 9,940 patients analyzed across various racial/ethnic groups

• Evaluated studies categorized by Asian, Black/Latinx, and combined SOC populations

📊 Evidence

• Response rate to BTX for glabellar lines at Day 30 reached 94.1% in Chinese subjects

• Masseter reduction with BTX in Asians showed maintained volume reduction over 4-year follow-up

• Hyaluronic acid fillers demonstrated significant improvement in moderate-to-severe nasolabial folds across SOC populations

• Black subjects showed no significant differences in clinical response between 20U vs 30U BTX doses for glabellar lines

• Studies found no increased incidence of keloid formation with dermal fillers in Black patients

• Post-inflammatory hyperpigmentation (PIH) rates were low across SOC populations despite theoretical risk

💡 Clinical Impact

• Awareness of racial/ethnic differences in facial structure and aging patterns enables targeted treatment approaches

• Cultural preferences influence aesthetic goals (e.g., Japanese women prefer thinner lips while Korean women prefer thicker lips)

• Modified injection techniques can minimize adverse events in SOC, including slower injection rates and linear threading

• Safe use of BTX for cultural preferences such as masseter reduction in Asian patients to achieve oval facial contour

• Clinicians can confidently offer these minimally invasive treatments to diverse patient populations

🤔 Limitations

• Significant research gap for Black and Latinx populations compared to Asian populations

• Most consensus guidelines originated from Asian countries with less guidance for other SOC groups

• Limited high-quality randomized controlled trials in Black and Latinx patients

• Studies varied in quality and methodology, making direct comparisons challenging