Received: 25 July 2023 | Accepted: 22 September 2023

DOI: 10.1111/jocd.16023

C L I N I C A L C O M M E N TA R Y

Cross-cultural perspectives on patient expectations in cosmetic

dermatology: A comparative analysis across countries and
ethnicities

Diala Haykal MD1 | Patrick Treacy MD2 | Tingsong Lim MD3 | Victor Gabriel Clatici MD4 |
Nabil Fakih-Gomez MD5 | Hector Leal-Silva MD, PhD6 | Dominique du Crest MBE7 |
Hugues Cartier MD8

1
Centre Laser Palaiseau, Palaiseau, France
2
Ailesbury Clinics Ltd, Dublin, Ireland
Abstract
3
Clique Clinic, Kuala Lumpur, Malaysia Patient expectations in cosmetic dermatology exhibit significant variations across
4
Sanador Floreasca, Bucharest, Romania countries, cultures, and ethnicities, thereby reflecting individual desires, concerns,
5
Facial Plastic & Reconstructive Surgery at and goals. While some individuals seek aesthetic enhancements, others prioritize ad-
Fakih Hospital, Saksakiyah, Lebanon
6 dressing specific skin conditions within the context of beauty norms in their respective
iDerma, University of Monterrey,
Monterrey, Mexico countries. The provision of personalized and culturally sensitive care plays a crucial
7
SkinAid SAS, Paris, France role in meeting these diverse expectations. Skin characteristics and concerns differ
8
Centre Médical Saint Jean, Arras, France among ethnicities, influencing treatment preferences. For instance, individuals with
Correspondence darker skin tones may prioritize the treatment of pigmentation disorders, whereas
Diala Haykal, Centre Laser Palaiseau, 49 those with lighter skin tones may focus on achieving a fair complexion. Furthermore,
Ter Rue de Paris, 91120 Palaiseau, Paris,
France. differences in facial anatomy among various ethnicities necessitate tailored treatment
Email: docteur.haykal@gmail.com approaches. This commentary aims to contribute to the effective understanding and
management of patient expectations, ultimately leading to satisfactory outcomes.
Additional research and regional studies are required to further deepen our under-
standing of patient expectations in cosmetic dermatology and enable the delivery of
improved and culturally appropriate care on a global scale.

KEYWORDS
cosmetic dermatology, cultures, ethnicities, expectation, patient

Understanding how patient expectations in cosmetic dermatology
can vary across countries, cultures, and ethnicities is an import-
ant aspect of providing culturally sensitive and personalized care.
Cosmetic dermatological treatments are sought for either aesthetic
enhancements or addressing specific skin conditions. Rather than
adopting a one-size-fits-all approach, practitioners should con-
sider each patient's specific needs, taking into account their ethnic
background, skin type, and cultural preferences in order to achieve
optimal outcomes. This personalized approach ensures that the
treatment plan is tailored to enhance the patient's natural features
while addressing their unique concerns. Ethnic and cultural differ-
ences among respondents in different geographical locations most
likely influence the degree of overlap between aesthetically con-
scious respondents and physician responses.1,2

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium,
provided the original work is properly cited.
© 2023 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.

J Cosmet Dermatol. 2023;00:1–4. wileyonlinelibrary.com/journal/jocd | 1


2 |
Patients often seek subtle and natural-looking results, aiming to
enhance their features without invasive procedures. They expect
cosmetic treatments to improve their self-esteem and confidence
by addressing specific concerns such as wrinkles, acne scars, hy-
perpigmentation, or uneven skin texture. Long-lasting results are
desired, reducing the need for frequent maintenance or touch-up
procedures. Patients also prioritize minimal downtime and a low
risk of adverse effects, enabling them to resume their daily routines
quickly and without complications.3–5 The rise of globalization has
led to an increased occurrence of cosmetic surgical interventions,
where the diverse ethnic backgrounds of surgeons and patients are
interfacing on the operation table.6 Similarly, research suggests that
favorable aesthetic features in beauty are predominantly influenced
by subjective editorial decisions rather than objective principles,
highlighting the emphasis on North American and European stan-
dards of beauty.7 Alongside, the proliferation of social media and
media exposure has become a significant factor in disseminating
8
Western beauty standards and exerting influence. Notably, several
studies have focused on the impact of social media on patients' ex-
pectations, revealing a connection between social media or general
media and attitudes toward cosmetic surgery. In fact, multivariable
models among different populations have demonstrated that social
media platforms, including Twitter, exhibit a positive correlation be-
tween following celebrities and an increased acceptance of cosmetic
surgery.9
Skin tone, pigmentation, and susceptibility to certain con-
ditions differ among ethnicities. For instance, individuals with
Fitzpatrick skin types IV to VI may have concerns related to hy-
perpigmentation, keloid scarring, or pseudo-folliculitis barbae.
Some cultures prioritize fair skin, while others focus on address-
ing pigmentation disorders. Facial anatomy also varies, affecting
treatment approaches. Dermatologists must consider these vari-
ations when performing cosmetic procedures. Some ethnicities
value facial symmetry and seek treatments to enhance balance.
Understanding these factors is crucial for providing personalized
care in cosmetic dermatology and effectively meeting patients'
expectations.
Treating Asian patients in aesthetic procedures requires careful
considerations to achieve optimal results while respecting cultural
differences and individual preferences. Understanding the unique
characteristics of Asian skin, such as thicker dermis, higher sebo-
cytes activities, and increased melanin content, therefore more
susceptibility to post-inflammatory hyperpigmentation, is crucial
for selecting appropriate treatments and products. To address the
unique facial anatomy of Asian individuals, it is crucial to recognize
features including higher cheekbones, stronger malar protrusions,
10,11
flatter nasal bridges, prognathism, and lower eyelid creases.
Some Asian patients have monolids—lacking creases below the
eyebrows—so they seek aesthetic treatments to create a wider and
more visible eye appearance. In the past, for most Asian traditions,
having rounder cheeks and a fuller forehead was considered beau-
tiful. However, recent influence from the west has driven some
Asians toward preferring a more western look, with higher nose
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HAYKAL et al.
bridge, sharper cheekbones and a “V” shape in the front profile.12
According to Fabi et al., the most common aesthetic concerns among
Asian patients encompass skin unevenness, sebaceous activity, en-
larged pores, lower facial contouring, loss of elasticity, skin laxity,
and jowling.13
In the Middle East, it is crucial to take into account the diverse
range of skin types, which can vary from fair to darker tones. These
skin tones present specific challenges, such as an increased risk of
post-inflammatory hyperpigmentation and melasma, which influ-
ence the selection of appropriate treatments. Striking eyes, defined
cheeks, and full lips are valued features in Middle Eastern beauty.
Rounder faces with fuller cheeks are preferred when wearing a full
hijab, as it enhances the attractiveness of the overall look.14 Cul-
tural factors also play a significant role in Middle Eastern aesthet-
ics. Certain features, like a well-defined nose, voluminous hair, and
prominent cheekbones, are highly valued and desired. For example,
patients from the United Arab Emirates often seek cosmetic derma-
tology treatments to address skin concerns resulting from sun dam-
age, hyperpigmentation, and melasma due to the intense sunlight
exposure in the region. Consequently, there is a high demand for
skin-lightening treatments, laser therapies, and facial rejuvenation
procedures (Table 1).15
In American countries, such as the United States, due to cultural
diversity, aesthetic perceptions can vary significantly among differ-
ent ethnic and cultural groups (Latino or Hispanic, African American,
and Asian American patients). American patients are often influ-
enced by societal beauty standards that are shaped by media, fash-
ion, and popular culture. They often value the expression of their
individuality through aesthetic treatments. They seek treatments
that help them feel more confident and reflect their unique person-
ality. Apart from this, American patients are interested in treatments
that promote skin health, such as skincare routines, facial rejuvena-
tion procedures, and non-invasive cosmetic treatments. According
to a recent study, aesthetic issues tied to skin quality were acknowl-
edged as a primary concern for Americans. More particularly,
patients from all ethnic origins in North America pointed out sub-
mental fullness or loss of jawline definition as an aesthetic concern
as well. Moreover, Hispanic and Latino patients in the United States
and Latin America were greatly interested in procedures that would
make them look less tired, more than half identifying dark circles
under the eyes as an aesthetic concern.16,17 Skin tone and pigmenta-
tion are significant considerations in cosmetic dermatology for Latin
patients. Latino individuals have a higher predisposition to develop
hyperpigmentation, including conditions like melasma. These con-
cerns lead them to seek treatments that address hyperpigmentation
and help even out their skin tone.18
In Europe, expectations regarding aesthetic treatments vary due
to the diverse cultural landscape across the continent and the migra-
tory background of Europe. European patients prioritize maintaining
a healthy and youthful appearance for their age, seeking subtle en-
hancements that yield natural-looking results. The mature European
patients, rather than pursuing drastic changes, value treatments
that enhance their existing features while preserving their individual

HAYKAL et al.
TA B L E 1 Summary of aesthetic
Feature
preferences of Middle Eastern patients.15
Skin
Face shape
Forehead/brow
Eyes
Midface
Lower face
Neck
identity. Achieving facial harmony, symmetry, and proportionality
within a holistic approach is important to European patients. Skin
health and texture quality are also significant priorities, with a focus
on maintaining a youthful and radiant complexion by addressing
issues such as fine lines, wrinkles, and pigmentation irregularities.
Cultural influences and regional beauty standards further shape
the expectations of European patients, with different countries
emphasizing specific beauty ideals and treatments tailored to their
preferences. For instance, Mediterranean countries may prioritize
a sun-kissed complexion and treatments that enhance their natural
tan or address sun damage. Overall, European patients seek aes-
thetic treatments that deliver natural-looking results, promote facial
harmony, preserve their unique features, and align with cultural in-
fluences and regional beauty standards.19
In African countries, patients prioritize treatments that support
the health and radiance of their melanin-rich skin. They have spe-
cific concerns related to hyperpigmentation, uneven skin tone, and
skin conditions associated with their ethnicity. Their aesthetic ex-
pectations revolve around achieving an even complexion, reducing
blemishes, and enhancing the natural glow of their skin. According
to Fabi's study, uneven skin tone and dark circles under the eyes
were the primary facial aesthetic concerns among African American
women. Skin pigmentation emerged as their top concern. Addition-
ally, African patients value facial harmony and proportionality. They
seek treatments that address specific features like a well-defined
jawline, balanced cheekbones, or a more pronounced nasal bridge.
The unique skeletal morphology of African individuals, coupled with
variations in skin thickness, results in a distinct aging pattern. Re-
garding skeletal morphology, the vertical proportions of African pa-
tients are similar to other patients, but the horizontal proportions
are relatively larger. Textured hair is another notable characteristic
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| 3
Preference
• Clear complexion, fair skin, smooth texture, no hypo/
hyperpigmentation, no visible pores, no fine wrinkles
• Wears a hijab
• Generally, a full, oval-shaped face, but there is a high degree of
variability
• Preferred face shape can be affected by whether the patient
• Upper third of the face conforms to proportions of facial thirds
• Foreheads are convex or flat
• Temples are full
• Thick, arched, elevated eyebrows
• Convex or straight profile (dependent on region)
• Large and almond-shaped
• Short, straight, slightly up-tilted nose tip and a narrow alar base
• Cheek preferences vary (e.g., prominent cheeks with submalar
fullness, more prominent cheeks, a slender shape, and submalar
hollowness)
• Defined jawline with no jowling
• Oval jawline in women; square and defined jaw in men
• Full, defined lips with more eversion in the upper lip
• Chin is pointed and anteriorly projected no further than the lower lip
• Slender, long, and smooth with no submental sagging or fat
among Africans. Many individuals seek treatments that celebrate
and enhance their natural hair texture. These may include hair care
procedures, styling techniques, or even hair restoration treatments
tailored to their specific needs. Patients express a desire for treat-
ments that promote hair health, manageability, and the preservation
of their natural hair patterns. 20
In conclusion, addressing patient expectations in cosmetic der-
matology requires practitioners to possess a comprehensive under-
standing of the unique needs and desires of each ethnic group. By
offering culturally appropriate care, dermatologists can enhance pa-
tient satisfaction and achieve optimal outcomes. However, it is im-
portant to acknowledge that these observations are generalizations,
and individual patient expectations can still vary significantly within
each country, culture, and ethnicity. The present study has examined
patients' concerns and goals across different regions, including Asia,
the Middle East, Europe, Africa, and the Americas. Research has
demonstrated a direct correlation between common ethnic anatom-
ical features and the cosmetic dermatological treatment preferences
of patients, thereby impacting the customization of aesthetic der-
matological treatments for optimal results. Consequently, a patient's
ethnic background plays a vital role in delivering effective treatment
and should be considered by physicians. Moreover, in the era of so-
cial media, the globalization of beauty standards has a major impact
on shaping these preferences. Social media platforms have prolifer-
ated the culture of beauty through trends and ideals across different
ethnicities and geographical locations. However, there is a limited
amount of literature available that describes beauty standards
worldwide. Therefore, further research and localized investigations
are crucial to deepen our understanding of patient expectations in
cosmetic dermatology and to provide culturally appropriate care on
a global scale.

4 |
AU T H O R C O N T R I B U T I O N S
DH had the concept for the review article and performed the litera-
ture search, with assistance from PT, TL, VC, NFG, HLS, DC, and HC.
All authors read and approved the final manuscript.
C O N FL I C T O F I N T E R E S T S TAT E M E N T
The authors declare no conflicts of interest.
DATA AVA I L A B I L I T Y S TAT E M E N T
The data that support the findings of this study are available on ref-
erences' part.
E T H I C S S TAT E M E N T
Authors declare human ethics approval was not needed for this
study.
ORCID
Diala Haykal https://orcid.org/0000-0001-7528-5088
Nabil Fakih-Gomez https://orcid.org/0000-0003-4464-8258
Dominique du Crest https://orcid.org/0000-0002-2496-3018
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How to cite this article: Haykal D, Treacy P, Lim T, et al.
Cross-cultural perspectives on patient expectations in
cosmetic dermatology: A comparative analysis across
countries and ethnicities. J Cosmet Dermatol. 2023;00:1-4.
doi:10.1111/jocd.16023