It’s time to inject dermatology into the conversation

The field of gender diversity in medicine is a rapidly growing one as more patients seek gender-affirming or transitional care. For dermatologists, helping to guide and sculpt those changes with injectables and other methods is an increasingly popular field of exploration.

Ronda Farah, MD, FAAD, associate professor of dermatology at University of Minnesota Health in Minneapolis, said gender care in dermatology could begin with something as simple as hair removal, but the possibilities don’t end there.

Ronda Farah, MD, FAAD“Typically, patients will see a dermatologist for hair removal when they are in the transitioning process; it improves the quality of life in this patient population,” she said. “However, once you begin, you find that they may also be undergoing a facial, top, or bottom transition, possibly with surgery or injectables.” 

Hit me with your best shot

Dr. Farah said it is critical that dermatologists work closely with the patient and listen to their needs and the goals they are trying to achieve. This is especially important when it comes to the timing of injectables if there is a surgical procedure involved.

“Having a discussion with a dermatologist on how to achieve what the patient is looking for is very important because it can be wrapped into their dermatologic care,” she said. “It’s important to time the injectables with the surgeon, because often they can be done after the surgery. A lot of times they won’t even have surgery, and you can offer the injectables right away.” 

As for what those injectables might be, Dr. Farah said she primarily uses hyaluronic acid fillers. But patients who have been having fillers for a while might prefer poly-L-lactic acid. She said toxins — such as Botox — can be good for sculpting and leveling brows if the patient wants it to look a little heavier.

Male-to-female gender affirmation injectable example.“These injectables can be useful if a patient is looking to feminize the cheeks or they can be used along the jawline to masculinize the cheeks,” she said. “Some patients may choose to keep certain parts of their face in some cases and only alter one part of their face, so it’s important to ask what they are looking for.”

Whatever the procedure, it is critical for dermatologists to listen to their gender-Female-to-male gender affirmation injectable example.diverse patients and pay close attention to their goals and what they hope to achieve.

“Not all patients in the gender-diverse population identify as transgender so they may not be moving forward with top, bottom, or facial surgery,” Dr. Farah explained. “Do not assume a patient’s gender or what they are hoping to achieve. Always engage the patient and ask them what they are looking for and what their timeline is — and coordinate with their surgeons.”

Transitioning toward the future

The area of gender-diverse care is a growing one, and Dr. Farah said patients will seek out dermatologists who are educated in it and can help them achieve their goals. One of the bigger growth areas in the coming years will be in body sculpting and lasers as a potential alternative or augment to surgery.

“Many patients are undergoing top and bottom surgery to achieve a gender transition, and I think some surgery may be avoidable with body sculpting, or body sculpting could complement those procedures,” she said. “Even with lasers we see that the scars forming in these areas (from surgery) can be really difficult to manage so laser devices are another area where we can take our general dermatology knowledge and apply it to treat those scars and help those patients.”

For those treatments, Dr. Farah said she might use a pulsed dye or CO₂ laser to target stubborn scars.

“For discoloration of the scars, I will often apply my knowledge of melasma and other skin coloration disorders,” she added.

Whatever the treatment, the most important lesson for dermatologists is to be open and available to this population as the demand for dermatologic treatments continues to grow.

“The bottom line is these patients are so happy to have dermatologists engage in their care,” Dr. Farah said. “And dermatologists should continue to lead this field and encourage enhanced technology and support our institutions to help our patients achieve their medical care.”