Everyone wants to look their best through every season of life, but choosing the best skin treatments can be challenging. This is particularly true for individuals with darker skin tones, as many laser and energy devices can cause more complications than benefits for these patients. Board-certified dermatologist Douglas Wu, MD, PhD, of Cosmetic Laser Dermatology, a skin care clinic in San Diego, CA, recently addressed those challenges in his webinar Melanated Beauty.

What is Skin of Color?

Dermatologists refer to darker skin tones as skin of color, using the Fitzpatrick skin type classification to categorize skin tones and customize treatments to ensure their safety and efficacy. Dr. Thomas B. Fitzpatrick developed this chart in 1975 based on the color of the skin and the way in which the skin responded to the sun. The Fitzpatrick scale breaks down skin color into the following types:

  • I – Pale white skin that always burns and never tans
  • II – White skin that almost always burns and rarely tans
  • III – Light brown skin that burns moderately and tans uniformly
  • IV – Moderate brown skin that burns minimally and tans easily
  • V – Dark brown skin that rarely burns and tans easily
  • VI – Dark brown to black skin that never burns

Melanocytes are the cells in the skin that are responsible for color. The more melanocytes, the darker the skin color. These cells also respond uniquely to lasers. Since darker skin tones contain more melanocytes, doctors need to use care in using lasers on skin of color to ensure the treatment produces the desired results without damaging the skin. Lasers can activate the melanocytes, causing them to produce more pigment and possibly lead to a condition known as post-inflammatory hyperpigmentation or PIH. The increased melanocytes can also make the skin more prone to burning from the laser.

Ethnicities with melanated skin tones include, but are not limited to, the following ethnicities:

Dr. Wu noted that based on current statistics, people with melanated skin are increasing in the U.S. and are predicted to continue to do so. With more patients with skin of color visiting dermatologists today, it is essential for doctors to be well-versed in how to treat all skin types safely and effectively.

PicoWay laser results on skin of color in san diegoBenefits of Lasers for Skin of Color

While there are many lasers that are not recommended for skin of color, Dr. Wu has a few different devices he can use safely at our San Diego skin care clinic on these special skin tones. When the right device is used correctly, lasers offer the following benefits:

  • Clear skin to reduce brown spots and pigmentation concerns
  • Smooth skin by reducing pore size, fine lines, and rough texture
  • Tighten skin to minimize sagging and increase lift

These issues are common with all skin types. However, treatment for lighter skin tones may differ from what works best for skin of color. Dr. Wu considers four factors when tailoring a treatment plan for a patient with darker skin: 

  • Type of laser used
  • Number of treatment sessions
  • Duration of each laser treatment session
  • Cooling of the skin during laser treatment

With many factors to keep in mind, it is clear why doctors need to understand the science behind skin of color, as well as the risks associated with treating darker skin tones the wrong way. The experience and expertise of the doctor you choose for your procedure cannot be overstated.

Primary Concerns of Melanated Skin

In his webinar, Dr. Wu lists some of the more common concerns for skin of color:


Brown spots on the skin may be the result of hormones, genetics, or sun damage and tend to occur more frequently in skin of color. These spots might include freckles, age spots, lentigos, birthmarks, and keratoses. This the most common issue Dr. Wu treats in his skin of color patients.

Laser resurfacing to treat melasma in San DiegoMelasma

This skin condition is characterized by gray or brown patches on the skin that typically occur on the cheeks, forehead, above the upper lip, and along the jawline. It is caused by increased pigmentation due to hormones, genetics, or UV exposure. Melasma cannot be cured, but you can effectively manage the symptoms.

Acne and Acne Scarring

While acne occurs in all skin types, the residual scarring can be more pronounced in skin of color. Unsightly, pitted skin and discoloration often prompt patients with darker skin tones to seek cosmetic treatments.

Roughened Texture and Enlarged Pore Size

All skin types and tones can experience a rough, uneven texture and enlarged pores over time. When it occurs in skin of color, it requires expertise in knowing which devices will produce the desired improvement without causing more issues. 

Treatment Options for Skin of Color

Dr. Wu uses a variety of devices in our San Diego office to treat these concerns in skin of color, which allows him to customize each treatment to the precise needs and goals of each patient for the best possible results. Devices that are both safe and effective for melanated skin include:

laser treatment options for skin of color in San Diego, CA

Picosecond Lasers

PicoWay, PiQo4, and PicoSure lasers emit energy in rapid pulses that shatter pigment while leaving surrounding skin and tissue untouched. The procedure is relatively comfortable and does not require any downtime afterward. These lasers treat brown spots, melasma, and acne scarring.

RF Microneedling

This procedure combines the microneedling process with the delivery of radiofrequency energy deep into the dermal layers to enhance skin improvement. Microneedling creates microscopic channels in the skin, which stimulate the body to produce more collagen. RF heating boosts collagen production even more for superior results when treating acne scarring and skin laxity.

Fractional Laser

A fractional laser works in a similar fashion to microneedling but uses a narrow laser beam to create the channels rather than needles. Dr. Wu works with a variety of fractional lasers, including Fraxel Dual. The treatment does involve some swelling and redness for a few days after treatment, but downtime is not usually necessary. This device works well on brown spots and acne scarring. To learn more about fractional laser resurfacing on skin of color, visit ncbi.nlm.nih.gov

Ultrasound Energy

Dr. Wu can also tighten skin of color safely using Ultherapy, a device that delivers ultrasound energy deep into the dermal layers and into the connective tissue. The ultrasound energy heats the tissue, causing constriction and boosting collagen production. Treatment does not require downtime and can provide long-lasting results.

Monopolar Radiofrequency 

Like any skin tone, skin of color can experience laxity and sagging over time. Dr. Wu often recommends Thermage for these patients. Thermage delivers monopolar radiofrequency energy deep into the dermal tissue without affecting the skin’s surface. The RF energy heats the tissue to cause constriction and boost collagen levels, creating smoother, firmer skin from the inside out. 

Dr. Wu closed his webinar by advising patients to be informed about the unique nature of their own skin, so they are empowered to seek the safest and most effective treatments. Melanated skin may face some unique challenges, but it is also uniquely beautiful. By working with an expert, skin of color can be safely treated with minimal complications and injuries. Finally, Dr. Wu reminded his audience that aging is a choice – with the right treatments you can be the best version of yourself at any age.

Schedule a Consultation At A Skin Care Clinic In San Diego, CA

To learn more about treatment options for skin of color, contact Cosmetic Laser Dermatology today online or by calling (858) 943-2113. Dr. Wu or any of our expert, board-certified dermatologists would be happy to meet with you and create a customized treatment plan to meet the needs of your skin and your aesthetic goals best.


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