Building Trust Through Cultural Competency in Aesthetic Dermatology

The field of aesthetic dermatology has witnessed exponential growth over the past decade, yet patients of color continue to face significant barriers to care—ranging from implicit bias to inadequate representation in clinical training. These challenges have a direct impact on treatment outcomes, patient satisfaction, and trust. Cultural competency is more than a buzzword; it is a clinical imperative.
The Trust Gap
Historically, Black and Brown communities have had fraught relationships with the medical system, including dermatology. Misdiagnoses, inadequate treatment plans, and poor communication continue to drive distrust.¹ When it comes to aesthetic care, that distrust is often magnified by societal beauty standards that rarely affirm melanin-rich skin.
In my own practice, I frequentlyencounter patients who are hesitant to seek aesthetic treatments due to prior negative experiences. Some share stories of being told their skin was "too difficult" to treat or that they should lower their expectations. Others express concern that providers are not trained to treat their skin type or cultural features appropriately.
Some patients have even disclosed that providers treated their skin knowing they lacked the training or understanding necessary to safely do so. In these cases, profit appears to be prioritized over patient safety. In my opinion, this is a dangerous attribute for any provider—to treat patients without the humility to admit when one lacks the appropriate expertise. It disregards the foundational principle of medicine: to do no harm. No matter how long we’ve been practicing or how experienced we are, we must remain open to learning. Growth, education, and curiosity are not optional—they are essential to delivering ethical and effective care.
For many African Americans, fear or skepticism about seeking dermatologic or even general care is deeply rooted. Some believe skin treatment is "not for us" or is only for white patients. When they do finally seek help and are mistreated, it reinforces their reluctance to return—not just for skin care, but for other health needs as well, including gynecology, prostate care, and primary health screenings. This delay often results in later diagnoses, more severe outcomes, and even avoidable deaths.² What begins as a bad experience in 1 area of care can lead to a ripple effect across all health access.³ We must do better—for African Americans, Asians, and all patients with ethnic skin tones who deserve inclusive, informed, and compassionate care.
Cultural Competency as Clinical Competence
For dermatology providers, developing cultural competency means:
- Understanding the diverse presentations of skin conditions in melanin-rich skin
- Acknowledging cultural beauty norms and how they shape patient goals
- Speaking with empathy and avoiding dismissive or reductive language
- Including skin of color in marketing and educational materials
This also involves self-awareness: recognizing what you don’t know and being open to learning. Providers must actively seek out continuing education, case studies, and mentorship that include patients of color.⁴
Case Vignette
A woman in her early 40s visited my clinic after a poor experience with a laser treatment at another facility. She had Fitzpatrick V skin and had been treated without proper settings or guidance. Not only did she experience post-inflammatory hyperpigmentation, but she also left feeling emotionally dismissed. During our consultation, I listened without judgment, validated her concerns, and explained why certain lasers can cause harm to darker skin. We developed a step-by-step plan to safely restore her skin tone while also rebuilding her confidence.
Practical Strategies for Providers
- Diversify your reference images: Ensure that before-and-after photos reflect a spectrum of skin tones
- Ask open-ended questions: “What does beauty mean to you?” can reveal deeply personal preferences
- Avoid assumptions: Do not assume every patient wants lighter skin, smaller features, or Westernized results
- Educate staff: Front desk and support staff should be trained on inclusive communication
Conclusion
Cultural competency is not optional—it’s foundational to safe and ethical care. As aesthetic medicine evolves, so must our ability to meet patients where they are, honor their lived experiences, and create a space where they feel seen, heard, and valued. For patients of color, building trust may take more time, but it is the key to lasting therapeutic relationships and optimal outcomes.
Natasha L. Copelin, DNP, AGNP, RN-BC, ST, is the founder of Vibrant Rejuvenation in North Babylon, New York. She specializes in aesthetic treatments for diverse populations and is passionate about closing the trust gap in dermatologic care through culturally informed clinical practice.

References

1. Alexis AF, Sergay AB, Taylor SC. Common dermatologic disorders in skin of color: a comparative practice survey. Cutis. 2007;80(5):387-394.
2. Grimes PE. Management of hyperpigmentation in darker racial ethnic groups. Semin Cutan Med Surg. 2009;28(2):77-85. doi:10.1016/j.sder.2009.04.001
3. Halder RM, Nandedkar MA, Neal KW. Pigmentary disorders in ethnic skin. Dermatol Clin. 2003;21(4):617-vii. doi:10.1016/s0733-8635(03)00083-4
4. Lawrence E, Syed HA, Al Aboud KM. Postinflammatory Hyperpigmentation. [Updated 2024 Nov 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559150/.