Energy-Based Devices for Skin of Color: Safer Lasers and Aesthetic Outcomes
Clinical Summary
Energy-Based Devices in Skin of Color: Safety and Device Selection
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Skin of color, energy-based devices: The primary consideration is minimizing interaction with epidermal melanin to reduce risks of burns, hyperpigmentation, and hypopigmentation. Earlier laser technologies were often highly absorbed by pigment, increasing complication rates in darker skin types.
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Microsecond 1064-nm Nd:YAG laser: This wavelength is “not that well absorbed by pigment,” and microsecond delivery generates less heat. According to the transcript, it is used to treat melasma, acne, and photoaging in ethnic skin populations.
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Ultrasound-based tightening devices and newer ablative lasers: Ultrasound technologies are “not absorbed at all by pigment,” and some newer resurfacing platforms are also less pigment-dependent. Clinicians are encouraged to select technologies suitable for darker skin types because these devices can also be used safely in lighter skin populations.
Reviewed by Jessica Garlewicz, Managing Digital Editor of Immunology Group
Dr David Goldberg discusses how dermatologists can safely use energy-based devices in patients with skin of color while minimizing risks such as hyperpigmentation, hypopigmentation, and burns. Learn how technologies like microsecond 1064-nm Nd:YAG lasers, ultrasound-based tightening devices, and newer resurfacing platforms can improve aesthetic outcomes across diverse skin types.
Transcript
I'm Dr David Goldberg. I am the director of Clinical Research and Cosmetic Dermatology for the national private equity-based dermatology group, Schweiger Dermatology Group. I am also a clinical professor of dermatology at the Icahn School of Medicine at Mount Sinai in New York.
What are the most important considerations when selecting energy-based devices for patients with skin of color to minimize complications like hyperpigmentation or hypopigmentation?
Dr Goldberg: So the issue with aesthetic treatments in skin of color, darker skin types, is they obviously have pigments in their skin. This is not a problem where you have someone who's blonde-haired, blue-eyed. But the increasing population of people with skin of color is obviously there. I practice in New York and New Jersey, and I would say probably 6 to 7 out of 10 people we see are darker skin types. Many of the earlier laser and laser-like devices were so well absorbed by pigment. that although we were trying to treat a problem on the skin, we ended up burning people. And so what we want now are devices, technologies that don't interact negatively with melanin, pigments in the skin, so that we can treat people, make them better, and not cause that problem.
How are newer technologies—such as microsecond lasers or novel resurfacing platforms—improving safety and efficacy in treating aesthetic concerns in ethnic skin?
Dr Goldberg: So a classic example of a laser we use in ethnic skin is a microsecond Nd:YAG laser. It's a 1064 nanometer Nd:YAG laser. That wavelength is not that well absorbed by pigment. That's already good. And then the microsecond technology emitted by that laser doesn't cause a lot of heat. So in that case, we use that laser to treat everything from melasma to acne to photoaging. And then there are other technologies such as ultrasound-based devices for skin tightening that aren't absorbed at all by pigment. There are some of the newer ablative lasers that we use for wrinkles that also are not well absorbed. Bottom line is if you're going to treat ethnic skin, and this can be anywhere from someone like me who tans very well to African Americans and everything in between, you have to make sure to use technology that is not going to be too well absorbed by their melanin.
With increasing demand from diverse patient populations, how should dermatologists adapt their approach to deliver predictable, culturally competent aesthetic outcomes?
Dr Goldberg: So, you know, I train 2 fellows a year, and what I say to them is to gear your technology toward darker skin types because you can always use them for lighter skin types. But if you start focusing on only treating lighter skin types, you're going to lose out, and your patient population is going to lose out on so many available treatments now.
