Dermal Fillers in Skin of Color: Safety Considerations, Cultural Perspectives, and Patient-Centered Approaches

BACKGROUND Patients with skin of color make up a growing share of aesthetic dermatology practice, yet evidence guiding filler treatment in this population remains limited. OBJECTIVE To review the evidence on dermal filler treatment in patients with skin of color, emphasizing safety, treatment planning, and patient-centered care. METHODS AND MATERIALS A narrative review of PubMed/MEDLINE was performed, focusing on filler safety and efficacy in Fitzpatrick skin types (FST) IV-VI, biologic characteristics of skin of color, and population-specific aesthetic considerations. RESULTS Hyaluronic acid fillers have the strongest evidence base in higher Fitzpatrick phototypes; biostimulatory fillers, particularly calcium hydroxylapatite, show favorable safety data, although evidence remains limited for poly- l -lactic acid. Key considerations include increased risk of postinflammatory hyperpigmentation, differences in recognizing vascular occlusion, and a theoretical, not clinically observed, predisposition to hypertrophic scarring and keloid formation. Treatment goals are often shaped by patient preferences regarding ethnic preservation and facial identity. CONCLUSION Dermal filler treatment in patients with skin of color can be performed safely and effectively when guided by an understanding of melanin-rich skin biology, population-specific aging patterns, and patient-defined aesthetic goals; additional studies in higher Fitzpatrick phototypes are needed.