66 / 86
distinguish between melasma and postinflamma-
tory hyperpigmentation when considering laser
therapy.
4,7,11–13
Options for laser treatment of
dyschromia include the Nd:YAG laser and frac-
tional nonablative devices.
7
Laser Hair Removal
The use of lasers for hair removal relies on melanin
absorption within the hair follicle (
Fig. 3
). Laser hair
removal may be complicated in patients with dark
skin because of unintended epidermal overheating
leading to blistering, crusting, and subsequent
pigmentary changes.
4
With this in mind, longer-
wavelength lasers (1064-nmNd:YAG) with lower flu-
ences and skin cooling may be used successfully in
darker skin types for the treatment of hypertrichosis.
2
Keloids and Hypertrophic Scarring
Keloids and hypertrophic scars occur more
commonly in dark-skinned individuals. Laser treat-
ment of thickened scars may be considered in
combination with intralesional steroid injections.
4
The pulsed dye laser has been shown to decrease
erythema, improve pain and pruritus, decrease
lesion height, and improve hypertrophic scar
pliability. These effects may facilitate intralesional
steroid injection. However, the pulsed dye laser
can target epidermal pigmentation and must be
used with caution in patients with dark skin. Ke-
loids may also be treated with the 1064-nm
Nd:YAG laser with moderate results of mild ke-
loids. The lesion is injected with intralesional triam-
cinolone 10 mg/mL up to 3 mL before starting
therapy with regular laser treatments (fluence 13–
18 J/cm
2
, 2000 pulses) for 6 weeks.
2
After 7 weeks,
the lesion may be reevaluated and treatment
repeated if necessary.
PREPROCEDURAL PLANNING: MEDICAL
OPTIMIZATION
Before embarking on laser rejuvenation of facial
skin, it is important to emphasize routine skin
Table 3
Classes of lasers and clinical outcomes
Laser
Outcomes
Risks
Ablative nonfractionated
10,600-nm CO
2
laser
2940-nm Er:YAG laser
Combined CO
2
Er:YAG laser
Dramatic improvement in wrinkle
reduction, alleviate acne and
atrophic scars
7
Oozing, bleeding, and crusting
(100%)
7
; acne, transient
hyperpigmentation and
hypopigmentation (IV) (55%–
68%)
7,8
; scarring and poor
wound healing, permanent
skin hypopigmentation
4,7
Nonablative nonfractionated
1319-nm pulsed dye laser
1320-nm Nd:YAG laser
1540-nm diode laser
Improvement scar severity
(29%)
3
; improvement acne
scars (10%–50%)
2,9
; atrophic
scarring and acne-induced PIH
(III–VI) (51%–75%)
5
; limited
wrinkle improvement
2
Minimal, few hours of erythema,
no scaling or peeling, no
abnormal pigmentation
7
Nonablative fractionated
1410-nm laser
1440-nm Nd:YAG laser
1540-nm laser
1550-nm Er laser
1927-nm thulium fiber laser
Moderate improvement in
texture and wrinkles
4
;
significant improvement in
acne scarring (51%–75%)
3,5
and overall appearance:
excellent (30%), significant
(59%), moderate (11%)
3,9
; safe
in dark skin types because of
limited tissue damage and
melanocyte stimulation
7
Moderate downtime; moderate
pain
5
; postinflammatory
hyperpigmentation (III, IV, V)
(3%, 12%, 33%, respectively)
5
;
acne (2%)
8,10
; herpetiform
eruptions (2%)
8,10
Ablative fractionated
10,600-nm fractional CO
2
laser
2940-nm fractional Er:YAG
laser
1790-nm fractional Er:YSGG
laser
Moderate resurfacing power for
mild skin laxity and rhytides
2
;
moderate improvement in
photodamage, scars (37%), and
dyspigmentation
2,7
Moderate downtime, moderate
complications
8
;
postinflammatory
hyperpigmentation (II–V)
(44%)
3
; use with caution in skin
type VI
2
Abbreviation:
PIH, post-inflammatory hyperpigmentation.
Data from
Refs.
2–5,7–10
Richter et al