It is a common and unfortunate misconception that skin of color (i.e. skin types that naturally occur with higher levels of melanin, such as Fitzpatrick skin types IV and beyond) cannot receive laser hair removal. With technological advances and up-to-date training, there is no good reason patients of color cannot safely benefit from it.
Besides being a cosmetic treatment for normal but unwanted hair, laser hair removal can often address medical concerns such as folliculitis (characterized by bumps, itchy patches, and inflammation from ingrown hairs), which tend to be more prevalent in individuals with darker skin – which only serves to emphasize the need or demand for such treatment from this segment of the population.
In the early days of laser hair removal, patients of color would quite regularly experience adverse side effects, such as pigmentation concerns, burns, or scarring, without much hair reduction to show for it. Part of this can be attributed to the only available technology at the time not meeting the wavelength settings required to lase hair without severely damaging the surrounding high-melanin skin, and the rest to poor quality control and a lack of trained laser technicians.
As a result, patients of color were often turned away or treated with alternatives, being told that laser hair removal “could not accommodate their skin type”. To this day, several practices still continue to do so.
Since their beginnings, however, laser devices have been improved to be more precise and project various forms of light throughout the spectrum, minimizing damage to surrounding pigmented tissues and targeting the melanin in hair follicles more specifically.
Selective photothermolysis, or the destruction of a specific target with light and heat, is the functional principle behind laser hair removal. It relies on the use of light of specific wavelength settings to penetrate the skin and target only the melanin within the hair follicle (and not that of the skin itself), which is why it is often said that the best candidates for laser hair removal have light skin and dark hair.
Shorter wavelength lasers may hit melanin at the epidermis or skin surface instead of the hair follicles underneath, resulting in damage to the skin without much payoff in treatment goals. Patients of color, therefore, benefit most from the use of laser that has a longer wavelength and pulse width so that the light can travel past the skin surface (without significant harm to epidermal melanin) and hit the melanin in the follicles.
Besides appropriate wavelength, other parameters such as the timing of laser pulses, device compression, and amount of energy used should be considered to maximize results. YAG lasers (such as the Nd:YAG 1064 nm laser) with the right settings, and administered by a trained laser provider, can achieve these standards.
Combination lasers with multiple wavelength options also exist to treat a wide range of patients. In addition to using lasers with built-in cooling systems, applying topical cooling gels or creams and cool compresses can soothe treated skin and reduce epidermal damage.
In addition to light-based technology, newer types of FDA-cleared microwave technology, such as the miraDry®/miraSmooth® system, have shown much promise for hair removal. Because they involve heat-based microwave energy only, a chromophore or melanin-based target is not required. This means that microwave treatments can simultaneously heat and destroy hair follicles of any color (even lighter hair types that generally cannot be treated with a laser).
Cosmetic medical practices who do not continually educate themselves on the advances in technology and techniques, or perpetuate an antiquated myth to hide that they lack the required devices or trained providers, can end up stigmatizing a large segment of their patients against otherwise safe and effective treatments such as laser hair removal, and can lose out on the business of a significant consumer base.
Dr. Robin Levin is a board-certified dermatologist and the founder of South Jersey Skin Care & Laser Center. To learn more about laser hair removal or other types of cosmetic and medical dermatological treatments, request an appointment or consultation online or by calling her office at (856) 810-9888.