JAAD: Cosmetic Procedures in People of Color

The Journal of the American Academy of Dermatology (JAAD) recently published an interesting new article titled: “An update on cosmetic procedures in people of color.” Also on Instagram. It is part 1 of a series of papers that I am looking forward to reading this year. It seems like the AAD is finally focusing heavily on dermatological problems in darker skinned people.

The vast majority of before and after cosmetic treatment photos that you see online are of lighter skinned individuals. This situation is slowly changing to better reflect the diverse nature of the US population, where one-third of people are now of a darker complexion. Make sure to read my recent post on the use of machine learning in improving darker skin representation in medical textbooks and schools.

Differences in Fair versus Dark Skin

Note that the authors of this update are Dr. Rebecca L. Quiñonez; Dr. Oma N. Agbai; Dr. Cheryl M. Burgess; and Dr. Susan C. Taylor. The article starts with an interesting table that delineates key difference in dark versus light skin. Dark skin is defined as skin type 3-6 on the Fitzpatrick scale.

Of interest:

  • Dark and light skinned people have the same melanocyte quantity and size.
  • However, the melanosome size is much larger in dark skin. Moreover, the melanosome distribution is throughout the epidermis of darker skinned people. In lighter skin, it is contained in just the stratum basale and Malpighian layer.
  • People with darker skin have melanin type Eumelanin. Lighter skin consists of melanin type Pheomelanin. Not surprisingly, darker skin has much higher levels of melanin versus lighter skin.

Skin Problems in People of Color

Postinflammatory Hyperpigmentation
Post-Inflammatory Hyperpigmentation (PIH) from acne. Source: JAAD via Dr. Cheryl Burgess.

Among the photos in this article is the one on the right from Dr. Burgess that shows how severely a person of color (African American in this case) can get impacted by problems such as post-inflammatory hyperpigmentation (PIH). The authors also outline differences in the facial skin aging of people of the main ethnicities in the US (White, Black, Hispanic and Asian). Moreover, morphological differences and varying cultural preferences mean that even people of color can not be considered as a monolithic entity (in terms of desired outcomes from surgeries and procedures).

Some conditions are more common in certain ethnicities (e.g., seborrheic keratoses in African American women). Different racial and ethnic groups are also more of less likely to suffer from post-inflammatory hyperpigmentation (PIH). The authors suggest focusing on other measures of skin types besides the most popular Fitzpatrick (FST) scale. Among alternatives include the Roberts Skin Type Classification System (RSTCS). This is a 4-part scale that is used to “assess and assign a numerical value to a patient’s phototype, hyperpigmentation, photoaging, and scarring capability”.

Cosmeceutical Agents and Melanogenesis Inhibitors

There now exist a wide range of cosmeceutical agents for people of color (POC). These can be used for pre-procedure and post-procedure management, as well as to address daily cosmetic concerns. I will be writing about these in detail on this blog in separate posts in the coming months. Note that even some non-prescription strength skin lightening creams can cause side effects with overuse, so always consult a dermatologist before use.

In this JAAD paper, the authors highlight some cosmeceutical agents and melanogenesis inhibitors that are popular in treating hyperpigmentation in darker skin types. Most of these act as tyrosinase inhibitors.

  • Hydroquinone.
  • Topical retinoids.
  • Hydroxy acids (lactic, glycolic, salicylic acid).
  • Azelaic acid.
  • Kojic acid.
  • Licorice extract.
  • Niacinamide.

When it comes to anti-aging, among the products that are commonly used by people of color include: antioxidants, peptides and growth factors. Photoprotection via sunscreen use is significantly lacking in the black population.

Triton Laser from InMode

In 2018, InMode launched an interesting multi-wavelength hair removal laser that could be used to treat both light skinned and dark skinned patients. The product comes with two hand-pieces:

  1. Triton Duo Light. Emits a unique blend of three wavelengths. Best for treating light hair and skin types I to III. Uses the 755nm Alexandrite and 810nm Diode lasers. Duo Light is supposedly the only “simultaneous multi-wavelength technology” per the manufacturer’s website.
  2. Triton Duo Dark: Uses the 810nm Diode and 1064nm Nd:YAG wavelengths simultaneously. Best used to effectively and safely treat darker skin types. Operates at a high peak power output and comes with the company’s 3P Cooling technology.

I have not seen much new information about this laser in recent years. The latest video on the Triton Duo Dark from InMode seems to be only from 2018:

Even on Instagram (#tritonlaser), you do not see much on the use of Triton Duo Dark lasers for treating darker skinned individuals. Most recent videos seem to be about people with lighter fair skin. In any event, this is an interesting product, so I decided to write this short post on yet another treatment option.

Motus Lasers from DEKA

The DEKA Motus AX & AY hair removal lasers use the proprietary “Moveo” technology. Moveo means move in Italian, and these lasers use “in motion” technology. The latest version is the Motus AZ+.

Motus AX and AY Lasers

  • The original Motus AX laser was the first, high-speed Alexandrite laser that could also treat dark skin tones safely despite the lower wavelength. Historically, darker skinned people who wanted laser treatments had to use higher wavelength diode or Nd:YAG technology. These latter types of lasers are a bit less effective, but also less likely to cause skin damage in darker skin tones. Given the power of the Alexandrite wavelength, individuals could see desired long-term results in fewer treatment sessions.
  • The Motus AY shares the same innovative laser delivery system as the Motus AX. The main difference is that the AY laser hair removal machine also comes with a Nd:YAG hand piece. Repeated passages of the hand piece and low power pulses prevent any major side effects and safety concerns.

Motus AZ+

Motus Laser
Motus MZ+ lasers are used for hair removal, lesion reduction and skin rejuvenation.

The success of the original DEKA Motus AX and AY platforms has resulted in the new Motus AZ+ laser machine (see video below). It features Gold Standard laser technology with both the Alexandrite (755nm) and Nd:YAG (1064nm) wavelengths. This enables the product to deliver effective treatments for darker skin types.

In addition to hair removal (like its predecessors), Motus AZ+ lasers can treat three other skin conditions. It comes with four separate hand pieces to cover the following laser treatments:

  • Hair Removal. Used the SkinclusiveTM Alexandrite laser hair removal technology.
  • Pigmented Lesions. Using Alexandrite.
  • Skin Revitalization. Using Nd:YAG.
  • Vascular Lesions. Using Nd:YAG.

Motus AZ+ is manufactured by DEKA, Europe’s top aesthetics laser manufacturer. It is available exclusively in the US via Cartessa Aesthetics.

The latest version: Motus AZ+

The Deka Motus AZ+ “in-motion” Alexandrite and Nd:YAG gradual heating results in treatments that are comfortable and quick. The 20mm sapphire tip means that larger areas can be treated quickly. The AZ+ also features integrated contact cooling, limiting potential skin damage and discomfort from overheating.

Dr. Paul Frank’s nurse treating a patient with Motus AX: