During the winter months, evidence of days spent poolside and in the sun (read: fine lines, dullness and dark spots) become apparent. For lighter skin tones, lasers can reinstate even skin tone and texture, and obliterate breakouts and redness. But for darker skin tones, it’s not as easy. There’s a risk of burns, scars and hyperpigmentation.
Lasers have not always been compatible with deeper skin tones, but that is changing. Modern lasers are now more inclusive and consider the abundance of natural pigment in melanin-rich skin, making them safer and more effective under the supervision of a well-trained and watchful eye.
Are All Skin Tones Now Equal With Lasers?
Lasers reverse sun damage, acne and scars, eliminate unwanted hair, and rejuvenate skin tone and texture. However, some lasers and light-based devices can be risky to use on deeper skin tones, says Chapel Hill, NC dermatologist Lisa Ishii, MD. “Some lasers can’t distinguish between normal skin tone and the pigment being treated. Darker skin tones and certain ethnicities are prone to post-inflammatory hyperpigmentation (PIH). As the skin heals from a laser, it becomes inflamed, sending pigment-producing melanocytes into overdrive. This leads to more pigment.”
Chapel Hill, NC dermatologist Sue Ellen Cox, MD says the innovation of novel light, laser and energy-based devices expands treatment options for skin of color to safely treat acne scars, pigment, skin laxity, hair and wrinkles. Campbell, CA dermatologist Amelia K. Hausauer, MD explains that these lasers spare native skin pigment, earning them a place in an overall skin-rejuvenating plan for melanated skin. Still, there is no guarantee that pigmentation or reactions won’t occur. “It is more of a reduced risk than anything,” adds Delray Beach, FL dermatologist Dr. Janet Allenby.
What to Know About Lasers If You Have Melanin-Rich Skin
Laser advancements make treatments more palatable for deeper skin tones, but precautions must be considered. Using lasers on darker skin can cause blistering, burns, pain, scarring, hypopigmentation and hyperpigmentation, especially when the wrong laser is used. “Lasers that put a lot of heat into the skin and risk skin color changes are generally unsafe for darker skin,” Dr. Cox says. “Ablative lasers, which produce a deeper injury, can scar darker skin types.” Dr. Hausauer adds that Intense Pulse Light (IPL) can be difficult to customize in the darkest skin tones. “Advancements in cooling technology are helpful, but patients still need to be careful.”
The Best Lasers for Skin Rejuvenation + Anti-Aging
Many lasers can improve the effects of aging and skin health in darker skin. Dr. Allenby says several lasers keep the skin surface cool and deliver wavelengths at a deeper level to avoid disrupting pigment cells. She prefers fractionated CO2 lasers with CoolPeel to resurface, tighten and even out the skin. “I also like nonablative lasers, such as Chrome, for discoloration from acne and acne scars.”
Another safe-for-all-skin-tones rejuvenating laser is UltraClear. According to the company, the cold ablative fiber laser improves dark spots and hyperpigmentation while rejuvenating the skin, even on darker Fitzpatrick skin types.
Then, there is the newer-to-market MIRIA laser, a 1550nm laser that targets water in the skin. “Because it targets water, it can be used safely on all skin colors,” explains Phoenix dematologist Dr. Karan Lal. “It can help soften fine lines and sun damage with multiple treatments over time. MIRIA is also considered nonablative, which means it does not break the top layer of skin. Thus, it is a lower-downtime treatment.”
Many dermatologists only treat deeper skin with a pre-laser protocol to suppress pigment production. Dr. Allenby recommends using skin-lightening products for two weeks and no retinoids for three days before treatment. “Patients must also be diligent about reduced sun exposure.” Dr. Ishii prescribes a short course of steroid ointment to calm inflammation and redness and minimize PIH. “Occasionally, I pre-treat the skin with hydroquinone, which dampens melanocyte activity to minimize hyperpigmentation.”
The Post-Laser Toolbox
Post-procedure care is essential to maximize results and ensure skin heals beautifully. At Skin 22 in Beverly Hills, nurse practitioner Ted Vuong has found that patients who commit to a dedicated post-procedural skin-care regimen consistently achieve the best outcomes. “For this reason, we encourage all patients to commit to a skin-care protocol prior to any laser procedures to optimize healing and results,” he says, recommending a four-step Revision Skincare routine.
On Vuong’s must-use list: Revision Skincare’s C+ Correcting Complex 30% ($185), D.E.J Face Cream ($165), Intellishade Truphysical SPF 45 ($86) and Gentle Cleansing Lotion ($50).
The Best Lasers for Hyperpigmentation + Discoloration
“Adjusting a laser to fit a patient’s needs is essential when treating darker skin,” Dr. Hausauer says. One of her favorite devices for darker skin is Clear + Brilliant. “It is gentle and safe for pigment-prone skin and those with melasma. I also use HALO, which is a step up. When the settings are correct, and cooling is maximized, it gives radiant results.” The Picosecond, Nd:YAG and MOXI lasers are also options to consider.
Dr. Ishii is a fan of the Clear + Brilliant Permea laser and the low-heat Picosure Pro laser for improving skin tone while reducing hyperpigmentation. “Sometimes, I opt for Fraxel DUAL to target sun damage and stubborn pigment. I alter the settings to ensure maximum safety because lasers are not one-size-fits-all.”
On the other hand, Dr. Cox prefers utilizing non-laser treatments, like radio-frequency microneedling and ultrasonic devices such as Sofwave and Ultherapy to address these issues. They can help improve acne scarring and tissue tightening in darker-skinned patients.
The Best Lasers for Hair Removal
Laser hair removal delivers light and heat to target dark-colored hair follicles without damaging the skin. Traditionally, these devices couldn’t differentiate between dark hair and dark skin. “The evolution of laser hair removal is an example of how lasers are more inclusive of darker skin tones,” Dr. Hausauer explains. “The Nd:YAG laser and other devices delineate between these structures for safer treatments.” And, several wavelengths can be used. In Dr. Cox’s office, she uses “a 1064 nm long-pulse YAG (Gentle Max) for laser hair removal in darker-skinned patients safely and successfully.”
The Best Lasers for Acne
Acne and its scars are challenging to treat, but new technologies are promising for deeper skin tones. To treat acne, Dr. Ishii uses Accure, a laser that targets oil glands and minimizes nonspecific damage to melanin. “This is a great option because it has a robust cooling mechanism to protect the skin from the heat.” Another effective treatment is AviClear. According to the company, it is FDA-cleared to treat mild, moderate and severe acne, and it is safe for all skin tones.
