Section 4 Plastic and Reconstructive Problems

Laser Skin Treatment in Non-Caucasian Patients

area of treatment may be performed, as individ- uals of the same ethnicity and phototype may react differently to the laser depending on variable skin characteristics. 14 Test spots should be started at low-density, low-fluence, and longer- pulse-duration settings. Full response and side ef- fects should be observed at 1 month, at which point scarring and pigment changes will likely be evident. Fig. 3. Laser hair removal. Lasers can be used for treat- ment of hypertrichosis in all skin types by targeting the melanin chromophore in the hair follicle with a low risk of dyspigmentation. PROCEDURAL APPROACH: CHOOSING A LASER For historical reasons, one should note the ablative nonfractionated lasers, including the 10,600-nm carbon dioxide (CO 2 ) laser, the 2940-nm erbium- doped yttrium aluminum garnet (Er:YAG) laser, and the combined CO 2 Er:YAG laser (see Table 3 ). These lasers target the water molecules in the dermis and vaporize the epidermis. This laser has the most significant outcomes with significant improvement of fine wrinkles and acne scars. 9 However, side effects are a significant issue with this category of devices and include acne, perma- nent hypopigmentation, temporary hyperpigmen- tation, skin infections, and scarring. For these reasons, ablative nonfractionated lasers should be used with extreme caution in patients with

Fig. 2. Dyschromia may present as hyperpigmentation or hypopigmentation and is one of the most common treatment goals of laser therapy in ethnic populations.

care to patients to optimize facial skin health before procedures. Sun should be avoided when possible, and mechanical and chemical blockade (broad-spectrum A and B sunscreens) should be used daily. Acne vulgaris can be treated with topical and oral antibiotics, hormonal treatments, and isotretinoin safely in all skin types and should be optimized before starting laser rejuvenation therapy. 8 However, all isotretinoin should be avoided for 6 to 12 months before starting laser therapy due to the possibility of poor healing. In addition, all herpes simplex virus (HSV) outbreaks should be treated with antivirals, and prophylaxis antivirals should be given to patients with HSV before starting laser treatments. Additional topical treatments with melanin sup- pressors, such as hydroquinones, kojic acid, aze- leic acid, or emblica, may be considered for treatment of dyspigmentation and melasma before laser treatments, particularly in dark phototypes where nonablative laser therapies require a series of treatments to achieve satisfactory results. 4 When considering laser treatment on a patient with dark skin, a test spot adjacent to the intended