Patients with non-Caucasian skin represent a largely untapped market for aesthetic treatments. Many potential patients are still being told that they cannot get laser or light-based treatments because of their skin type.

Over one half of the world is brown-skinned. Imagine turning someone away from your practice because you can’t treat that skin type, when we have safe lasers that can treat the darkest Indian and African skin safely. You will never become an expert if you can’t treat brown skin. Dr Fitzpatrick devised his skin typing system of I-VI, with one (I) being your Scandinavian, blue-eyed person and six (VI) being as dark as you can get. Three or four through to six are the skin types that require attention and care. With the right technology and proper technique we can treat all skin types as safely and effectively as we can Caucasian skin (I and II).

People with colored skin have a thicker stratum corneum, and their fibroblast cells are much more robust. That is why, with skin tightening, people with darker skin can get better results with less energy (fluence). It is important to understand the difference between dark skin and ethnicity. If you had five people and one was an Indian (from India), one was African American, one Korean, one Japanese, and one was Brazilian, and they all had the same skin color, you wouldn’t be able to tell the difference. But if you treated them with the same lasers, with the same settings, the same chemicals , and cosmeceuticals, you would get five totally different results.

It’s not skin color we treat, it is the ethnicity and all hereditary background that comes with it!

Intense pulsed light (IPL) and laser devices, which target epidermal melanin, work well on fair Caucasian skin. However, since darker skin has more melanin than light skin, the risk of epidermal damage is higher. The dermis houses the blood vessels, hair follicles, sebaceous glands and fibroblasts, so the ideal device is one that can deliver energy to the dermal layer without damaging the epidermis.

When traditional devices are used on non-Caucasian skin, post-inflammatory hyperpigmentation (PIH) in the epidermis is the most common adverse effect. If the PIH is deep enough, it may become permanent. Even now, patients with non-caucasian skin treated with less invasive and less aggressive fractional devices experience PIH and erythema. Scarring and keloids may result from more aggressive treatments. One solution is to modify treatment settings to minimise possible adverse effects. When we do this, however, we risk reducing efficacy and wasting patients’ time and money.

Heavily filtered IPL and Nd:YAG lasers can be safely used on darker skin types. In cases of low light tolerance lasers can be combined with a bipolar radiofrequency (RF) energy for a more effective treatment of non-Caucasian skin.