Which laser is best for beard removal on skin type III or IV?

I have used the Soprano XL laser from Alma Lasers for the past 2-3 years and have been very happy with it for hair removal in all skin types, especially darker skinned individuals.  This laser has much reduced discomfort and is safe even in the darkest skin tones or in those with an active suntan.  Although it can be used, I don't think the 755nm Alexandrite laser you had for the test patch is the best choice for darker skin.  This laser can sometimes lead to pigmentary alterations in the skin and is usually quite uncomfortable. 

As for the white bumps after treatment, I agree topical prescription products such as benzoyl peroxide and/or clindamycin gel should be enough to resolve the problem.  Good luck! 

The beard or any part of the face are often very sensitive. I recommend either the Diode or Nd:Yag laser. Both can have excellent results on the beard. After years of years of treating beards and even thinning my own, I think it makes sense to shrink the beard slowly and symmetrically to avoid severe discomfort and complications that may occur during a full facial treatment. It may take longer to achieve your goals, but it is safer and much more tolerable. I usually recommend you start on the neck and work your treatment up.

There are various excellent laser hair removal systems. Generally for darker skin, a diode or Nd:Yag laser is an excellent option, although assessing the quality and experience of the medical centre and its staff where you will be having your treatment is as critical as the laser system selected. The lightsheer duet laser is a particularly effective laser system which causes less discomfort than most laser systems.

There are several lasers available to reduce your beard hair.  What's more important is choosing a physician and a center with extensive experience rather than a specific laser, since nuances and setting variations make a big difference in lowering complication rates and increasing rates of success. 

Lasers for hair removal target the hair pigment.  This is why laser hair removal is not effective on blonde or white hair.  It is also why treating darker skin types is more challenging.  Pigment on the skin competes with the pigment in the hair.  As a result, different settings must be selected to protect the skin.

In general, I favor the Gentlemax laser, which allows me to select between an alexandrite or an Nd:Yag laser.  For darker skin I favor the Nd:Yag wavelength and for the fairer skin types I favor the alexandrite.  Other lasers, such as diodes and others out there may also be effective.  You have indicated in your question that you are skin type 3 or 4.  This gives your physician several options.  If you are truly type 3 skin (always tan, sometimes burn in the sun), then I would select the Gentlemax using the alexandrite component.  If you are type 4, I would want to evaluate your hair and skin contrast to choose the proper settings and laser.  Either way, you should have success.

The white heads are simply the result of inflammation in the hair follicle following the treatment.  It can actually be somewhat of a good sign that the laser is targeting the proper areas (i.e. the follicle), although I do understand the white head aftermath is a nuisance.  As a result, talk to the physician performing the procedure.  You might be a good candidate for a benzoyl peroxide wash.

I wish you luck.  Stick with it, because the beard  hair should respond very well.  I strongly recommend having physicians involved in your care rather than a spa environment, as it will markedly diminish risk to your skin and increase the chances for success.

Warmly, Robert Anolik, MD

There are several questions here.

First, for your type of skin the alexandrite is a very tricky laser.  It can be used in Type 3 carefully, buy for type 4 it has a much smaller safety window.  I would recommend something in the 810nm range like the Lightsheer or the Duet.

As for the pain.  The beard hair is so thick that it absorbs large amounts of hear and thus can be very painful.  So yes, it is normal to have this be painful.

The pimples is a result of the folliculitis that occurs with hair removal.  Not a concern, and you may get small whiteheads, but as long as you don't play with them, they should not be of any long term consequence.

Laser hair removal is safe in the right hands.  I would avoid the medispas that do not have a physician present.  They are more likely to have problems with your color skin.

The laser I would recommend is the long pulsed Nd:Yag, however any laser is best when used on those with lighter skin and dark hair. For those with skin of color lasers may help make the hair finer and grow more slowly, but will most likely not lead to permanent hair removal, and the risks of burns/scarring are increased. A test spot is not always a good indicator of how you will do after a full treatment. Treatments should be done by a trained aesthetic physician.

To treat/prevent white bumps you can try a cleanser that contains benzoyl peroxide and if that does not resolve the issue, your dermatologist may prescribe a topical antibiotic that contains clindamycin to apply to the area after washing.