Energy-Based Devices: Optimizing Outcomes in Skin of Color

CONTRIBUTOR:‍ ‍Dr. Sheila Barbarino, MD, FAAO, FAACS, FACS

Overview

Many clinicians have avoided lasers and energy-based devices in patients with darker skin tones because of the risk of PIH, hypopigmentation, burns, and scarring. These concerns are real, melanin competes as a chromophore and holds heat longer, raising the risk of injury. But as Dr. Barbarino emphasizes, with the right prep, parameters, and post-care, lasers can be both safe and effective.

A message From OUR COUNCIL:

‍Dr. Sheila Barbarino

“In novice hands, especially with darker skin types, outcomes can be irreversible. “

DIY devices promoted online are risky. Patients should avoid them and work with medical professionals who can ensure safe, tailored care.

If You See Trouble…

• EARLY WARNING SIGNS

  24-48 hours post-procedure:

  • Persistent Dark Redness
    Consider oral + topical steroids promptly.

  • Severe Pain
    Add anti-inflammatory therapy + steroids as indicated.

  • Blistering or Worsening Redness
    Follow daily and escalate treatment quickly if symptoms progress.

• PIGMENTARY CHANGES

  • Post-Inflammatory Hyperpigmentation (PIH)
    Treat with hydroquinone, vitamin C, or other brightening agents.

  • Hypopigmentation
    Consider bimatoprost to support repigmentation.

• SUPPORTIVE CARE

  • Monitor Daily
    Have patients submit daily photos to track healing and identify changes early.

  • Cool + Hydrate
    Encourage hydration, cooling masks, cold compresses, and LED therapy when available.

  • Avoid Heat for 24–48 Hours
    Limit exercise, saunas, hot showers, and other heat triggers during early recovery.

Dr. Barbarino’s Top Pearls

• PREP MATTERS.
  Start melanocyte-stabilizing topicals 4–6 weeks before treatment; stop photo-sensitizers; enforce strict SPF

• POST-CARE IS CRITICAL.
  Ice/cooling masks immediately and for 24-48 hrs if redness or pain persists. Watch for dark red skin and start oral/topical steroids early

• CULTURE COUNTS.
  In many Asian, Hispanic, and Middle Eastern cultures, pigment is undesirable, so expectations need extra care

• IF HYPOPIGMENTATION OCCURS
  Bimatoprost can sometimes help restore pigment.

• STAY CLOSE.
  Daily photo check-ins in the first 48 hrs catch adverse events early

Frame the conversation with patients

• Be transparent: Name risks of PIH, hypo, and scarring up front

• Show real cases: Before/after photos of similar tones set realistic expectations

• Use test spots: Demonstrates safety and builds patient confidence

• Set expectations: Improvement takes multiple sessions; safety comes before speed

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RESOURCES AND REFERENCES

Laser Use in Skin of Color: 
Guidelines and Reviews
Kaushik S, Alexis A, Nonablative Fractional Laser Resurfacing in Skin of Color: Evidence-based Review
J Clin Aesthet Dermatol. 2017;10(6):51–67 

Alexis A, How to Properly Use Lasers in Skin of Color Patients
Dermatology Times, January 2023 (Vol. 44. No. 01)

Hyperpigmentation: 
Moolla S et al., Dermatology: how to manage facial hyperpigmentation in skin of colour.
Drugs Context. 2022;11:2021-11-2.

Roberts WE, et al., Laser Treatment of Skin of Color for Medical and Aesthetic Uses With a New 650-Microsecond Nd:YAG 1064nm Laser. J Drugs Dermatol. 2019 Apr 1;18(4):s135-137. PMID: 31017752.

Acanthosis nigricans:
Bitterman D, et al.  Systematic review of topical, laser, and oral treatments in acanthosis nigricans clinical trials. Arch Dermatol Res. 2024 Jun 21;316(7):424. doi: 10.1007/s00403-024-02931-3. PMID: 38904687.

Rosacea: 
Chen, A., et al Review of laser and energy-based devices to treat rosacea in skin of color.
Journal of Cosmetic and Laser Therapy, 2024,  26(1–4), 43–53.

Acne:
Huerth Ket al., Established and Emerging Laser Treatments for Acne Vulgaris in Diverse Skin Types. J Clin Aesthet Dermatol. 2025 Jun;18(6):41-48. PMID: 40575606; PMCID: PMC12189219.

Combination Lasers and Peels

DIY Laser Use

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