Tailoring Aesthetic Treatments for Patients With Skin of Color

In a recent interview with Dermatology Times, Omer Ibrahim, MD, reviewed important considerations for clinicians providing aesthetic care to patients with skin of color. Ibrahim, a board-certified dermatologist at Chicago Cosmetic Surgery and Dermatology and co-director of Chicago Cosmetic and Dermatologic Research, reviewed findings from an Allergan Aesthetics survey evaluating facial aesthetic concerns across genders, ethnicities, and generations; post-inflammatory hyperpigmentation; laser settings, specific devices safe for use on patients with skin of color, non-device aesthetic treatments, and how to improve inclusivity and education surrounding treatments for patients with skin of color.

Q&A With Omer Ibrahim, MD

Omer Ibrahim, MD | Image credit: Chicago Cosmetic Surgery and Dermatology

Q: When you begin to discuss aesthetic procedures with patients with skin of color, what immediate thoughts or considerations come to mind?

A: Aesthetics ideals and treatments have often focused on the needs and concerns of white female patients. Recently, I was a lead investigator in an Allergan Aesthetics-led US survey aimed to better understand facial aesthetic concerns across genders, ethnicities, and generations. As aesthetic ideals differ among diverse populations, it is important to understand how aesthetic concerns and desires may vary across demographic groups.

Importantly, the research findings suggest that aesthetic concerns vary among demographic groups and differ from what current aesthetic paradigms may suggest. This indicates that Allergan Aesthetics’ data can be used by health care professionals to better understand the aesthetic preferences across their diverse patient populations and enhance consultations and treatment recommendations. It’s important that patients pursuing aesthetic treatments seek out a provider who is educated about how different procedures may affect diverse skin types, and who carefully customizes the treatment plan to suit the patient's skin type.

Q: With post-inflammatory hyperpigmentation (PIH) being a main risk with devices or lasers in patients with skin of color, what procedures do you avoid or how do you mitigate risks of PIH?

A: Although laser treatments are popular, all types of dark spots and skin types aren’t suited for them. Melanin-rich skin requires specific laser wavelengths and techniques to avoid targeting the pigment and causing further damage, and alternative approaches or specific wavelengths should be considered. Patients with active acne breakouts, very sensitive skin, or flare-ups of skin conditions could also see more harm than good with certain lasers. However, if a patient’s skin is suited for it, broadband light therapy uses high-intensity light that's gentler than a laser and can be more affordable than traditional lasers.

According to Allergan Aesthetics’ research, uneven skin color and hyperpigmentation were ranked as top facial concerns across a wide array of racial demographics, but most prevalent for Black and Asian women. This illustrates that addressing hyperpigmentation concerns is something healthcare practitioners need to be mindful of when having consultations with diverse patients and ensuring their specific needs are prioritized and met—but they need to take a customized approach to avoid further damage to diverse skin tones.

Q: What considerations do you take into account when selecting laser settings for patients with skin of color?

A: The ideal treatment(s) all depend on a patient’s particular needs and skin type, but there are certain factors to consider when selecting laser settings. Wavelength selection, energy density, and pulse duration are some. 

• Longer wavelengths are generally safer for darker skin tones because they penetrate deeper into the skin and are less likely to be absorbed by melanin, reducing the risk of hyperpigmentation and burns. 
• Lower fluence and even more importantly, lower density settings are necessary in order to minimize overheating the skin and causing hyperpigmentation or worse, hypopigmentation. 
• Longer pulse durations are preferred for patients with skin of color. They deliver the same amount of energy over a more extended period, preventing overheating and minimizing the risk of hyperpigmentation. 

Most importantly, patients need to consult a dermatologist who has experience treating patients with darker skin and who understands the impact lasers will have on melanin-rich skin. 

Q: Are there specific laser or light-based devices you find particularly effective or safe for patients with skin of color?

Image credit: © etonastenka - stock.adobe.com

A: My preferred devices include Fraxel Dual, a nonablative resurfacing laser that combines the 1550nm and 1927nm wavelengths to safely and effectively resurface all skin types; however, settings need to be tailored for the specific patient’s skin type and needs. The Nd-YAG laser for laser hair reduction is the laser of choice in more pigmented skin as this wavelength reduces the risk of burns and post-inflammatory pigmentation.

Q: Outside of lasers and devices, are there other aesthetic procedures that you find particularly effective and safe for patients with skin of color?

A: Yes, and each patient’s skin needs and skin type need to be considered when prescribing these solutions, which is why I always recommend an initial consultation. Chemical peels and microneedling are popular options that can be tailored to a patient’s skin type and tone to ensure the safest results. For chemical peels, the strength of it is usually determined by skin type. Patients with more melanin in their skin tend to use a more superficial peel, while deeper peels are generally safer for lighter skin tones. 

Microneedling is considered safe for skin of color because it does not rely on heat or light, reducing the risk of hyperpigmentation. A well-curated skincare routine, including the use of products with ingredients like niacinamide, vitamin C, retinoids, and sun protection, can address various concerns such as hyperpigmentation, acne, and aging. A licensed health care provider can help patients with skin of color find the optimal product treatment regimen.

Q: What additional work still needs to be done regarding improving education surrounding aesthetic procedures for skin of color and up-to-date training for clinicians?

A: Allergan Aesthetics’ research clearly highlighted the discrepancy between traditional white female aesthetic concerns, and the aesthetic concerns of patients of different ethnicities. Education is such an important part of ensuring HCPs understand diverse patient needs. Expanding medical training to include more robust and detailed education on skin physiology, common concerns, and treatment approaches for skin of color is crucial. 

Even for established practitioners, providing them with access to advanced workshops, webinars, and continuing education courses focused on treating skin of color can help keep them updated on the latest techniques, devices, and research. Clinical trial diversity is also an important step forward. This will help generate data that is truly representative of the broader population and inform safer, more effective treatments.

Lastly, mentorship and the sharing of knowledge among professionals who specialize in treating skin of color can foster a community of practice and raise the overall standard of care. 

Q: Do you have any additional or closing thoughts we did not discuss?

A: I recommend all patients, including those of color, have a consultation to discuss their specific skincare concerns and what tailored measures your provider can take to address them. When dermatologists align on a treatment plan, it’s important to ensure that all factors that make up a patient’s unique skincare needs are considered. This will protect the safety of your skin and lead to the most effective results.