Can Fraxel Be Used on Dark or Hispanic Skin Types?

Question

Can this laser be used on a dark skinned person? i'm 23, latino male, with some hyperpigmentation and some depressed scars. i been looking for some kind of treatment but most doctors won't recommend much since my skin has  a dark tone. please help me out.

Gregory Turowski, MD, PhD, FACS · Answer

When treating darker skin types with Fraxel it is very important to use Hydroquionone for 2-3 weeks prior and 7-10days after the procedure. The bleaching cream will suppress the melanin production and will prevent hyper pigmentation post laser. Darker skin should be treated with caution, less energy and intensity. More consecutive treatments are also necessary for darker skin with prolonged recovery time. As long as the procedure is done by an expert, with experience in treating darker skin type, you will see very good results with fraxel.

Ron Shelton, MD · Answer

Depending on the patient's skin type, and history of postinflammatory hyperpigmenation, such as getting darker brown after acne blemishes, I will often do a test spot behind the ear and if there is no darkening seen after a few weeks, then I often do a second test spot on the face usually upper outer forehead or temple. If a hyperpigmented test site develops then treatment with the laser is not done. I do tell all my patients, who have two good test spots that there is no guarantee that they won't develop a darkening on the facial treated site. Sunblock is imperative and often we prescribe lightening creams before and after the procedure to limit the ability of the skin cells to create darkening as a result of the laser. We have noted less hyperpigmentation after Permea than Fraxel Dual, but many patients respond well to both.The information provided in Dr. Shelton's answer is for educational purposes only and is not intended to constitute medical advice.  The information provided should not be relied upon as a substitute for consultations with a qualified health professional who may be familiar with your individual medical needs.

Raffy Karamanoukian, MD, FACS · Answer

Fractionated laser has become quite popular in the United States because of the increased depth of treatment and the minimal downtime. The depth of fractionated laser can acheive greater results in comparison to typical laser resurfacing, while the fractionated beam diffuses the treatment area between treatments.
In ethnic skin types, there is a propensity to develop hyperpigmentation of the skin. This can be managed post-procedure, or more appropriately, before the treatment itself. 
Our office uses a very strict protocol to minimize post-procedural hyperpigmentation before laser resurfacing. 
In many cases, patients with hyperpigmentation after laser can be treated successfully with a topical prescription regimen.  If you have developed hyperpigmentation after a surgical or laser procedure, you may be a candidate for reparative treatment.

Brian E. Dubow, MD · Answer

Unfortunately, the advice you received is correct. People with darker skin tones (darker Caucasians tones, Latinos, Asians and African Americans) are not good candidates for aggressive laser procedures that are necessary to treat deep acne scarring. Furthermore, less aggressive treatments, such as light chemical peels and microdermabrasion, are ineffective at treating acne scars.

	However, the newer fillers, such as Restylane and Juvederm, are effective at filling in and smoothing many acne scars in darker skinned patients. Yes, this is temporary and has to be "touched up" about once a year, but it is still a good option for darker skinned patients who are not good candidates for the laser.

David Goldberg, MD · Answer

You are correct. Certain darker skin types are more difficult to treat and require enormous expertise on the part of the physician. It is impossible to determine if you are an appropriate candidate unless I see your skin. In general, however, the darker the skin, the higher the risks for post-treatment hyperpigmentation.

Nissan Pilest, MD · Answer

Any ablative or "hot" laser on Hispanic skin is a little dicey. The melanin content in your skin type is high, making you far more susceptible to post-inflammatory hyperpigmentation (PIH). Fraxel will have the potential to cause PIH in darker skin. I tend to be very conservative when treating olive skin tones with heat technology and will pretreat with a pigment inhibitor like prescription strength hydroquinone prior to laser procedures.
Melasma is an overfunction of the pigment-making cells. One of the most effective ways to lessen melasma is with a pigment production inhibitor. This is where a product system like Cosmelan excels. The ingredients of Cosmelan suppress melanin production probably better than any system available. The Cosmelan peel jumpstarts the process by forcing cell turnover so the superficial pigment cells are exfoliated. Cosmelan home products "instruct" the melanocytes to calm down.
An additional option which seems to improve melasma for your skin type is the use of salicylic acid peels which tend to lessen pigmentation appearance.
Any pigment control program is only as good as your ability to stick with it and follow all the regiment. Sun exposure will immediately ramp up the pigment production if you aren't protected with a full spectrum sunscreen. The really good ones may seem expensive, but if you use them as instructed, they go a long way toward to keeping your skin tone better blended.
It's not just the sun you need to protect yourself from. Heat is another factor - hot tubs, being in a hot climate (even with sunscreen), participating in sports, working out, cooking over a hot stove--all these can worsen melasma.

Kamran Khoobehi, MD · Answer

Fraxel laser does not target the pigment and cn be used on any skin color. I have used Fraxel laser treatment on many different skin type with excellent and predictable result.

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