Taking the guesswork out of Botox, lasers, and more for deeper skin tones.
Nov 2, 2021
As a Black skincare professional who treats mostly Black women, I understand the reluctance to try certain cosmetic procedures. There’s still an assumption that darker skin is impervious to aging, which may be one reason we don’t pursue these treatments. But there are others: Traditionally, chemical peels and laser were viewed as unsuitable for darker skin tones, which are more at risk for scarring or hyperpigmentation. Add in a lack of diversity among both practitioners and in clinical texts (only about 3 percent of practicing dermatologists are Black, and a 2020 survey of medical textbooks revealed that an abysmal 4.5 percent of educational images showed dark skin), and it’s understandable why Black patients likely feel less confident about their options.
“I once went into a spa and asked for microdermabrasion and was told no because they thought I might develop a keloid scar, even though that had never happened before in my life,” says cosmetic doctor Tijion Esho, who is based in the United Kingdom. “Some of us are denied access simply because practitioners don’t have the right experience.”
But that’s starting to change. As technology evolves to account for the nuances of treating melanin-rich skin and aesthetic practices become more diverse, interest in these procedures is rising. The number of Black Americans receiving cosmetic procedures increased 10 percent between 2018 and 2020, according to the American Society of Plastic Surgeons. “Black people and other people of color can benefit from these treatments, and it’s clear we’re interested in them,” says dermatologist Corey L. Hartman, MD, medical director of Skin Wellness Dermatology in Birmingham, Alabama. As the industry catches up with the demand, here’s where things stand.
Treat dark spots and unwanted hair with lasers
How they work: These devices sound like the stuff of Star Wars, but they do great things right here on Earth. Lasers use individual light wavelengths to eradicate hyperpigmentation, as well as unwanted hair and broken blood vessels. They can also improve skin texture and fine lines by removing the top layer of skin or heating the underlying tissue. The challenge: Melanin-producing cells, called melanocytes, are sensitive to trauma and more active in darker skin, so excessive heat from clinical treatments may potentially lead to hyperpigmentation and even burning in darker skin tones. Older laser technology struggled to differentiate between brown skin and dark spots, increasing the risk of adverse reactions for people of color.
What you need to know: Thankfully, there are better laser options today. One is the Nd:YAG, widely considered the most suitable for hair removal (although some doctors also use it for pigmentation concerns) in darker skin. The laser’s specific wavelength penetrates deep enough into the skin to reach its target without damaging the surrounding tissue. Other newer laser systems like PicoSure and PicoWay use picosecond-timed pulses that reduce contact with the skin without compromising energy. This allows the laser to destroy its target faster while reducing the risk of complications. Although lasers continue to improve, the experts we spoke with still advise against IPL and BBL treatments. These devices use multiple wavelengths of light with varied penetration depths and targets, making them too imprecise for darker skin.
In addition to knowing the right lasers to look for, vet your potential technician. A laser operator’s experience with their technology, as well as with treating darker skin, can make a big difference, both in terms of the results you’ll see and the cost. “I’ve had patients tell me they’ve had 12 laser hair removal treatments in a row and didn’t see any change,” says Dallas dermatologist DiAnne Davis, MD. “It may have been that the technician kept the settings too low, ensuring its safety but also not removing the unwanted hair.” Many lasers automatically adjust to patient information, but an experienced technician must confidently make additional modifications to provide better treatment. “You want someone who has done a laser fellowship or additional laser training,” says Davis. Ask if the practitioner has done an accredited laser training program, and find out whether they’ve dealt with complications. “If a practitioner hasn’t had a complication, they haven’t done enough treatments,” says Davis. “And if they have, ask how they addressed the situation with the patient.”
Get smoother skin with neuromodulators
How they work: First, a little lesson in skin aging, because contrary to popular belief, Black does crack. “It just takes longer,” says Esho. Fine lines and wrinkles are divided into different categories. Static wrinkles are typically caused by lifestyle factors such as smoking, diet, and—primarily—sun exposure. Melanin does provide some protection against UV exposure, possibly delaying the onset of sun-induced visible aging in dark skin. Dynamic wrinkles, on the other hand, are caused by the movement of facial muscle. “If you have thicker muscles that are more expressive, your risk of wrinkling is greater regardless of skin tone,” says Hartman. Botox and other neuromodulators, such as Dysport and Xeomin, can help address dynamic wrinkles by inhibiting muscle movement.
What you need to know: Esho tends to recommend smaller doses for Black patients. “I find that they generally don’t want to look ‘done,’” he says. “They want it to be more representative of their face in its natural state. This ‘baby Botox’ or ‘micro-tox’ softens lines rather than eradicating them completely.” He also warns that the biggest concern with neuromodulators in darker skin is the development of hyperpigmentation at injection points; he solves for this by reducing the number of jabs and avoiding multiple passes over the face. Otherwise, these injections have few caveats for darker skin. Still, our experts recommend thumbing through a doctor’s portfolio of before-and-after photos to ensure they can achieve your desired look.
Plump and lift with fillers
How they work: Sometimes confused with Botox and the like, fillers work quite differently, filling in fine lines on the face or the lips, typically with hyaluronic acid. They can also be used to lift the face and define certain features. Fillers, particularly those used in the lip area, like Juvéderm, are a treatment that some may wrongly assume are pointless for Black patients—and Hartman feels that aesthetics companies are partly to blame for this misconception. “If, in your marketing materials, you’re always showing before-and-after pictures of a Caucasian person who goes from virtually no lips to very plump, that’s the type of consumer you’re going to attract,” he says. “But Black women with fuller lips also want them to stay that way. There’s a market.”
Fillers are also beneficial for use under the eyes, making them particularly useful for women of color, who are more prone to darkness in that area as well. “Bone structure and underlying support start to recede as we age, which can lead to the look of tiredness and dark circles that creams alone are unlikely to treat,” says Davis. “When it comes to hollowness, filler is a home run because it plumps the skin, so you don’t have that valley that leads to under-eye darkness. It’s instant gratification.”
What you need to know: Talking to your doctor about how they approach fillers for clients with different ethnic backgrounds can help you determine if they’re the right fit. Esho (also known as the Lip Doctor) emphasizes the importance of respecting ethnic proportions when administering filler.
“In a white patient, the bottom lip is usually twice as big as the top lip,” he says. “It’s different for Black patients, who tend to have top and bottom lips that are equal in size.” Your practitioner should discuss with you how they will respect your natural features in the treatment process. Again, ask for before-and-after photographs and a practitioner’s history with patients of color.
Tighten with radiofrequency
How it works: Harnessing low-level radiation energy to heat the deepest layer of skin, radiofrequency stimulates cells called fibroblasts to churn out more plumping collagen, which firms skin, softens lines, and adds definition to features on the face and body. “The nice thing is that radiofrequency is, for the most part, color-blind,” says Davis. “It’s a great treatment you can use on any skin tone, and recovery time is minimal.”
What you need to know: Even so, it’s important to find a professional who understands how heat interacts with melanin. “Practitioners must have the knowledge to adjust the settings so that the treatment doesn’t cause unwanted hyperpigmentation,” Hartman says. “In those cases, I’ll do more treatments with lower energy.”
The main takeaway: With an experienced skincare professional, most aesthetic treatments can be safely performed on darker skin, and arming yourself with knowledge ensures you’ll receive the best results. That’s something to be happy about—smile lines or not.
