Botox is more popular than ever among black Americans

Corey L. Hartman (46), a dermatologist, has received Botox every 3-4 months since his residency 15-years ago. “If I have severe heartburn and know there is a cure, then I will go to the doctor and get it treated.” Hartman states, “If I see a line in my forehead that I don’t like, and I know there’s a solution for it, then I will go to get it if I have the money.”

Hartman, who is the founder and medical director at Skin Wellness Dermatology, Birmingham, Alabama, said that he has witnessed a significant increase in interest in Botox and other injectables from Black and Brown patients.

Hartman states, “This topic has become socially acceptable across all age groups. People are now bringing their friends to the doctor’s office or having Botox parties. This is a corrective action for Generation X and Baby Boomers, while Gen Z and millennials see it as self-care and preventive medicine.

Hartman grew up in a Black family in New Orleans. He recalls being told by an aunt that Black people don’t visit the dermatologist because they are blessed with good genes. This is in keeping with the old saying “Black don’t crack”. Hartman said that injectables are plagued by poor representation and the distortions of perceptions due to social media.

You can’t see it, so you can’t be it. Hartman stated that when these procedures were introduced, the marketing was limited to white women and that studies were conducted only on white women.

Botox: The Ongoing Rise

According to the 2020 Plastic Surgery Statistics Report of the American Society of Plastic Surgeons (ASPS), more than 15.5 Million cosmetic procedures were performed in 2018, with almost 13.3 million of these being minimally invasive.

Intense pulsed light (IPL), chemical peel (931,473 procedures), laser skin resurfacing (97,245 procedure), soft tissue fillers (3.84 million procedures) were the top five most popular cosmetic minimally-invasive treatments. Botulinum toxin A was first (4.4 million procedures). Botulinum toxin type A is commonly referred to by the name “Botox”, which is the brand most commonly associated with injections. There are also other botulinum-toxin type A injections, such as Dysport and Xeomin.

While the majority of these procedures weren’t performed on Black people (the ASPS found only 11 percent total cosmetic procedures in 2020 and only 4 percent botulinum-toxin Type A injections on Black patients), this particular group is showing increasing interest in these types. According to the 2020 Plastic Surgery Statistics report by the ASPS, which breaks down procedures according to ethnicity, 1.78 million Black Americans chose to have cosmetic procedures in 2018. The numbers have increased annually from 1.68million in 2018 to 1.77million in 2019. Although “Black don’t crack” may seem true to some, many people are taking their beauty in their own hands. But the question remains: Why?

Saedi states that while Instagram and Snapchat filters can lead to unrealistic standards, the social media platform has helped to open up access to information and beauty knowledge. Cosmetic treatments and enhancements were traditionally seen as a luxury for the wealthy and white. But that is rapidly changing.

Botox: Why Black People Want It

The perception that only wealthy white people can get non-invasive treatment is slowly changing. The United States still has a large racial wealth gap. The median income for Black households was $45,000 according to U.S. Census data released last year. This is approximately 45 percent less than the median income of white households. Despite the financial inequalities, Black people continue to find ways to finance their “tweakments.” It’s not a money issue, says Hartman. Hartman says that people will find the money to do what they want.

Users can now see that these procedures “are not just for sun-damaged Caucasian skin with wrinkles,” says Saedi.

Patients of color experience a slightly different aging process. Photo aging in patients of color is slower due to the increased melanin. However, you may notice dullness, hyperpigmentation and sagging. There are cosmetic treatments that can help. Nazanin Saedi currently serves on the American Society for Dermatologic Surgery’s board of directors. “You can see the 11 lines between your brows more than you can see the forehead lines. Those of the same age as Caucasians will have lines across their foreheads, as well as the 11 lines. Asians are more likely to have crow’s feet. As signs of aging, hyperpigmentation and hollowing around eyes in black patients is a common problem.”

Saedi, a Persian-American of Persian descent, has more than 12 years experience in this field and has been receiving Botox since she was late 20s. Botox relaxes the muscles that move. It relaxes areas of movement, so you don’t have to scowl. Filler can replace volume lost. It’s a form “prejuvenation” that she views as starting young with less Botox in order to avoid having to lift heavy later.

Hartman states that collagen levels peak at 22 years old. For every year thereafter, you lose 1% of that collagen. Although Black people age differently than those with less melanin but the volume of their collagen is decreasing, it can cause significant volume loss. Hartman estimated that Botox could be applied to the three areas indicated — the forehead, between the eyebrows and crow’s feet — for an average of $780 every three or four years.

Patients

Chloe (name has been changed), a twenty-two-year old girl, is willing to pay the price. She’s spent over $2,000 on noninvasive treatments in the past two years. The young consultant, whose father was Ghanaian and her mother white, was often told throughout her childhood that she did not have distinctive African features such as high cheekbones and wide eyes. She has had filler to correct this and prevent smile lines.

Chloe claims that most people in her social circle are against cosmetic treatments. They say “you don’t need it.” Chloe stated that many people believe it’s in vain. There is an unjust expectation that Black women must be flawless. It’s because it’s assumed that it’s impossible to be natural. Look at the people who aren’t natural to see where all the praise and admiration is going.

Black influencers are still under pressure to look flawless, even though their skin isn’t as prone to aging as other skin types. Sean Garrette, a beauty therapist, is well-known for his radiant complexion on Instagram. He spends his days filming tutorials and interviews. This allows him to sense when bad habits are creeping in. The 29-year old recalls growing up with a family that was extremely conscious of appearance.

He is now based in New York City and says that the greatest pressure to maintain appearances was when he lived in Los Angeles as gay Black man. He had under-eye and nasal filler to create smile lines.

“You’ll see many different ethnicities and types of people in New York. It’s almost as if there is one standard for beauty in Los Angeles. Los Angeles is almost a fetishized city for men, particularly Black men. You would need to have beautiful, thick hair, beautiful bones, and clear skin. Garrette says, “I’m none of these things.”

His provider was excellent, but she is also very conservative in her work. He was advised to not get too excited about fixing problems that do not exist. It doesn’t matter if you choose Botox for cosmetic reasons, temporomandibular dysfunction or to stop sweating in the glands, it is important that your doctor has your best interest at heart.

Danielle Gray, a thirty-nine year-old skin-care blogger based in Queens (New York), took some time to find a dermatologist she trusted. Gray stated, “A dermatologist reached me because I might’ve written about laser hair removal.” The worst part was realizing that she had burnt me and had hyperpigmentation on parts of my skin.

This is a sign of some dermatologists’ inability treat Black skin despite advances in technology. Dermatologist Carlos A. Charles founded Derma di Colore in New York City. This practice focuses on melanin rich skin. Charles believes that the disparity could be multifactorial and can be attributed to a lack in training.

“Historically, textbooks have described a lot about diseases and pictures in a lot of them. They are usually written in light skin tones or white tones.” Charles said that this creates a bit of a blind spot as things can look differently on darker skin.

Michelle Henry is Gray’s dermatologist. Gray had filler for undereye hollows in 2018. Gray received Botox by Henry one year later after she noticed some fine lines. She shared her experience online. Gray believes that it is important to consult a Black dermatologist due to their expertise. Gray has been through similar issues and understands how they will be perceived. One of Gray’s Instagram posts was prompted by a comment from a user: “You need to age gracefully as these Black celebrities do.”

Gray states, “Just because celebrities aren’t telling you what they do, doesn’t mean that they’re not doing it,” Gray said. “It is all bullshit, to be honest. People don’t know what they want. People will tell people that they want natural hair. They won’t like it when you show them.”

Gray doesn’t seem to be bothered by the negative comments. Gray is happy with her decision to explore aesthetics. “I don’t fear aging. I think that the older I get, the more self aware I am, the higher my self-esteem and the greater my self-confidence. I learned early that it is important to ignore what others say. “I just look out for my community.”