PHOENIX - Using laser technology to treat patients requires not only paying attention to the color of their skin, but also to the patient's ethnicity, according to Dr. Eliot F. Battle Jr.
"In my practice we don't just talk about skin of color anymore," Dr. Battle said at the annual meeting of the American Society for Laser Medicine and Surgery. "We talk about skin of cultures. It's not just their skin color but their ethnicity also makes a difference."
Photo courtesy Dr. Eliot F. Battle, Jr.
Before image of a patient treated with the long pulsed Nd:YAG laser for hair removal.
He explained that African Americans "have different combinations of black, white, Latin, Spanish, and Indian. Is my ethnicity a mixture of Nigerian, Italian, and Cherokee Indian, or am I a mixture of Cameroonian, Spanish, and Creek Indian? The future of this field, to improve the way we treat people, is going to appreciate more ethnicity as it relates to skin of color."
Brown skin "competes for the light of the laser, because melanin is absorbed across most of the photobiological spectrum, and we are a diverse population of people," said Dr. Battle, who said that he is a mix of Saharan African, Indo-European, and Asian. "To safely treat skin of color we have to use lower wavelengths, lower fluences, lower pulse durations, and aggressive epidermal cooling."
When he treats skin of color, Dr. Battle, a cosmetic dermatologist and laser
Photo courtesy Dr. Eliot F. Battle, Jr.
After image (results at 1 year after 12 treatments) of a patient treated with the long pulsed Nd:YAG laser for hair removal.
surgeon who is director of Cultura Cosmetic Medical Spa in Washington, normally favors an integrated approach and often combines laser treatments, medical skin care, and facial injectables.
For safe laser-hair removal in patients with Fitzpatrick skin types V and VI, Dr. Battle recommends using a long-pulsed diode laser and the long-pulsed Nd:YAG laser.
Safe lasers for complexion blending and skin rejuvenation to improve texture include the microsecond Nd:YAG laser, fractional therapy, the excimer laser, the Q-switched Nd:YAG laser, and the potassium-titanyl-phosphate (KTP) laser, while safe lasers for skin tightening include infrared lasers and radiofrequency technology.
"There are many lasers we can use for skin of color," he said. "The key is to find a laser that you're comfortable with. Become an expert with that laser and go forward. I don't treat skin of color with vascular lasers, resurfacing lasers, or with intense pulsed light. I don't trust most parameters supplied by the manufacturers. I find my own, safe parameters. I treat more conservatively, and I do not cause erythema or edema."
Aggressive skin cooling is key, he said, and can include ice packs, cold gel, cold liquid, cold air flow, a copper plate, and sapphire windows. "We all get side effects when our skin temperature goes past 45° C," said Dr. Battle, who is also on the dermatology faculty at Howard University, Washington. "By using longer pulse durations, and thus pouring the energy in slower, I'm able to remove heat from the skin more effectively and more efficiently. Longer pulse durations are by far the safest way to treat skin of color."
More than two-thirds of Dr. Battle's patients have darker skin. Between 2002 and 2009, the two most popular nonsurgical procedures in his practice were laser hair removal and laser complexion blending, followed by Botox injections, laser skin rejuvenation, fillers, and laser skin tightening.
Lasers "have come a long way in the last decade," he said.
If side effects occur "show compassion and empathy," Dr. Battle noted. "Allow time to help, and always be available to your patients, even if it means giving them your cell phone number."
Dr. Battle disclosed that he has received equipment, discounts, and honoraria from a number of medical device companies.