With any cosmetic procedure, it’s crucial to assess the risks against the benefits, and this holds particularly true for individuals with skin of color. Since those with darker skin tones have higher melanin levels, they are more susceptible to pigmentation—specifically, postinflammatory hyperpigmentation (PIH)—after undergoing a cosmetic treatment.
However, ranging from lasers and injectables to microneedling and peels, there exists a diverse array of safe and efficacious aesthetic treatments for skin of color. Here, three board-certified dermatologists specializing in treating skin of color elaborate on what you need to know before scheduling an appointment.
What is postinflammatory hyperpigmentation?
Postinflammatory hyperpigmentation is a skin disorder brought about by skin inflammation or injury, resulting in the darkening of the skin. Melanin is the pigment accountable for giving our skin its color. When the skin is injured or inflamed, it generates more melanin as part of the healing process, leading to dark spots and patches. According to New York City board-certified dermatologist Dr. Nkem Ugonabo, “PIH can manifest in all skin types but is more prone to occur in people with melanin-rich skin, likely due to differences in melanin-related molecules at the cellular level.”
Safe cosmetic treatments for PIH-prone skin types
Chemical peels
A chemical peel is a cosmetic treatment entailing the meticulous application of exfoliating skincare ingredients. It can be employed to address various conditions, including acne, melasma, sun damage, and more. Chemical peels can pose higher risks for patients with skin of color due to the potential for hyperpigmentation and scarring. Nevertheless, utilizing a milder-strength peel can assist in minimizing these risks.
The intensity of a peel is contingent upon multiple factors—such as the peel ingredient itself, its concentration and volume, and the duration of skin contact. Superficial peels are regarded as the safest option for patients with deep skin tones. Houston-based board-certified dermatologist Dr. Adeline Kikam prefers using substances like mandelic acid, glycolic acid, salicylic acid, and lactic acid to enhance skin texture and even out the tone. Other superficial peels encompass low-concentration TCA (trichloroacetic acid) and Jessner’s. After a chemical peel, diligent sun protection is of paramount importance. Dr. Ugonabo highlights that “sunscreen is vital on peeling skin as the skin is vulnerable and highly prone to burns and pigmentation.”
Microneedling
Microneedling is a minimally invasive cosmetic procedure that involves the use of tiny needles to create channels within the skin. This process boosts the production of collagen and elastin, which can aid in improving the appearance of wrinkles, stretch marks, enlarged pores, and the overall skin texture. Microneedling can also be combined with the application of serums and platelet-rich plasma to enhance the delivery of the products to the skin. Generally, it’s a well-tolerated procedure across all skin tones, with minimal recovery time. An in-office microneedling procedure performed by a skilled professional is safer and more effective than a home-based treatment.
Radiofrequency (RF) microneedling
Radiofrequency (RF) microneedling is a cosmetic procedure that involves using fine needles to create micro injuries and deliver radiofrequency energy to the skin. This process stimulates collagen production and tightens the skin. Dr. Ugonabo has carried out RF microneedling, achieving favorable outcomes, on individuals with dark skin tones and asserts that it’s “a safe treatment when executed with appropriate settings—for instance, lower energy to evade postinflammatory hyperpigmentation.” Dr. Rishi Chopra, a board-certified dermatologist in New York City, also conducts RF microneedling on patients with deep skin, especially those with acne scarring. He adds that “it is imperative that an insulated or coated tip is utilized to safeguard the surface layer of the skin from the heat. Treatment settings, such as depth and pulse duration, as well as the operator’s technique should also be optimized to maximize safety.”
Injectables (botulinum toxin and filler)
Both injectables like botulinum toxin (Botox, Dysport, Xeomin, Jeuveau, Daxxify) and filler are regarded as safe and effective treatments for patients with skin of color. Botulinum toxin is commonly employed to treat dynamic wrinkles, such as frown lines, “11” lines, and crow’s-feet. Filler can be used to restore volume loss in various areas of the face as well as add contour and definition. Minor bruising at injection sites is common. It’s essential to seek treatment from a provider who has extensive training in injectables and an in-depth comprehension of facial anatomy.
PRP
Platelet-rich plasma, or PRP, is a treatment that involves injecting one’s own enriched blood products into the skin. This process stimulates collagen and elastin production and enhances skin repair at the cellular level. When injected into the scalp, PRP has been demonstrated to promote hair growth as well. It’s considered a safe treatment for all skin tones, with minimal recovery time. Side effects such as temporary redness and mild bruising are common.
Lasers
From hair removal to skin resurfacing, laser technology has made significant advancements over the years. However, not every laser is safe for every skin tone. Since lasers involve applying heat and energy to the skin, this can activate inflammatory and pigment cells, with the potential for skin darkening. Nevertheless, when appropriate lasers and settings are utilized by experienced providers, these risks are mitigated.
According to Dr. Chopra, “Generally, non-ablative fractional lasers for skin rejuvenation, vascular lasers, fat-reduction lasers, acne lasers, and longer-wavelength hair removal lasers can be safely employed on dark skin.” For example, the Nd:YAG is a type of laser that can be safely used for hair removal on dark skin tones.
Cosmetic treatments to avoid if you have skin of color
In general, experts concur that it’s advisable to avoid deep chemical peels, as they can lead to hyperpigmentation and scarring. In terms of lasers, Dr. Chopra emphasizes that those with dark skin tones should steer clear of fully ablative resurfacing lasers, intense pulsed light (IPL), shorter-wavelength picosecond and Q-switched lasers, and hair removal lasers intended for light skin tones (such as the 755 nm alexandrite laser). He explains that these devices are perilous to use on melanin-rich skin, as they can either target the patient’s own natural melanin or be overly aggressive, resulting in unpredictable outcomes and complications.
Managing hyperpigmentation
The prime way to manage hyperpigmentation is to prevent it from the outset. All skin tones require sun protection, without exception. Even though those with dark skin tones are less likely to suffer from sunburn, they are more prone to pigmentation due to skin damage and aging. Dr. Kikam explains that UV radiation can cause skin inflammation, leading to an excessive production of melanin and pigmentation in exposed areas.
After any cosmetic procedure, the risk of hyperpigmentation is even higher—that’s why using a broad-spectrum sunscreen with an SPF of 30 or above is indispensable. Specifically, using a tinted sunscreen formulated with iron oxides provides protection against visible light, which has been shown to contribute to skin darkening. Dr. Chopra states that “a tinted sunscreen with iron oxides is not merely preventive—it is a treatment,” and is the most crucial aspect of his pre- and post-procedure routine. Gentle exfoliation with ingredients such as lactic acid and glycolic acid can complement a skincare routine to target uneven texture and tone as well. The key is to be gentle, as harsh exfoliation can trigger inflammation. Some of Dr. Kikam’s favored brightening ingredients are hydroquinone, kojic acid, vitamin C, and retinoids. Dr. Ugonabo adds that a multimodal approach—utilizing a combination of topical lightening creams, chemical peels, and laser treatments—for PIH can be beneficial as well.
