Skin of Color Considerations in Aesthetics

Performing aesthetic procedures on individuals with skin of color, specifically those falling under Fitzpatrick skin types IV-VI, require special considerations due to their propensity for hyperpigmentation reactions, as opposed to the erythema more commonly observed in individuals with lighter skin tones. Cheryl Burgess, MD, founder and president of Center for Dermatology and Dermatologic Surgery in Washington, DC, will present a session delving into best practices to utilize laser treatments safely in patients with skin of color at the 2023 Fall Clinical Dermatology Conference in Las Vegas, Nevada on October 22.

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

Burgess gave a sneak peek of her top pearls to put into practice.

Postinflammatory Hyperpigmentation: A Predominant Concern

Regardless of geographical location or ethnic background, postinflammatory hyperpigmentation remains a paramount concern in skin of color. This concern manifests in various forms, be it innate, as in the case of acne, or as an adverse event after aesthetic procedures such as laser treatments or hair removal. It is essential for clinicians to recognize and address this issue proactively.

Distinguishing Cosmetic Concerns

Patients seeking aesthetic procedures often present unique concerns depending on their skin type. In skin of color, the emphasis shifts towards 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.

The Efficacy of Stimulatory Fillers

In skin of color, sinking and sagging tend to be more prevalent than fine lines and wrinkles. 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

When it comes to laser treatments, choosing the right device and settings is crucial. Over the years, data has indicated that 1064 nm Nd: YAG lasers exhibit superior safety profiles for skin of color. While 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.

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. Aesthetic procedures in 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 stand as 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 and dynamic patient demographic.