Evaluating Hyaluronic Acids in Patients with Skin of Color

In the past decade, dermal fillers have quickly defined a new branch of cosmetic dermatology that both patients and physicians enjoy. In this short time, fillers of all types have entered the market, giving patients a variety of options to achieve their desired effects. Physicians now also have wider capacities and increased range to address subtler aspects of facial aesthetics. However, given the great popularity of fillers and opportunities they present, little research has been conducted on their effect in patients with skin of color.

One recent study addresses this area, assessing both the safety and efficacy of hyaluronic acids fillers in skin of color.¹ Ahead, lead author Pearl E. Grimes, MD, Director of the Vitiligo and Pigmentation Institute of Southern California, discusses the results and explains why they are significant in the scope of research on dermal fillers.

Why is this study significant?
There was a need for data addressing fillers in patients of skin of color simply because physicians know so little about how fillers affect skin of color, according to Dr. Grimes. She observes that, historically, fillers are known for safety when used properly, but data are needed to confirm that in skin of color. “We had no reason to believe that hyaluronic acids in patients with skin of color would result in drastic differences, but little data exists to demonstrate that,” she notes.

While the differences between white skin and skin of color are not significant, Dr. Grimes observes that there are basic differences in skin of color that might impact the delivery and effectiveness of fillers. “The basic skin morphology is different, and we have found that the dermis tends to be thicker in skin of color,” says Dr. Grimes. Therefore, it is worthwhile to consider how fillers take effect when injected into a thicker dermis and how long results last, she says.

What was the study design?
What did you find?
The article actually chronicles two different studies based on patients from two different databases, according to Dr. Grimes. In the first, patients were injected with high concentration (24mg/mL) doses of either Juvéderm Ultra, Juvéderm Ultra Plus, or Juvéderm 30 in one nasolabial fold and a Zyplast collagen injection in the other. In the other study, patients received one of three low-concentration (5.5 mg/mL) hyaluronic acids in both nasolabial folds. The fillers were Hylaform, Hylaform Plus, and Captique. “The results of both studies showed great efficacy with all of the hyaluronic acids,” says Dr. Grimes.

Also, in both studies, Dr. Grimes points out, there was no significant increase in hyperpigmentation (three patients), and the incidence of keloids and hypertrophic scarring was also quite low, she notes. “In general, based on these two studies, we can deduce that the acute side effects profile for hyaluronic acids in skin of color is comparable to white skin,” says Dr. Grimes.

Also, in both studies, Dr. Grimes points out, there was no significant increase in hyperpigmentation (three patients), and the incidence of keloids and hypertrophic scarring was also quite low, she notes. “In general, based on these two studies, we can deduce that the acute side effects profile for hyaluronic acids in skin of color is comparable to white skin,” says Dr. Grimes.

How will the increased prominence in research on skin of color affect the continued development of dermal fillers?
Dr. Grimes observes that as delivery methods and filler technology continue to develop, it will likely evolve with the shifting demographics of the overall population in the US. “In roughly 40 years, more than half of the US population will be individuals with skin of color,” explains Dr. Grimes. Therefore, as procedures are researched and performed today, it's important to establish a safety and efficacy profile for filler agents in skin of color so that it may lead to new research and approaches.

According to Dr. Grimes, this research will be instrumental in paving the way for new agents to come to the market. Ultimately, she says, physicians bear the responsibility to set the learning curve for aesthetic procedures. “It is up to us as researchers to facilitate and establish these standards so that agents in the future cater to patients of all skin types,” explains Dr. Grimes.

1. Grimes PE, Thomas JA, Murphy DK. Safety and effectiveness of hyaluronic acid fillers in skin of color. Journal of Cosmetic Dermatology. June 2009. 162-168.