Mirrors and windows
Expanded diversity in cosmetic dermatology patient population requires fresh perspectives and personalized care.
From a young age, we all learn lessons and values that eventually form the doctrines by which we conduct our personal and professional lives. At times, these evolve or need to be updated. Rohit Kakar, MD, FAAD, a cosmetic dermatologist in Bloomfield Hills, Michigan, said now is one of those times. Dr. Kakar directed the Pearls: Cosmetic Dermatology session at the 2026 AAD Innovation Academy and spoke about his real-world, clinical experience with filler treatments.
According to the U.S. Census Bureau, half of the country’s population will be of nonwhite descent by 2044. From 2010–2023, the American Society of Plastic Surgeons reported a significant increase in procedures on patients of diverse racial and ethnic backgrounds. The average number of white patients decreased from 83% to 66.5%, while nonwhite patients nearly doubled from 17% to 33.5%.
These numbers may not completely correlate within the field of cosmetic dermatology, Dr. Kakar said, but it should make doctors rethink how they care for their own patients who may or may not look like them.
Rohit Kakar, MD, FAAD
- Ethnicity
- Facial structure
- Skin type
- Pigmentation
- Aging pattern
It’s also critical to fully understand a patient’s cultural preferences, beauty ideals, and desired outcomes, he said, as these vary widely and should not be presumed based on one’s own outlook. Dynamics like race, status, socioeconomics, and — more recently — social media can shape patients’ dermatologic objectives.
“Population-level differences among different ethnicities can help guide our assessment, but it is important to always be aware that there is tremendous variation within every racial and ethnic group,” Dr. Kakar said. “Ultimately, treatment should be based on the individual patient’s anatomy, skin type, aging pattern, and aesthetic goal.”
Dr. Kakar said he has seen a shift toward more young patients seeking fillers. While chronological age is a key consideration, so is one’s biological age. People of certain ethnicities or ancestries tend to have skin that doesn’t age at the same rate. They may also be more or less susceptible to wrinkles, elasticity, pigmentation, or ultraviolet radiation.
For example, he said, Black patients experience aging more in the upper half of their face and aren’t as predisposed to photoaging as white patients. Hispanic and Asian patients tend to have thick, heavy skin, hooded eyes, and fuller malar fat pads.
These all must be taken into account when deciding whether to perform a given treatment as well as achieve efficacy while ensuring safety, said Dr. Kakar.
“I recommend starting with identifying what you are actually trying to correct, whether it is volume loss, skeletal support, soft-tissue descent, dynamic lines, pigmentation, or skin laxity,” he said. “Then tailor the treatment and technique with consideration of the patient’s anatomy, ethnic/cultural background, and desired outcome while keeping safety paramount in your mind.”
Post-inflammatory hyperpigmentation is another important consideration, and one that can be mitigated, he said. Tips to avoid this outcome include:
- Evaluating the area under multiple lighting conditions
- Using a cannula or smaller-gauge needle
- Treating multiple areas with one entry point
- Applying slowly to achieve retrograde linear threading, fanning, and/or subtle contouring
These principles can help avoid overcorrection or undertreatment and ideally accomplish the patient’s cosmetic goals, said Dr. Kakar.
“As dermatologists, we need windows into perspectives and ideals of beauty that may differ from our own. My goal is never to impose a standard of beauty, but to understand and preserve what makes each patient uniquely themselves while keeping their ethnicity, culture, and aesthetic goals in mind.”