Laser, IPL and Chemical Peels on Olive and Darker Skin: Pigmentation Risk, Choice of Device and Safety Precautions

Why are laser and peels planned more carefully on darker skin?

The substance that gives skin its colour is melanin. Many laser and IPL devices direct light energy at a target, for example the hair root or a dark spot; however, the melanin in the upper layer of the skin also absorbs part of this light. The more melanin there is in the skin, the greater the share of the energy meant to reach the target that is converted into heat at the surface. This increases the risk of burns and changes in colour.

The second reason is that in darker skin the pigment cells react more strongly to stimuli. Scientific reviews characterise darker skin by the greater amount of melanin in the upper layer, pigment cells that are easily affected and more reactive wound healing. For this reason, an irritation caused by light, heat or acid that might pass without leaving a mark on fair skin can turn into pigmentation lasting months on darker skin.

This does not mean that people with darker skin cannot be treated. Whereas first-generation lasers were generally not recommended for darker skin, it is reported that today, with suitable technology and settings, treatment can be carried out on these skin types too. The difference is that the margin for error is narrower.

Which is my skin type? The Fitzpatrick classification and its limits

When assessing skin type, physicians often use the Fitzpatrick classification. This classification divides skin into six groups, from type I to type VI, according to how easily it burns in the sun and how much it tans. In this article, by darker skin we mean mainly types IV, V and VI; however, type III skin, which first reddens slightly in the sun and then tans markedly, is also more prone to pigmentation than fair skin.

Medium-olive skin tones are common in Turkey, and many of these people do not think of themselves as dark-skinned. Yet skin that looks fair in winter and tans easily in summer is in the group that calls for care with laser and peels. If dark marks that take a long time to fade are left after a spot, an insect bite or a small wound, your skin is prone to pigmentation, and it is important to tell your physician this.

The skin type test in the tools section of our site can give an approximate idea of how your skin reacts to the sun. The result is not a diagnosis. The Fitzpatrick classification measures the response to the sun; it does not fully describe skin colour or ethnic background, and it is less discriminating in darker skin. For a decision on a procedure, your skin type needs to be assessed by a physician at an examination.

What changes in colour can occur?

The most common problem is post-inflammatory hyperpigmentation, that is, darkening of the skin that develops after irritation or damage. In darker skin it is both more frequent and more noticeable. It mostly fades over time; however, how long this takes varies from person to person, may be longer in darker skin and is prolonged in sun-exposed skin.

The less common problem is hypopigmentation, that is, the skin remaining lighter than its surroundings. It suggests that the pigment cells have been damaged, is more conspicuous in darker skin because of the contrast with the surrounding skin, and may be slower to improve. In some cases it may be long-lasting or may not reverse. After deep burns, scarring can also develop and, in people prone to scar tissue, raised scars (keloids).

The signs of these problems, what to do at home and the treatment options are described in detail in our articles “Burns and Pigmentation Changes after Laser and IPL: Darkening, Lightening and Scarring — Prevention and What to Do” and “Problems after a Chemical Peel: Prolonged Redness, Dark Spots, Infection and Scarring — What to Do?”. In this article we focus instead on how the risk can be reduced from the outset.

Why does the choice of wavelength and technology matter with laser?

Each laser produces light at a particular wavelength, and the wavelength determines how much of the light is absorbed by melanin. In general, longer wavelengths are absorbed less by melanin and penetrate deeper into the skin; as a result the pigment at the skin surface heats up less. For laser hair removal on darker skin, the options that feature most prominently in the scientific literature are the long-pulsed Nd:YAG laser and the diode laser used with long pulse durations.

Wavelength alone is not enough. For darker skin, publications recommend lower energy levels, longer pulse durations, effective cooling that protects the skin surface and spreading the result over more sessions. This means a plan that progresses more slowly than for a fair-skinned person but is safer. An approach that promises results in a short time, or applies the same settings to everyone without asking about your skin type, is a warning sign.

A device’s brand, or its name in advertising, does not show whether it is suitable for your skin. What you need to ask is which technology and wavelength the device works with, whether it is used on your skin type, and how much experience the practitioner has with this skin type. For a general description of the procedures, see our articles “Laser Hair Removal: How It Works, Who It Suits and What to Watch For” and “Fractional Laser: How Suitable Is It for Acne Scars, Wrinkles and Skin Texture?”.

Why is tanned skin a separate risk?

A tan is additional melanin that the skin produces in response to the sun. In other words, as far as the procedure is concerned, tanned skin temporarily behaves like a darker skin type, and the pigment cells are already stimulated. Even in a fair-skinned person a tan increases the risk of burns and pigmentation; on olive skin this effect is more marked still.

For this reason, light-based treatments are usually postponed on tanned skin. Sunbeds and self-tanning lotions are treated in the same way. How long to wait varies with the device, the area and your skin; this period is decided by the physician who sees your skin. Planning a procedure in the summer months, or just before or after a holiday in the sun, is a common mistake that increases the risk.

What is a test pulse, and what is it for?

A test pulse means delivering a few pulses at the planned settings to a small and usually inconspicuous area before the full session and observing how the skin reacts. Because signs of a burn can appear within hours and days, and changes in colour within weeks, the assessment is not made immediately; your physician determines how long to wait.

A test pulse is no assurance of a trouble-free result. A favourable test suggests that the risk is low but does not show that it has been removed, because skin can react differently from one area to another and factors such as sun, medicines or a change of settings can come into play at later sessions. It is sensible for people who have darker skin, a history of pigmentation or are having a light-based treatment for the first time to ask whether a test pulse will be carried out.

How is a chemical peel chosen for darker skin?

With a chemical peel, the risk is closely related to how deep the acid penetrates into the skin. On darker skin, superficial peels that affect only the uppermost layer of the skin are generally preferred. With medium and especially deep peels, the risk of colour change and scarring increases markedly; for this reason physicians are very selective on darker skin.

In a single-centre, retrospective study examining superficial peels in patients with medium-olive and darker skin, the frequency of adverse effects was found to be low; crusting, post-inflammatory darkening and redness were the most common, and these resolved over months. In the same study, the likelihood of an adverse effect was found to be higher in the darkest skin type and lower in the winter months. These data suggest that in experienced hands superficial peels can also be carried out on darker skin; however, the results of a single centre cannot be generalised to every setting.

• Preparation: the physician may recommend a skin care plan that prepares the skin in the weeks before the procedure, and sun protection. The physician decides which product is to be used.
• Timing: the months when the sun is strong and periods of holiday in the sun increase the risk.
• The condition of the skin: a peel is not applied to skin that is irritated, peeling, or has an active cold sore or infection.
• The products you use: be sure to mention before the procedure any acid-containing, exfoliating or prescription creams you use at home.
• High-strength acids for home use: strong peeling solutions bought online can cause long-lasting pigmentation on darker skin; do not apply these on your own.

The types of peel and the recovery process are described in our article “Chemical Peels: What They Are, Who They Suit and What Recovery Involves”.

Why is sun protection so decisive?

Treated skin is more sensitive to the sun for a time, and the pigment cells are easily stimulated. For this reason, sun protection is the basic step in preventing pigmentation on darker skin, and it should begin in the weeks before the procedure and continue afterwards. Choosing the shade and wearing a wide-brimmed hat and protective clothing are as important as sunscreen.

There is an additional detail for darker skin: not only ultraviolet rays but also visible light can cause pigmentation in people with darker skin. Broad-spectrum sunscreens protect against ultraviolet rays but may not provide adequate protection against visible light. Because tinted sunscreens containing iron oxide also provide protection against visible light, they may be useful for people with a tendency to pigmentation. You can ask your physician which product is suitable for you.

The idea that people with darker skin do not need sunscreen is a common misconception. Melanin provides some natural protection, but it is not enough to prevent pigmentation and colour change after a procedure. For the causes and treatment of existing pigmentation, see our article “Dark Spots and Melasma: Causes, When to See a Physician and What Treatments Are Available”.

Be sure to tell your physician before the procedure

• If pigmentation that took a long time to fade was left after a spot, a wound or a previous procedure
• If you have a tendency to raised scars (keloids) or there is such a history in your family
• If you have melasma or another pigment problem
• If in recent weeks you have sunbathed, used a sunbed or used a tanning product
• All the medicines, herbal products and skin care products you use regularly
• If you have a history of cold sores
• Whether you are pregnant or breastfeeding

When should you contact a physician after the procedure?

When you notice a change in colour, do not try a skin-lightening cream, an acid-containing product or a new procedure on your own; on darker skin any irritating treatment can darken the pigmentation. Early assessment by a physician helps the process to be managed better.

What can you do to reduce the risk?

• Ask for the procedure to be planned by a physician who assesses your skin type by examination and has experience with darker skin.
• Ask not about the brand of the device but about its technology and its suitability for your skin type.
• Ask whether a test pulse or a trial on a small area will be carried out.
• Do not sunbathe or use sunbeds before and after the procedure; do not let your sun protection lapse.
• Do not ask for the energy to be increased or the sessions to be brought closer together for a quick result.
• If during the procedure you feel a sharp pain or burning that is different from what was expected, say so immediately.
• When assessing the place where the treatment will be carried out, make use of our article “A 10-Point Safety Checklist for Choosing a Clinic and Physician for Medical Aesthetics”.

Limits of the evidence: most of the publications on laser and light treatments in darker skin were carried out in patients of East Asian origin; data are more limited for very dark skin (types V–VI) and for the medium-olive skin common in Turkey. Most of the studies are small and retrospective. For this reason you cannot be given a personal risk rate. This page is for general information and does not replace an examination.