Is Profractional laser safe for dark skin?

Question

My dermatologist recommended that I should use profractional laser to treat my deep acne scars on my temples and cheeks. I was wondering if this would be the right treatment for my acne scars?

Jason Emer, MD · Answer

in the right patient and the right doctors hand, stronger lasers can be used in dark skin. be sure you pretreat our skin with cosmelan and post treat appropriately. this needs an expert.

at home peels like cosmelan, enlighten and aerify along with dermarolling (MTS roller with anteage MD ampules weekly) should be started now

if you have post inflammatory hyperpigmentation/melasma/discoloration that needs cosmelan or enlighten peels at home which we can do virtually and send to your home along with aerify peels regularly, vivatia foam, restorsea 10x, faith essence serum, and cosmelan 2 cream.

Acne scar treatment needs a combination approach for improvement.  For the best results, one should target the acne scar type.  As everyone has a unique pattern of acne scarring, the best solution is a tailored one.  Typically you need fillers like bellafill and sculptra for atrophic indented type scars with or without subcision.  Subcision for depressed tethered scars.  Vascular lasers like yellow laser, aerolase, excel V or IPL for redness or thick scars. And lasers such as fraxel, erbium, co2 or fractional radiofrequency like venus viva, skinfinity, intensif or fractora microneedling RF for textural issues and superficial scarring.  Deep ice pick scars and narrow box car scars are best treated with TCA CROSS and punch excision.  All lasers are combined with microneedling and PRP to get even better results and improve healing times.   The majority of patients will have a collection of different scar types, and hence a tailored treatment plan is needed by an expert physician.  It is never about the laser or product that gives the results, its about the expert behind the equipment that gets you the outcome.  Scars cannot be cured and will need life-long treatments to maintain and build on the results.  For those at high risk for hyperpigmentation (darker skin types or asian or hispanic or mixed ethnicities) we already pre-treat the skin with cosmelan or enlighten lightening peels to prevent complications from energy-based or chemical-based treatments.  Best, Dr. Emer.

Nelson Lee Novick, MD · Answer

Light-based therapies should be used with caution in skin of color, since the greater presence of pigment in such individuals translates into potentially more light absorption and hence the increased possibility for the development of postinflammatory dyspigmentation problems, such as prolonged or permanent hyperpigmentation or even permanent loss of pigmentation. Ablative therapies carry this risk and then some. You might look into simpler, less expensive and less pigment-risky techniques for acne scars that have stood the test of decades of use. These include Field Subcision, for treating large swaths of acne-related skin atrophy;  subcision for individual boxcar and rolling scars; and TCA CROSS for ice pick scars and dilated pores.  All of these are "color blind," meaning that they have been shown to be safe for use in all skin types , including even the most darkly pigmented skin. Make sure, however, to consult with a board certified aesthetic physician with experience in these procedures and not just any one or any medspa hawking its expensive, supposedly "next big thing" device. Best of luck.

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