Aesthetic Procedure Considerations for Skin of Color

Performing aesthetic procedures on individuals with skin of color, specifically those falling under Fitzpatrick skin types IV to VI, requires special considerations due to their propensity for hyperpigmentation reactions, as opposed to the erythema more commonly observed in individuals with lighter skin tones. During her presentation at the 2023 Fall Clinical Dermatology Conference, Cheryl Burgess, MD, FAAD, founder and president of the Center for Dermatology and Dermatologic Surgery in Washington, DC, discussed best practices to utilize laser treatments safely in patients with skin of color.¹

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“Sometimes we recommend a little skin test or a little test spot in order to determine how a person is going to respond,” Burgess said in an interview with Dermatology Times. “But you never know what pigment people have or what ancestry people have unless you ask them [during your intake process].”

Postinflammatory Concerns

“You find that in skin of color postinflammatory hyperpigmentation is one of the biggest concerns whether it’s innate, as with acne, or it’s the result of a procedure that’s done being done to the skin. Or sometimes we see laser issues where there’s hyperpigmentation, even though the hair may be removed or you’re trying to lighten pigment,” Burgess explained.

Regardless of their geographic location or ethnic background, postinflammatory hyperpigmentation remains a paramount concern for patients with skin of color. This concern manifests in various forms, such as in acne cases, or from an adverse event after aesthetic procedures such as laser treatments or hair removal. Clinicians need to recognize and address this issue proactively.

Cosmetic Concerns

“If someone comes in to see you for an aesthetic procedure, it’snot uncommon that evening their complexion is one of the concerns that they have,” Burgess said. Patients seeking aesthetic procedures often present unique concerns depending on their skin type. In skin of color, the emphasis shifts toward addressing issues related to complexion uniformity, rather than fine lines and wrinkles commonly seen in individuals with lighter skin tones. Clinicians should be mindful of this distinction, adapting their approach to cater to the specific needs of their patients.

Stimulatory Fillers

In patients with skin of color, sinking and sagging tend to be more prevalent than fine lines and wrinkles. “We see cosmetic procedures with botulinum toxins and fillers, [and] you see more of a sinking and sagging versus a lot of fine lines and wrinkles in skin of color,” Burgess said. “Therefore, the stimulatory fillers are more beneficial to patients and that skin type because they have kind of a reactionary collagen.”

This characteristic reactionary collagen response makes stimulatory fillers particularly beneficial, as they effectively stimulate collagen production, resulting in noticeable skin tightening. This approach yields superior outcomes in skin of color compared to their lighter-skinned counterparts.

Optimizing Laser Technology

“There are a lot of modalities and different laser devices, light and energy devices, out there. We find that over the years, at least 20 years, we have data that [indicate] 1064 nm Nd:YAG [neodymium-doped yttrium aluminum garnet] lasers seem to be best suited for skin of color. We see fewer adverse events in the right hands. Of course, we can see burns with any of these devices, but a lot of times they’re the safest that we have,” Burgess said.

When it comes to laser treatments, choosing the right device and settings is crucial. Over the years, data have indicated that 1064 nm Nd:YAG lasers exhibit superior safety profiles for skin of color. Although any device can pose a risk of burns if mishandled, these lasers, when used skillfully, tend to yield the best outcomes. Adjusting parameters, including frequency and fluence, allows for a personalized approach, ensuring optimal results while prioritizing patient safety.²

Take-Home Pearls

With a growing population of individuals with mixed heritage, accurately assessing a patient’s skin type can be challenging. It is prudent to include questions about self-identified ethnicity and heritage in patient intake forms.

“It’s important for people to realize that an increasing number of [individuals in the US] are in interracial marriages. You don’t know who you’re treating and how much melanin they have in their skin; they can look [like a White individual but] react as if they have [skin of color]. Soit’s better to be cautious [and ask],” she explained.

Aesthetic procedures for patients with skin of color necessitate a nuanced approach that prioritizes patient safety and optimal outcomes. Recognizing the prevalence of postinflammatory hyperpigmentation and tailoring treatments to address complexion concerns are paramount. Stimulatory fillers and 1064 nm Nd:YAG lasers are invaluable tools in enhancing the aesthetic experiences of individuals with skin of color. By embracing these considerations, dermatology clinicians can elevate the standard of care for this diverse patient demographic.

References

1. Burgess C. Aesthetics and skin of color. Presented at: 2023 Fall Clinical Dermatology Conference; October 19-22, 2023; Las Vegas, NV.

2. Roberts WE, Henry M, Burgess C, Saedi N, Chilukuri S, Campbell-Chambers A. Laser treatment of skin of color for medical and aesthetic uses with a new 650-microsecond Nd:YAG 1064nm laser. J Drugs Dermatol. 2019;18(4):s135-s137