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Test spots are never a bad idea, although typically they are performed when there is a risk of problem which is in people with tanned skin, or darker skin tones. In this case, a test spot in a relatively hidden area is a good idea to avoid potential problems such as a laser burn.
This depends upon your skin color. Most experienced physicians can treat lighter skin individuals without performing a test area. Darker skin individuals are at greater risk of complications so I sometimes will perform several test spots in areas as hidden as possible and then wait a half hour to assess the results.
Experienced dermatologists often do not need to do test spots for routine laser hair removal. For darker skinned patients test spots may be a good idea and in certain settings should be performed. The need for test spot is therefore based on the experience of the laser doctor and the patient's skin type. In general, you cannot go wrong with a test spot to see that it is safe at the planned laser setting. The only "side effects" is that it just may delay the treatment start date and may cost a little extra in the long run to assure your safety if there is any concern.
There is likely some variability in recommendations for test spots. As a general rule a test session is a way of erring on the side of safety. In my practice, I consider test spots for the following situations among others: 1. Patients with darker skin types who are at higher risk of complications from laser 2. Patients who wish large areas treated. Even if side effect risk may be low, it is prudent to do test areas first because if they have side effects it will be over a large or visible area.
This varies based on your skin color and the laser being used. Make sure you are seeing someone with a lot of experience with your skin type, particularly if you have dark or tanned skin. I would recommend finding a doctor who is a member of the American Society of Lasers in Medicine and Surgery (ASLMS).