Asian Patients Want Less Facial Volume, Not More

ORLANDO – Be conservative when injecting Asian patients with botulinum toxin type A, advised Dr. Jessica Wu.

She said she has seen her fair share of patients who come to her complaining about their botulinum toxin treatments. "Many Asian patients come to me saying that Botox or Dysport isn’t for them," Dr. Wu said in an interview. "They say their forehead feels heavy or they have trouble opening their eyes, and they can’t apply eye makeup properly." This, said Dr. Wu, is because of a lack of experience and knowledge in treating Asian patients.

As the U.S. population becomes more diverse, there’s a growing need for dermatologists to learn about differences in treating skin of color. The Asian population, for instance, was the fastest growing ethnic group in the United States between 2000 and 2010, according to 2010 data from the U.S. Census Bureau. And, Asian patients accounted for 6% of all cosmetic procedures in 2010, according to a 2010 report from the American Society of Plastic Surgeons.

Meanwhile, injectable fillers, botulinum toxin A, and chemical peels were the most-requested minimally invasive procedures among Asians, said Dr. Wu, assistant clinical professor of dermatology at the University of Southern California, Los Angeles.

"I think many of my colleagues would benefit from more education on treating Asian patients," said Dr. Wu. "We treat a diverse population. It’s something that’s not discussed enough."

Asian patients tend to have heavier eyelids, more melanin in their skin, thicker dermis, and more prominent collagen bundles. So their skin "generally requires less fillers when compared with Caucasian patients of the same age," said Dr. Wu. Fillers can also be used to enhance facial contours, including the nose and lips.

In addition, fine lines and wrinkles are less obvious in patients under age 50. Instead, hyperpigmentation is the earliest sign of aging in Asian skin. "Asian patients are more likely to seek help with pigmentation than wrinkles, so [dermatologists] should become familiar with hyperpigmentation disorders," said Dr. Wu.

Masseter hypertrophy is another common complaint among Asian patients, whether from bruxism, gum chewing, or diet. Dr. Wu said she has used onabotulinumtoxinA and abobotulinumtoxinA to slim down jawlines. "Ask the patients to clench teeth and palpate the muscle," said advised. She said she uses 12-32 units of onabotulinumtoxinA in 1 to 3 sites per side.

"Facial shaping has become synonymous with adding volume, whereas many of my patients want less volume, especially in their lower face," said Dr. Wu.

While there’s a growing body of literature and research coming from Asia, particularly Korea, there’s tremendous need for research in the United States, said Dr. Wu. "The number of Asian patients seeking cosmetic procedures is higher than their representation in the population, so dermatologists can provide better care for their patients if they become more educated about Asian skin and anatomy."

Dr. Wu is an investigator and consultant for Allergan, and a consultant for Johnson & Johnson and Unilever.

ORLANDO – Be conservative when injecting Asian patients with botulinum toxin type A, advised Dr. Jessica Wu.

She said she has seen her fair share of patients who come to her complaining about their botulinum toxin treatments. "Many Asian patients come to me saying that Botox or Dysport isn’t for them," Dr. Wu said in an interview. "They say their forehead feels heavy or they have trouble opening their eyes, and they can’t apply eye makeup properly." This, said Dr. Wu, is because of a lack of experience and knowledge in treating Asian patients.

As the U.S. population becomes more diverse, there’s a growing need for dermatologists to learn about differences in treating skin of color. The Asian population, for instance, was the fastest growing ethnic group in the United States between 2000 and 2010, according to 2010 data from the U.S. Census Bureau. And, Asian patients accounted for 6% of all cosmetic procedures in 2010, according to a 2010 report from the American Society of Plastic Surgeons.

Meanwhile, injectable fillers, botulinum toxin A, and chemical peels were the most-requested minimally invasive procedures among Asians, said Dr. Wu, assistant clinical professor of dermatology at the University of Southern California, Los Angeles.

"I think many of my colleagues would benefit from more education on treating Asian patients," said Dr. Wu. "We treat a diverse population. It’s something that’s not discussed enough."

Asian patients tend to have heavier eyelids, more melanin in their skin, thicker dermis, and more prominent collagen bundles. So their skin "generally requires less fillers when compared with Caucasian patients of the same age," said Dr. Wu. Fillers can also be used to enhance facial contours, including the nose and lips.

In addition, fine lines and wrinkles are less obvious in patients under age 50. Instead, hyperpigmentation is the earliest sign of aging in Asian skin. "Asian patients are more likely to seek help with pigmentation than wrinkles, so [dermatologists] should become familiar with hyperpigmentation disorders," said Dr. Wu.

Masseter hypertrophy is another common complaint among Asian patients, whether from bruxism, gum chewing, or diet. Dr. Wu said she has used onabotulinumtoxinA and abobotulinumtoxinA to slim down jawlines. "Ask the patients to clench teeth and palpate the muscle," said advised. She said she uses 12-32 units of onabotulinumtoxinA in 1 to 3 sites per side.

"Facial shaping has become synonymous with adding volume, whereas many of my patients want less volume, especially in their lower face," said Dr. Wu.

While there’s a growing body of literature and research coming from Asia, particularly Korea, there’s tremendous need for research in the United States, said Dr. Wu. "The number of Asian patients seeking cosmetic procedures is higher than their representation in the population, so dermatologists can provide better care for their patients if they become more educated about Asian skin and anatomy."

Dr. Wu is an investigator and consultant for Allergan, and a consultant for Johnson & Johnson and Unilever.

ORLANDO – Be conservative when injecting Asian patients with botulinum toxin type A, advised Dr. Jessica Wu.

She said she has seen her fair share of patients who come to her complaining about their botulinum toxin treatments. "Many Asian patients come to me saying that Botox or Dysport isn’t for them," Dr. Wu said in an interview. "They say their forehead feels heavy or they have trouble opening their eyes, and they can’t apply eye makeup properly." This, said Dr. Wu, is because of a lack of experience and knowledge in treating Asian patients.

As the U.S. population becomes more diverse, there’s a growing need for dermatologists to learn about differences in treating skin of color. The Asian population, for instance, was the fastest growing ethnic group in the United States between 2000 and 2010, according to 2010 data from the U.S. Census Bureau. And, Asian patients accounted for 6% of all cosmetic procedures in 2010, according to a 2010 report from the American Society of Plastic Surgeons.

Meanwhile, injectable fillers, botulinum toxin A, and chemical peels were the most-requested minimally invasive procedures among Asians, said Dr. Wu, assistant clinical professor of dermatology at the University of Southern California, Los Angeles.

"I think many of my colleagues would benefit from more education on treating Asian patients," said Dr. Wu. "We treat a diverse population. It’s something that’s not discussed enough."

Asian patients tend to have heavier eyelids, more melanin in their skin, thicker dermis, and more prominent collagen bundles. So their skin "generally requires less fillers when compared with Caucasian patients of the same age," said Dr. Wu. Fillers can also be used to enhance facial contours, including the nose and lips.

In addition, fine lines and wrinkles are less obvious in patients under age 50. Instead, hyperpigmentation is the earliest sign of aging in Asian skin. "Asian patients are more likely to seek help with pigmentation than wrinkles, so [dermatologists] should become familiar with hyperpigmentation disorders," said Dr. Wu.

Masseter hypertrophy is another common complaint among Asian patients, whether from bruxism, gum chewing, or diet. Dr. Wu said she has used onabotulinumtoxinA and abobotulinumtoxinA to slim down jawlines. "Ask the patients to clench teeth and palpate the muscle," said advised. She said she uses 12-32 units of onabotulinumtoxinA in 1 to 3 sites per side.

"Facial shaping has become synonymous with adding volume, whereas many of my patients want less volume, especially in their lower face," said Dr. Wu.

While there’s a growing body of literature and research coming from Asia, particularly Korea, there’s tremendous need for research in the United States, said Dr. Wu. "The number of Asian patients seeking cosmetic procedures is higher than their representation in the population, so dermatologists can provide better care for their patients if they become more educated about Asian skin and anatomy."

Dr. Wu is an investigator and consultant for Allergan, and a consultant for Johnson & Johnson and Unilever.