Why Diversity is Important in Medical Aesthetics—and How to Make a Difference

Twenty or thirty years ago, people had an image in their head of who the typical medical aesthetic patient was; similarly, they had an image of who that patient’s provider was. Over time, as medical aesthetic procedures have grown in popularity, both the patient base and the providers who treat them have continued to evolve. There is more diversity across the board—in gender, ethnicity, age, and race. However, there is a lot of work that still needs to be done, and your journey into Medical Aesthetics can be part of the solution.

Although Black people comprise some 13 percent of the U.S. population, only 4 percent of physicians and less than 7 percent of recent medical school graduates are Black, according to the Association of American Medical Colleges. This underrepresentation—which affects all aspects of medicine, from medical training and courses to clinical practice to pharmaceutical research and development—means people of color often distrust the medical establishment because they do not feel heard or understood.

Improving diversity in aesthetics will not only help address these disparities in this specialty, but it may help you to potentially provide better service to patients. “The whole idea of being a doctor is to help people—all people. Not just some people,” says Dr. Camille Cash, a double board-certified plastic surgeon with a private practice in Houston. “The diversity of this nation is changing,” she adds, “so we all should educate ourselves on how to treat all people, not just some of them.”

Here’s what you need to know about why diverse representation matters, the steps the industry still needs to take to move the equity needle for people of all races and ethnicities, and how you can make a difference.

1. Patients want to feel seen and heard.

It’s not surprising that people prefer providers who “get” them. Patients tell Dr. Cash that they have traveled far to see her, the first Black female board-certified plastic surgeon in Texas, saying, “I feel more comfortable talking to you. I feel like you hear me; you listen to me.”

When patients are more comfortable with their doctor, they tend to get better care. “Studies have shown time and time again, especially for the African American population, that we do better when our doctors share our background,” Dr. Cash adds. “Culturally, there are similarities—the comfort level is different. And I think it makes me, as an individual, more open to diversity across the board.”

Dr. Corey Hartman, a dermatologist in private practice in Homewood, Alabama, stresses the importance of providers speaking their patients’ language, or what he calls having cultural compassion. “A lot of things that are unique to the Black experience are cultural, and they're tied to the particular needs of our hair, skin, etc,” he explains. “I don't think only Black people can deliver services effectively to Black people, but there are definitely a few key things you can pick up on in a conversation that let you know whether or not someone has the cultural competency to meet your needs.”

2. Aesthetic Medicine needs more diverse perspectives.

Promoting diversity means honoring the fact that there is not one standard for how everyone should look. People have unique features, skin textures, body compositions, and all of that should be celebrated, not changed.

Simone Hopes, a Physician Assistant in Houston, Texas, travels around the world—immersing herself in a country’s culture and artistry—to further broaden her understanding of the unique aesthetic each culture brings to the global table. She has brought what she learned traveling the world into her work as a traveling aesthetic provider—she books appointments in private homes—to lift the perceived pressures that some people might feel when they enter a typical med spa or practice. “It’s their environment, they're free,” she says. “They can tell me their aesthetic goals without feeling pressure to look like somebody else.”

Dr. Hartman tries to dismantle rigid notions of how people think they should look by helping patients highlight what they like—and make those features shine through, instead of hiding them or changing them. “My vision for aesthetics is a world where our unique features are celebrated and complimented,” he says. “We don't want to turn everybody into the exact same thing.”

3. Diversity should be covered in every aesthetics curriculum.

All providers—not just those of color—should have expertise in the care of skin of diverse patients. And although academic institutions are making progress, the training and courses are not where they need to be.

After matching with the University of Alabama School of Medicine for his residency, Dr. Hartman went from the richly diverse community of Meharry Medical School, an HBCU (Historically Black College and University), to one that was fairly uniformly white. And although the faculty was “fantastic,” he says, “they couldn’t get me what I needed with respect to treating skin of color.” Dr. Hartman advocated for himself and was allowed to travel to work with some “giants in the space.” “And that's really where I started to be able to focus on how to craft these aesthetics procedures and think about these things in terms that were different from the traditional education and residency,” he says.

Although there’s more diversity now among both students and faculty at many medical schools, the textbooks haven’t caught up. “There’s a reckoning going on right now and we're evaluating how we do this,” Dr. Hartman says. He was just asked by the American Board of Dermatology to submit clinical images for the examination, so that moving forward there will be diverse imagery in the exams to help bring new perspectives to doctors who are becoming board-certified. “There are going to be a lot of changes to help educate new residents moving forward, because the Board did a survey last year of the graduates from dermatology residency, and they’re still saying they don't feel adequately trained to go out and treat a diverse population of patients, which is very sad in 2021,” he says. Ultimately, Dr. Hartman adds, “unless you specifically carve out ways of enhancing the curricula, like I was able to do, you're going to come out at a disadvantage, even though you went through a great program.”

Hopes’ training didn’t come close to addressing the full palette of skin tones in the U.S. population today. Like Dr. Hartman, she started her Physician Assistant (PA) program at an HBCU (Historically Black College and University), the University of Maryland Eastern. There, she had people of color as preceptors and instructors. At the second program she attended, a different school, there were no teachers of color. And out of 40 students, there were only seven minorities, mirroring the fact that minorities make up only 4% of PAs nationwide.

4. All providers should seek out resources on diversity.

Until diversity becomes a standard part of every aesthetics curriculum, Dr. Hartman recommends that providers, if eligible, join societies that raise awareness of and support research on dermatologic health issues related to skin of color. For example, Dr. Hartman serves on the board of a professional organization dedicated to this matter. These societies hold educational opportunities throughout the year, including networking events and symposia, which bring together lecturers on issues that impact racial and ethnic groups. Plus, representatives of major companies that make laser devices that tend to be safer for darker skin tones often frequent these events.

It was on the website of one of these societies that Hopes found books on how to treat skin and hair in people of color.“ For people with fair skin, their main focus is wrinkles and rosacea, things that lasers can help with,” she explains. “But when you’re darker, the lasers can’t pick up the pigment from the hair shaft, and so many things like that aren’t studied or aren’t publicized.”

5. Reaching out to BIPOC in marketing materials.

Often, the way aesthetic procedures are marketed doesn’t reflect the needs and desires of people of color, which besides leaving people seemingly without options, also leaves a lot of potential patients wanting treatment but not knowing it is an option specifically for them.

Of course people look in the mirror and see something that they don't like. But if you don’t see ads for products or procedures that provide a treatment option, then you're just going to assume that there are no options for that problem. And you won't seek treatment. “And then it becomes a self-fulfilling prophecy,” Dr. Hartman explains. “Because when you only see a certain kind of person in advertising—whether that is a lack of diversity in ethnicity, age, gender, etc, you assume that the products being sold are only intended to treat the issues those people have. So you have to speak to more people, and then you’ll realize that there's a whole lot more people to treat—a whole lot more.”

6. There needs to be more diverse participation in clinical trials.

Racial and ethnic minorities have also been chronically underrepresented in clinical trials, which leads to lack of evidence for racial diversity for products that get approved for use on their skin.

Part of the problem is a hesitance to participate. “There's a lot of mistrust among Black people, people of color, indigenous people, people who have not necessarily always been treated well by the medical establishment,” Dr. Hartman explains. There are historical examples of abuse—like the Tuskegee experiments (a U.S. Public Health study from 1932 to 1972 that examined the effects of untreated syphilis in Black men in Macon County, Alabama)—but modern ones, too. “Even famous Black female athletes have spoken about how their pain is not taken seriously because there's a myth that Black women endure more pain,” Dr. Hartman says. “It's crazy to even say it out loud, because it sounds so ridiculous, but there are misconceptions that have been passed down, even among highly intelligent people in medicine, that get in the way of effectively delivering medical care to all people, creating health disparities.”

That’s one of many good reasons to recruit more Black and other minority doctors to run clinical trials—so patients will be more likely to trust them. “They’ll have at least a willingness to listen to what we say because there's not going to be an automatic assumption that they'll be taken advantage of, mistreated, or undervalued,” Dr. Hartman says.

7. We need to cultivate community over competition.

“Nobody does it on their own,” says Dr. Hartman. He’s an especially strong advocate of community, having grown up in a mostly Black enclave in suburban New Orleans where people supported one another and genuinely wanted to see each other succeed.

Dr. Hartman has since cultivated a sense of community everywhere he’s been—in the nurturing environment of the HBCU Meharry Medical College and in the network he’s built with local dermatology business owners who rely on each other and even mentor each other. “There are going to be little things that come up where you want to have a community of people around,” he says. “I don't know many successful people who can unabashedly say that they never had anybody help them.”

Hopes has also benefited from the community and sings its praises. “I think that's what we need as an aesthetic field, in medicine in general, and overall, to help us progress,” she says. She and another woman of color she met at a conference started a group of about 25 Black injectors from all over the country. Members bounce ideas off one another and ask about policies and procedures. They make sure to like each other's posts on social media and just generally try to help each other out. Hope believes that fostering a strong sense of community and inclusion can potentially help move the equity needle for people of all races and ethnicities.

There are many paths you can take in your career that will help develop and encourage diversity, equity and inclusion in all aspects of medical aesthetics. When you are met with roadblocks make your own opportunities by looking for mentors or building your own community of like-minded providers, join societies or seek out specialized curriculums that answer your questions or point you in a new direction, and speak to manufacturers and ask to be part of clinical trials or on advisory boards so that your voice can be heard. Change does not happen overnight, but you have the power to be part of the change we all want to see in this industry.

Learn more about Plastic Surgeon Dr. Camille Cash, Dermatologist Dr. Corey Hartman, and Physician Assistant Simone Hopes.