Facial Aging: Aesthetic Treatments for Every Decade of Life in Skin of Color

Introduction

Facial attractiveness significantly influences self-perception, social interactions, and professional outcomes. Universally attractive facial features include youthfulness, symmetry, adherence to average norms, and secondary sexual characteristics, which reflect masculinity or femininity. Additionally, cultural and ethnic preferences, perceived physical health, and apparent chronological age further shape the concept of beauty. These factors underscore the complexity and individuality of facial aesthetics. When discussing aesthetics, it's important for dermatology NPs to obtain comprehensive education so we can deliver safe and culturally sensitive care. See my previous article titled, The Importance of Learning About Skin of Color and Gender-Affirming Care in Aesthetics Training.

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Progression of Facial Aging

Facial aging is a non-uniform process influenced by both intrinsic and extrinsic factors. Intrinsic factors include genetics, ethnicity, and anatomical variations, while extrinsic contributors encompass lifestyle choices (e.g., smoking, alcohol consumption) and environmental exposures, such as ultraviolet (UV) radiation and pollution.

Aging manifests through skin surface changes, tissue repositioning, and volume loss, disrupting aesthetically pleasing facial proportions. Studies reveal differential aging patterns in various facial components, such as fat compartments (atrophy or repositioning), ligament laxity, dentition, and bony structures. Importantly, facial aging patterns and rates vary across racial and ethnic groups. For instance, White/Caucasian women often exhibit advanced facial aging earlier than Hispanic, Asian, and Black women. Furthermore, epigenetic factors also influence these changes.

Certain aesthetic concerns, such as submental fat accumulation resulting in a double chin, may stem from genetics or weight gain rather than age. Therefore, understanding the progression of age-dependent and condition-specific aesthetic needs is essential for effective facial rejuvenation and beautification strategies.

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Aesthetic Procedures in Your 20s and 30s

In recent years, there has been a notable rise in aesthetic procedures among younger individuals, particularly those in their 20s and 30s. This trend is driven by heightened awareness of cosmetic options and a desire to address early signs of aging or enhance naturally attractive features. Non-surgical interventions, such as botulinum toxin injections and dermal fillers, are popular choices due to their minimally invasive nature, affordability, and quick recovery times.

Younger patients often seek aesthetic treatments to achieve preventive benefits. For instance, botulinum toxin can relax dynamic wrinkles, such as forehead lines and crow’s feet, effectively delaying the formation of permanent static wrinkles. Dermal fillers, on the other hand, are used to restore or enhance volume, contour facial structures, and refine symmetry. These procedures align with the concept of "prejuvenation," where clients proactively address aesthetic concerns before significant signs of aging occur.

Note, aesthetic providers must balance patient desires with realistic outcomes. Younger patients may benefit from conservative treatments to enhance their features subtly, preserving their natural appearance while boosting confidence. By focusing on individualized care, integrative medicine, and informed decision-making, dermatology NPs can ensure a positive experience and long-term satisfaction.

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Social Media

Social media has amplified awareness and interest in aesthetic procedures for younger clients, communities of color, and men. Filters, photo editing tools, and the rise of influencers have created a culture where individuals closely scrutinize their appearances. Consequently, younger patients frequently consult aesthetic NPs with specific goals, often referencing idealized images or trends. Social media has provided a safe space for people to see other people who have their genetic makeup and aesthetic concerns, something that can easily be taken for granted when you’re part of the dominate culture, narrative, and marketing strategy. Traditionally, when it comes to communities of color and barriers to care it has been well documented that a lack of trust, a lack of providers, costs, misconceptions, and a paucity of diverse images contribute to disparities in care.

Social media, while it has its negatives, I focus on the positives. I’ve seen how it also allows people to see before and after photos which can decrease fear. It has created a dedicated space for people to ask questions and build rapport with providers who are well-versed in treating diverse skin tones with confidence. Most importantly, it has helped evolve the culture, advance the conversation, and change cultural norms in communities of color.

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Considerations for Cultural Diversity in Aesthetics

The growing diversity in patient demographics requires a nuanced approach to aesthetic treatments. Cultural, ethnic, and anatomical variations significantly influence facial structure, aging patterns, and aesthetic preferences. Dermatology NPs must consider these factors to deliver personalized care and optimize outcomes.

For example, differences in skin thickness, elasticity, and pigmentation between ethnic groups affect how facial aging manifests and how treatments should be tailored. Asian and Black individuals, for instance, often experience slower wrinkle development due to increased dermal thickness and higher melanin levels, which offer some protection against UV-induced damage. However, these populations may be more prone to specific concerns, such as hyperpigmentation or volume changes.

Cultural ideals of beauty also play a pivotal role. Individuals of East Asian descent may prioritize a softer, V-shaped jawline, while patients of Middle Eastern or African descent may focus on nose refinement or facial contouring. Understanding these preferences ensures that dermatology NPs respect and align treatments with each client’s unique goals.

Patient education is critical when discussing treatment options and potential outcomes. Misaligned expectations can lead to dissatisfaction, especially when patients compare themselves to digitally altered or unrealistic standards of beauty. By emphasizing realistic goals and celebrating individual diversity, we can foster trust and satisfaction in our patient relationships.

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Understanding Skin Physiology

Skin of color typically has higher melanin content, which provides a natural photoprotective effect, delaying visible signs of aging such as fine lines and wrinkles (rhytides). However, this same characteristic makes skin of color more prone to pigmentation disorders, such as post-inflammatory hyperpigmentation (PIH), melasma, and keloid scarring. These risks necessitate careful selection of treatment modalities and techniques to avoid adverse effects.

For instance, energy-based devices like lasers or intense pulsed light (IPL) require specific settings to minimize the risk of burns or pigmentary changes. Dermatology NPs must prioritize devices and wavelengths proven to be safe for darker skin tones, such as Nd:YAG lasers, which target deeper layers of the skin while sparing the epidermis. Additionally, when using chemical peels, dermatology nurse practitioners should select milder formulations, such as superficial peels with salicylic acid or mandelic acid, which are less likely to cause irritation or PIH.

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Treatment Preferences and Techniques

Patients with skin of color often present with concerns such as uneven skin tone, blemishes, hyperpigmentation, acne scarring, or volume loss. While injectable treatments like dermal fillers and botulinum toxin remain widely applicable, dermatology NPs must be mindful of techniques that enhance natural beauty without compromising the skin's integrity.

Strategic filler placement can restore volume in areas such as the cheeks or under-eye region, creating a more youthful appearance without distorting facial proportions. However, overcorrection or improper techniques can lead to complications, such as Tyndall effect (a bluish hue caused by fillers placed too superficially) or asymmetry, which are more noticeable in skin of color.

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Cultural and Aesthetic Considerations

A culturally sensitive approach is vital when treating patients with skin of color. Aesthetic ideals vary across cultures, and dermatology nurse practitioners must ensure that treatments align with patients’ goals and preferences. For example, some patients may prefer maintaining specific cultural features, such as a prominent nose bridge or fuller lips, while seeking subtle enhancements that boost overall facial balancing.

Open communication and active listening are essential for building trust and understanding patient expectations. Additionally, patient education on realistic outcomes and the importance of maintaining natural features can enhance satisfaction. Addressing any concerns about safety, particularly given historical disparities in healthcare, is also critical in fostering a positive experience. See my recommendations for essential dermatology textbooks for skin of color that should be added to the required and recommended reading list for nursing and medical schools.

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Advocacy and Representation

As the demand for aesthetic treatments grows among diverse populations, dermatology nurse practitioners play a crucial role in advocating for inclusivity and representation. Ensuring access to safe treatments, improving education about skin of color in training programs, and expanding research on treatment outcomes in diverse populations are essential steps toward equity in aesthetic medicine. One way this can be done in research is by ensuring the inclusion criteria for participation addresses barriers to recruitment and retention that are well documented in communities of color. One place to start discovering these barriers is by understanding social and political determinants of health.

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Aesthetic Considerations in the 40s

By the 40s, the cumulative effects of aging become more pronounced. These changes include significant collagen and elastin degradation, leading to reduced skin elasticity and firmness. Bone resorption and fat redistribution intensify, resulting in more noticeable hollowing under the eyes, flattening of the cheeks, and deeper nasolabial folds. Dermatology nurse practitioners must take a comprehensive approach to restore volume, improve skin texture, and maintain facial balance during this decade.

Injectable Treatments

• Dermal Fillers: Restoring mid-face volume through cheek augmentation can help lift the appearance of the lower face and soften smile lines. Strategic filler placement can also address under-eye hollows, marionette lines, and volume loss in the temples.

• Neuromodulators: Continued use of botulinum toxin for forehead lines, crow’s feet, and glabellar wrinkles remains essential. Regular maintenance prevents static wrinkles from becoming more deeply etched into the skin.

Skin Quality Improvements

• Collagen-Stimulating Treatments: Microneedling with radiofrequency or injectable biostimulatory agents like poly-L-lactic acid (e.g., Sculptra) can improve skin quality, restore lost volume subtly, and stimulate collagen production.

• Laser Treatments: Non-ablative fractional lasers can treat fine lines, uneven texture, and pigmentation concerns while preserving a shorter recovery time, which is particularly appealing to patients balancing family and career obligations.

Preventive Skincare

Dermatology NPs should continue to emphasize a robust at-home skincare routine tailored to the client's evolving needs. Incorporating retinoids, antioxidants, and peptides helps improve skin firmness and delay further signs of aging. Patient education on the importance of sunscreen remains critical, especially for those with skin of color, where UV exposure exacerbates hyperpigmentation and melasma.

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Aesthetic Considerations in the 50s

For patients in their 50s, hormonal changes, particularly post-menopause, accelerate the visible signs of aging. Estrogen decline leads to a decrease in skin hydration, density, and thickness, causing skin laxity, fine lines, and a loss of facial contours. A multifaceted treatment plan is essential to address these concerns and restore a refreshed, natural appearance.

Restoring Facial Volume

• Advanced Filler Techniques: Dermatology NPs may use deeper injection techniques with robust fillers to address significant volume loss in the cheeks, temples, and jawline.

• Fat Grafting: Autologous fat transfer can be an option for patients seeking long-lasting volume restoration.

Tightening Skin

• Energy-Based Devices: Skin-tightening treatments using radiofrequency or ultrasound technologies, such as Thermage or Ultherapy, can non-invasively lift and firm the face and neck.

• Thread Lifts: Biodegradable threads can provide a subtle lift to areas like the mid-face and jowls, creating a rejuvenated appearance without surgery.

Comprehensive Skin Rejuvenation

• Combination Therapies: For clients seeking overall rejuvenation, combining laser-safe treatment options for pigmentation and texture, and fillers or biostimulators for volume can address multiple concerns in one plan.

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Aesthetic Considerations in the 60s and Beyond

In the 60s and beyond, maintaining natural facial harmony and improving skin health are the primary goals. Patients often present with advanced skin laxity, deep wrinkles, and sun damage accumulated over decades. Dermatology nurse practitioners play an important role in guiding patients through minimally invasive options while respecting their preferences for subtle or more noticeable changes.

Lifting and Contouring

• Advanced Injectable Techniques: High-density fillers can restore volume to areas like the cheeks, lips, and chin. However, overcorrection should be avoided to ensure a natural aesthetic.

• Surgical Referrals: For patients with significant skin laxity, referral to a plastic surgeon for facelifts or blepharoplasty may be appropriate. Collaborating with other specialists, including primary care who can address underlying diseases, can ensure the best outcomes for patients seeking dramatic improvements.

Skin Restoration

• Ablative Lasers: For deep wrinkles and severe sun damage, ablative laser treatments like CO2 or erbium lasers can offer significant improvements.

• Platelet-Rich Plasma (PRP): PRP can improve skin texture, elasticity, and hydration, promoting a healthier, more youthful appearance.

Patient-Centered Care

Patients in their 60s and beyond often focus on treatments that offer high value with minimal downtime. Dermatology nurse practitioners should prioritize patient education, ensuring realistic expectations while highlighting the importance of consistent maintenance treatments and a comprehensive skincare regimen.

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Lasers Considered Safe for Skin of Color

1. Nd:YAG Laser

A long-wavelength laser effective for medium to dark skin tones, the Nd:YAG laser penetrates deep into the skin, bypassing the surface layer and minimizing the risk of damaging melanin.

2. Sciton ProFractional

This versatile laser is a popular choice for skin rejuvenation and can address a range of skin concerns, making it suitable for a variety of skin types, including darker skin tones.

3. Aerolase

Aerolase laser technology is designed to treat various skin concerns, such as acne and pigmentation, with minimal risk of scarring or hyperpigmentation, especially for patients with darker skin.

4. triniti™ Plus

Known for its safety and efficacy, triniti™ Plus offers a comprehensive solution for facial rejuvenation, suitable for patients with skin of color.

5. elōs® SUBLIME

The elōs® SUBLIME system combines laser and radiofrequency energy, effectively addressing signs of aging while ensuring safety for darker skin tones.

6. elōs® Sublative RF

A radiofrequency-based laser system that delivers safe and effective treatments for skin resurfacing, particularly beneficial for skin of color.

7. LaseMD™

LaseMD™ is designed for treating skin issues like pigmentation and texture concerns, offering a safe treatment option for patients with darker skin tones.

These lasers are specifically chosen for their ability to treat a variety of skin concerns while minimizing the risk of adverse effects like hyperpigmentation or scarring, which is a safety and aesthetic concern for skin of color. See my previous article on Cosmetic Treatment Options for Skin of Color.

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Conclusion

The practice of aesthetic dermatology offers dermatology NPs a unique opportunity to combine technical expertise with patient education and advocacy. By prioritizing individualized care, fostering cultural sensitivity, and pursuing advanced education, we can enhance the quality of aesthetic treatments and empower our patients to feel confident in their skin at every stage of life. As the demand for aesthetic care continues to grow, dermatology nurse practitioners must lead the way in promoting equitable, evidence-based, and inclusive practices for all patients, especially those with skin of color.

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References

Alexis, A. F. (2023). Procedures in cosmetic dermatology: Cosmetic procedures in skin of color (1st ed.). Elsevier. https://doi.org/10.1016/C2020-0-04284-6

Cohen JL, Goodman GJ, De Almeida AT, et al. Decades of beauty: Achieving aesthetic goals throughout the lifespan. J Cosmet Dermatol. 2023; 22: 2889-2901. doi:10.1111/jocd.15968

Desai M, Gill J, Luke J. Cosmetic Procedures in Patients with Skin of Color: Clinical Pearls and Pitfalls. J Clin Aesthet Dermatol. 2023 Mar;16(3):37-40. PMID: 36950048; PMCID: PMC10027327.

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Kimberly Madison, DNP, AGPCNP-BC

I am a Board-Certified Nurse Practitioner, educator, and author dedicated to advancing dermatology nursing education and research with an emphasis on skin of color. As the founder of Mahogany Dermatology Nursing | Education | Research, I aim to expand access to dermatology research, business acumen, and innovation using artificial intelligence and augmented reality while also leading professional groups and mentoring clinicians. Through engaging and informative social media content and peer-reviewed research, I empower nurses and healthcare professionals to excel in dermatology and improve patient care.

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