Laser-based treatments can be some of the most transformative treatments for a client, but also some of the riskiest, as improper application can result in blistering, delayed healing, infection, and even scarring. If your scope of practice includes light-energy devices, you need to know how light energy is absorbed by the skin. Skin of color requires additional consideration when performing laser treatments.
UNDERSTANDING WAVELENGTH
Lasers are wavelengths of light that convert to energy and can be precisely controlled through technology. The light waves travel cohesively in one direction and penetrate to a specific depth in the skin. Each laser has a specific chromophore or target that they are attracted to. There are five relevant chromophores: water, melanin, fat, hemoglobin, and a foreign substance, such as tattoo ink.
Typically, the longer the wavelength, the deeper it travels in the skin. Concerning laser wavelengths common for hair removal, a laser that is 810 nanometers travels deeper than one that is 755 nanometers, and a laser that is 1064 nanometers travels deepest. This trend is constant until 1300 nanometers, when the energy shifts and begins to penetrate less deeply.
An intense pulsed light device (sometimes called an IPL or photofacial) uses light energy in a similar way to a laser but has more risks associated with it. Rather than using a single wavelength from the visible light spectrum, an intense pulsed light device uses filters to block wavelengths in the spectrum that are not needed for the treatment. Despite the filters, additional wavelengths can still pass through into the client’s skin. Since these renegade wavelengths don’t travel uniformly, they may affect parts of the skin you did not intend to target.
The challenge during a laser or intense pulsed light treatment session when the chromophore is melanin is that the light doesn’t know if it should target the melanin in the skin or the melanin in a hair follicle. Additionally, when laser energy travels into the skin, not all of the energy is absorbed. Some of the energy scatters into the surrounding tissue. This creates a riskier situation for a client with skin of color, as resulting heat can create post-inflammatory hyperpigmentation.
Since longer wavelengths have less scatter, the gold standard for laser hair removal is the 1064 nd:yag long-pulse laser. The light energy penetrates to the bulb of the hair follicle in a pulse that is one-thousandth of a second. This is enough time to destroy the follicle’s ability to grow hair if the treatment is done while the hair is in its anagen, or growth, phase.
TREATING SKIN TONES
Skin of color frequently has to deal with pseudofolliculitis barbae, or curved hair follicles that can cause hair to grow back into the skin. If dead skin cells, sebum, and dirt collect over the top of the hair follicles, clients can experience simulated folliculitis, or inflammation of the hair follicle. There are many recommended skin care treatments to reduce pseudofolliculitis barbae, but laser hair removal with a 1064 nd:yag long-pulse laser is currently the best solution.
Melasma is a hormonal pigmentation disorder. Melasma requires a combination approach to keep it under control. Treatments that include tyrosinase inhibitors, sun protectant factor products, chemical peels, and the use of Q-switch lasers have all improved outcomes for clients with melasma. The laser pulse lengths appropriate for hair removal are far too slow for treating melasma. Instead, use a Q-switched laser that delivers energy in billionths or trillionths of a second.
Timing is extremely important in any laser treatment, but especially when treating skin of color. If the pulse is too slow, the heat from the pulse will dissipate into the tissue and can cause inflammation or increased melanocyte production as the body tries to protect itself. Q-switch timing is so incredibly fast that melanin is shattered into tiny fragments for the body to absorb and the heat produced cools quickly enough that the surrounding tissue does not have time to absorb the energy.
BENEFITS OF TREATMENT
Laser skin rejuvenation for improving fine lines, texture, and pore size is best achieved with a fractional laser rather than a full on skin resurfacing laser. The fractional approach creates a controlled injury in small segments or channels of the skin, leaving the skin surrounding it uninjured. The risks of post-inflammatory hyperpigmentation and keloid scar formation are greatly reduced with a fractional treatment.
For the best outcome, your client needs to have a treatment plan that includes a series of sessions – conditioning the skin by starting with conservative settings. Gradually increase the strength or intensity as their skin increases tolerance. Homecare that includes melanocyte inhibiting products will help to prevent post-inflammatory hyperpigmentation.
Advances in skin care technology have created amazing opportunities for laser technicians to offer transformative skin rejuvenation treatments without the risk of a surgical procedure. With the right light-based treatment using optimal settings, clients with skin of color can achieve their skin care goals without complications. Skin of color can enjoy the benefits of the new technology with a conservative, mindful approach.
A technician, educator, mentor, and business owner, Mary Nielsen has been at the forefront in medical aesthetics since its infancy in the early 1990s. She is currently vice chair and industry expert on the Oregon Board of Certified Advanced Estheticians. She is the author of “Fearless Beauties,” along with other aesthetic texts. She is the executive director of an aesthetic school, the founder of Fearless Beauties, and the creator of Cascade Aesthetic Alliance and Skintelligent Resources.