aFlorida Hollywood Dermatology and Cosmetic Surgery Specialists, Hollywood, FL bDepartment of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, FL
and scarring. The emergence of the nonablative resurfacing lasers has allowed people of darker skin tones an opportunity to treat pigmented skin condition, rhytides, as well as skin texture, with less risk of side effects. Fractional or pixelated resurfacing is another safe nonablative device that can be used for resurfacing in people with skin of color. We outline the lasers we use in our practice for resurfacing in Table 3.Skin Rejuvenation Traditionally, ablative lasers, such as the carbon dioxide (CO2) and Erbium:YAG have been the gold standard in rejuvenation but can cause several unwanted side effects in Latino skin. Specifically, it has been described to cause hyperpigmentation in 31% of all skin types increasing to 50% in type III Fitzpatrick skin phototypes.5 In addition, there can be a delayed onset of hypopigmentation and transient erythema lasting months. The increase in adverse effects when resurfacing patients with skin of color makes pre-treatment and patient selection important in order to reduce these outcomes. Some more appropriate treatment alternatives for darker skin types include non-ablativeThe newer category of micro-ablative resurfacing lasers (fractional CO2, fractional Erbium, and the 2790nm Yttrium Scandium Gallium Garnet [YSSG]), offers a safer modality with which to treat Fitzpatrick skin type IV and above. Compared to the older generation resurfacing lasers the micro-ablative lasers minimize the amount and duration of erythema and edema, which can last just three to four days. A recent retrospective study of Chinese patients treated with the 1,550nm erbium-doped fractional laser (Fraxel 1550, Solta Medical) found that using fewer passes per treatment but increasing the total number of treatments was associated with a lower risk of post-inflammatory hyperpigmentation without compromising efficacy.6 Management of Complications One of the most common malpractice lawsuits is laser complications. It is important to ensure that all laser practitioners are certified and that providers have reviewed laser laws their state. Pre- and post-treatment photos are essential. It is also important to document settings and informed consent. If an issue arises, the provider should make themselves available 24/7 and prepare for a lot of hand holding. The best treatment for complications is prevention. Table 4 outlines acute and chronic complication management that we practice in our office.
The use of lasers in people with skin of color requires an understanding of laser physics and laser tissue interactions. It is very important to be familiar with the laser device as not all energy-based devices work similarly. The Latino population encompasses the range of all phototypes and therefore one rule cannot apply to all Latinos. Proper selection of device, wave
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