With any cosmetic procedure, it’s essential to weigh the risks against the rewards, but this is especially true for people with skin of color. Because those with deep skin tones have higher melanin levels, they are also more prone to pigmentation—specifically, postinflammatory hyperpigmentation (PIH)—after a cosmetic treatment.
However, from lasers and injectables to microneedling and peels, there’s a variety of safe and effective aesthetic treatments for skin of color. Here, three board-certified dermatologists who specialize in treating skin of color break down what you need to know before booking an appointment.
What is postinflammatory hyperpigmentation?
Postinflammatory hyperpigmentation is a skin condition caused by skin inflammation or injury that results in darkening of the skin. Melanin is the pigment responsible for giving our skin its color. When the skin is injured or inflamed, it produces 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 occur in all skin types but does tend to occur more often in people with melanin-rich skin, likely due to differences in melanin-related molecules on the cellular level.”
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Safe cosmetic treatments for PIH-prone skin types
Chemical peels
A chemical peel is a cosmetic treatment that involves careful application of exfoliating skin-care ingredients. It can be used to treat a variety of conditions, including acne, melasma, sun damage, and more. Chemical peels can be riskier for patients with skin of color due to the potential for hyperpigmentation and scarring. However, using a lighter-strength peel can help minimize these risks.
The strength of a peel depends on multiple factors—including the peel ingredient itself, its concentration and volume, and the duration of skin contact. Superficial peels are considered the safest for patients with deep skin tones. Houston-based board-certified dermatologist Dr. Adeline Kikam prefers using ingredients such as mandelic acid, glycolic acid, salicylic acid, and lactic acid to improve skin texture and evenness of tone. Other superficial peels include low-concentration TCA (trichloroacetic acid) and Jessner’s. Following a chemical peel, diligent sun protection is key. Dr. Ugonabo emphasizes that “sunscreen is critical on peeling skin because the skin is vulnerable and highly susceptible to burns and pigmentation.”
Microneedling
Microneedling is a minimally invasive cosmetic procedure that involves the use of tiny needles to create channels in the skin. This process boosts the production of collagen and elastin, which can help improve the appearance of wrinkles, stretch marks, enlarged pores, and 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. Overall, it’s a well-tolerated procedure in all skin tones, with minimal downtime. An in-office microneedling procedure with a skilled professional is safer and more effective than an at-home 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 performed RF microneedling, with favorable results, on individuals with dark skin tones and states that it’s “a safe treatment when done with appropriate settings—e.g., lower energy to avoid postinflammatory hyperpigmentation.” Dr. Rishi Chopra, a board-certified dermatologist in New York City, also performs RF microneedling on patients with deep skin, particularly those with acne scarring. He adds that “it is imperative that an insulated or coated tip is used, to protect the surface layer of the skin from the heat. Treatment settings, such as depth and pulse duration, as well as operator technique should also be optimized to maximize safety.”
Injectables (botulinum toxin and filler)
Both injectables such as botulinum toxin (Botox, Dysport, Xeomin, Jeuveau, Daxxify) and filler are considered safe and effective treatments in patients with skin of color. Botulinum toxin is commonly used 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. Mild 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 understanding 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 on a cellular level. When injected into the scalp, PRP has been shown to promote hair growth as well. It’s considered a safe treatment for all skin tones, with minimal downtime. Side effects such as temporary redness and mild bruising are common.
Lasers
From hair removal to skin resurfacing, laser technology has made remarkable strides 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. However, when appropriate lasers and settings are used by experienced providers, these risks are minimized.
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 used safely 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.
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Cosmetic treatments to avoid if you have skin of color
In general, experts agree that it’s best 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 avoid 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 dangerous to use on melanin-rich skin, as they can either target the patient’s own natural melanin or be too aggressive, leading to unpredictable results and complications.
Managing hyperpigmentation
The best way to manage hyperpigmentation is to prevent it in the first place. All skin tones need sun protection, no matter what. Even though those with dark skin tones are less likely to experience sunburn, they are more susceptible to pigmentation because of skin damage and aging. Dr. Kikam explains that UV radiation can cause skin inflammation, leading to an overproduction of melanin and pigmentation in exposed areas.
After any cosmetic procedure, the risk of hyperpigmentation is even greater—that’s why using a broad-spectrum sunscreen with an SPF of 30 or higher is essential. Specifically, using a tinted sunscreen formulated with iron oxides protects against visible light, which has been shown to contribute to skin darkening. Dr. Chopra states that “a tinted sunscreen with iron oxides is not just preventive—it is a treatment,” and is the most important aspect of his pre- and post-procedure regimen. Gentle exfoliation with ingredients such as lactic acid and glycolic acid can supplement a skin-care routine to target uneven texture and tone as well. The key word is gentle, as harsh exfoliation can trigger inflammation. A few of Dr. Kikam’s favorite 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 helpful as well.
