Aesthetic treatments and clinical differences in different Fitzpatrick skin types

A growing middle class around the world is enjoying the luxuries that increased disposable income can afford. The reduced costs of medical aesthetic treatments are contributing to the overall growth of the aesthetic beauty market, which is expected to reach a global market size of US$15.9 billion by 2025¹.

Consumers are now more aware than ever about aesthetic treatments, ranging from laser hair removal to injectables. Because they see these services as an investment in their long-term success² they’re also doing more research into the clinics they choose to frequent.

This is where a physician’s knowledge becomes relevant. Doctors can educate clients about the intricacies of achieving a specific aesthetic ideal, and how different aesthetic technologies might affect them on that journey. This includes knowledge about Fitzpatrick skin types, which have historically restricted the range of treatments³ certain patients could receive.

Understanding how Fitzpatrick skin types differ

With the Fitzpatrick skin type, or phototype, physicians categorize different skin colors based on their melanin content. This is important because different phototypes react differently to ultraviolet radiation⁴ and laser treatments.

There are six Fitzpatrick skin types. Skin types I to III burn easily and tan poorly. Many traditional lasers have been tested and designed for these skin types. Skin types IV to VI tend to burn less but are more prone to developing post-inflammatory hyperpigmentation⁵ (PIH) after injury or external triggers. Because laser treatments can impact the amount of melanin in the area of treatment, they can inadvertently cause hypopigmentation or hyperpigmentation when used on darker skin.

Darker phototypes also tend to have an increased prevalence of pigmentary disorders and a higher prevalence of keloids, which could lead to hypertrophic scarring. A doctor that mainly practices on lighter skin types may assume that their laser device is safe for more diverse clients—but these assumptions may eventually result in unexpected effects and, in worst-case scenarios, medical malpractice suits⁶. 

Being a responsible physician and beautician requires accommodating these differences. Every patient has different needs, and by developing a customized treatment that helps the patient achieve their personal standard of beauty, doctors can strengthen their relationship and establish their value in an increasingly saturated market. 

Traditional treatments have alienated consumers

The use of traditional millisecond or nanosecond lasers is restricted to certain phototypes due to the unpredictable rate of PIH among different phototypes. Lasers of the past—CO₂ lasers and Q-switched (QS) lasers—tended to cause scarring and microscopic thermal damage because of the large, imprecise amounts of photothermal energy being released.

These traditional lasers can safely remove benign pigmented lesions in just one or two sessions in lighter Fitzpatrick skin types. But when used on benign lentigines in darker phototypes, they carry a relatively high risk of PIH—anywhere from 25% to 47% risk⁷. 

Modern solutions to treat all skin types

Named after the ultra-short picosecond pulses they utilize, picosecond lasers were originally designed for tattoo removal. Their pulses are over 100 times shorter than Q-switch lasers, and their higher peak power, yet shorter durations, deliver a non-thermal, photoacoustic effect that results in faster, more efficient clearance of cutaneous blemishes. Their benefits are outlined in the 2020 paper A Systematic Review of Picosecond Laser in Dermatology⁸, published by PhD Douglas C. Wu, PhD, in the Lasers in Surgery and Medicine Journal. 

Picosecond lasers have been shown by over 70 studies to be clinically successful in treating medical and cosmetic cutaneous conditions across all skin types, without the risk of unwanted side effects that other, older technologies cause⁸.

Considering the differences in picosecond lasers and devices

As picosecond technology is relatively new, practices should consider carefully when selecting devices for their practices. There are a number of picosecond wavelengths that have already been cleared by the Food and Drug Administration (FDA). The PicoWay System’s 730 nm wavelength handpiece⁹ , for example, is FDA-approved for the treatment of benign pigmented lesions and green tattoo removal¹⁰.

Picosecond lasers vary by wavelengths and pulse durations. The handpiece mentioned above has a competitive pulse duration of just 250 picoseconds, and one study showed that the 730 nm wavelength laser successfully absorbed 14% more melanin¹¹ than a 755 nm picosecond wavelength.

Candela’s PicoWay^® system contains wavelength of 532 nm, 730 nm, 785 nm, and 1064 nm¹² on a single platform. Each has its own unique strengths when handling specific skin conditions and phototypes.

1064 nm and 532 nm wavelengths can treat pigmented lesions without excessive photothermal effects. All four wavelengths can also be used to clear away different tattoo ink colors and treat various kinds of pigmented lesions. The 1064 nm is especially relevant for doctors with diverse clients: it can be used accordingly to target deeper lesions and severe photo-damaged skin on all Fitzpatrick skin types¹³. 

When comparing picosecond lasers—or any laser device at all—physicians should also consider ease of use. Some medical aesthetic devices may use multiple handpieces to adjust beam shapes and spot sizes. The PicoWay¹⁴ system avoids this hassle with the use of dials and software to change spot sizes*. Physicians can further control wavelength, fluence, and repetition rate¹⁵ to deliver treatments that suit any client who walks through their doors.  

The final factor to consider when selecting a picosecond device is it's actual versus specified performance. The difference between expected and delivered energy in competing picosecond systems has been shown to vary by up to 40%^16,17 Additionally, their pulse widths have exhibited variances of up to 194%—relatively high compared to the recorded 9% to 24% beam width variance of PicoWay pulses.

Select the laser that delivers the most outstanding experience

Much progress has been made in laser technology, making it possible for physicians to treat a wide range of conditions and clients with a single machine. Factors to consider when selecting a high-quality laser device include: 

• A wavelength that is specific to and well absorbed by the patient’s skin conditions’ chromophores
• A laser that achieves adequate skin penetration depth
• A laser that does not cause extensive overheat at surrounding tissues
• Customisable treatment parameters (adjustable power, spot size, fluence, and repetition rate)
• Clinically significant clearance measurable by a reduced number of treatment sessions relative to other laser treatment options and patients’ satisfaction
• Suitable for a wide range of Fitzpatrick skin types
• Consistency in energy output and laser pulse width

Candela is passionate about developing technologies that are reliable, consistent, and clinically successful for all consumers. The PicoWay laser system and handpieces are a versatile all-in-one tool in the hands of a skilled doctor, allowing them to increase the variety of clients they can accept. If you are interested in exploring laser options for your clinic, get in touch with Candela here.