PHOENIX - In the last 2 years, complexion blending has been the most sought-after procedure in Dr. Eliot F. Battle Jr.'s practice.
One of his favorite devices for treating dark spots, melasma, postinflammatory hyperpigmentation, and scarring is the microsecond Nd:YAG laser. With this device, "we're driving heat down deep and trying to break up pigment … that's been encapsulated by membranes," Dr. Battle said. "For a dark spot to last for months or years, we know there is a pigment problem in the dermis. Fractional technology has also been used, but we treat conservatively. I don't ever use the manufacturer's parameters. I don't cause erythema or edema. I'm always under the threshold of redness and swelling."
Speaking during the annual meeting of the American Society for Laser Medicine and Surgery on laser treatment for skin of color patients, Dr. Battle's take-home advice was to reduce conventional parameters and fluences to avoid erythema and edema.
"There are many lasers to use on Caucasians for complexion blending," he said.
Photo courtesy Dr. Eliot F. Battle, Jr.
A patient is shown before and 6 months after undergoing treatment with the microsecond Nd:YAG laser for complexion blending and texture improvement.
"For skin of color, we're limited to the microsecond Nd:YAG, Q-switched Nd:YAG, KTP [potassium-titanyl-phosphate], and infrared lasers."
Prior to treatment he asks patients about their ethnic background because ethnicity plays as much a role in how their skin reacts as their skin color, he said.
He also gets a sun protection history to find out whether he will be treating brown skin that is sun protected, as is the case with some people of Pacific-Asian ancestry, or whether he will be treating brown skin that has been suntanned, as is the case with some people of African-American ancestry.
"Don't make assumptions," he said. "Don't think that the person in front of you, who has the same skin color as the person you just treated, has the same response to lasers, because the ethnicity of the patient dictates how the skin reacts as much as their skin color."
He also recommends investing in an imaging system, such as the VISIA Complexion Analysis system, "that allows us to see what we're treating."
To maximize results of complexion blending, consider concomitant nonlaser "old-school" treatments, such as aesthetic peels, hydroquinone, and a hyfrecator, he said.
"The true art of cosmetic therapy is integrating spa treatments, cosmeceuticals,
Photo courtesy Dr. Eliot F. Battle, Jr.
A patient is shown 6 months after undergoing treatment with the microsecond Nd:YAG laser for complexion blending and texture improvement.
prescription medications, and lasers all together," remarked Dr. Battle, who is also on the dermatology faculty at Howard University, Washington. "Lasers don't speak for themselves, particularly when treating pigmented lesions such as melasma and dark spots. We really have to take advantage of the product side of this, also. We have most of our patients on alpha hydroxy acids, Retin A, vitamin C, and we use hydroquinone bleaching cream up to 12%. I'm not bashful with hydroquinone. I monitor them very closely, but I think our patients can benefit from a higher strength."
Dr. Battle disclosed that he has received equipment, discounts, and honoraria from numerous medical device companies, including Canfield.