Restylane and People of Color

By Millicent Odunze, M.D., MPH, Alvin Cohn, M.D. & Julius W. Few, M.D.
Published in Plast Reconstr Surg 2007, 120;7:2011–2016

With the increase in both the population of people of color in the United States and the number of cosmetic procedures, specifically, nonsurgical procedures performed in the United States, this article examined whether Fitzpatrick skin types IV to VI have an increased incidence of adverse outcomes associated with the use of Restylane (Q-Med Aesthetics, Stockholm, Sweden).

Restylane is a cross-linked hyaluronic acid used as a soft-tissue filler for the face. With people of color, their primary concern when having cosmetic procedures performed is risk of injury to the skin. Any trauma to the skin, however minor, can cause postinflammatory hyperpigmentation in darker skinned individuals. Adverse events like hyperpigmentation, hypersensitivity, keloid formation and hypertrophic scarring are common concerns for patients with darker skin. This article explores whether Fitzpatrick skin types IV to VI can experience the same benefits of Restylane therapy without concern for postinflammatory hyperpigmentation and other adverse events for people of color.

Patients and Methods

The 60 participants were all treated by a single surgeon and received a follow-up at least 6 months after the initial Restylane treatment. Each procedure began with a patient review and consent form for the treatment with full facial photographs. A cold compress was applied for 5 minutes to the treatment area. This step was followed by the application of a triple anesthetic cream. The treatment area was cleaned once the anesthetic took effect. The surgeon treated the patient with Restylane while having the patient fully upright and placing the Restylane deep into the dermal-epidermal junction, into the mid dermis. The primary goal of injection was to minimize the number of skin puncture sites. Each injected treatment area was then massaged to smooth the Restylane injectable and patients were then assessed in an upright position.

Results

The Fitzpatrick types I to III patients showed no permanent adverse outcomes related to the Restylane injection in 100% of the participants. Similarly, in the Fitzpatrick types IV to VI, there were no transient or permanent adverse outcomes related to the Restylane injection in 100% of the participants.

Discussion

When using the correct injection technique, the study authors found that the choice of tissue depth will have an effect on the quality of the treatment and the duration of the effect. They believe that delivery deep to the dermal-epidermal junction, specifically mid-dermal deliver, will decrease the risk of dermal-epidermal separation and thus decrease the risk of local inflammation and hyperpigmentation. The study authors also found that the use of cold compresses before and after injection and massage are helpful to their technique.

Conclusion

The use of Restylane in people of color has at least the same efficacy and with proper and meticulous injection techniques, Fitzpatrick skin types IV to VI can experience the same benefits of Restylane as Fitzpatrick skin types I to III.

Reprint requests to: Julius W. Few, Jr., M.D., Division of Plastic Surgery, Feinberg School of Medicine, Northwestern University, 675 North Saint Clair, Suite 19-250, Chicago, Il 60611.