Inclusive Cosmetic Care: Navigating Risks, Costs, and Outcomes in Laser Therapy

Cosmetic dermatology offers a wide variety of treatments, each with unique benefits and associated risks. As interest in antiaging procedures like laser therapy continues to grow, many patients remain unaware of critical aspects of these interventions. This knowledge gap often stems from limited access to accurate information, unrealistic expectations, and insufficient communication between patients and providers. Since patients may not always know what questions to ask, health care professionals—beyond dermatologists—must be proactive in clearly and effectively conveying key information about these procedures as outlined below.

Accurately Explaining the Treatment
Laser therapy works by stimulating collagen remodeling, enhancing skin strength, elasticity, and firmness. Collagen, a structural protein, naturally declines with age, leading to wrinkles, skin sagging, and textural irregularities. Lasers deliver controlled energy to the skin, activating the body’s healing response and prompting the production of new collagen. This process smooths skin texture, reduces fine lines, diminishes scars, and addresses pigmentation concerns, resulting in a rejuvenated appearance.

Communicating Patient-Specific Risks
While laser therapy has a low overall risk profile, patients must be informed about potential adverse reactions, including burns, scarring, postinflammatory hyperpigmentation (PIH), hypopigmentation, and infection. Importantly, these risks are not evenly distributed among all patient populations.

Commonly recognized risk factors, such as older age, atherosclerotic disease, and poor blood flow, can impair healing. However, the impact of skin color on treatment outcomes is often underappreciated by patients. Adverse events occur disproportionately in individuals with darker skin colors (higher Fitzpatrick types), as increased melanin content absorbs more energy, elevating the risk of heat-related damage and pigmentation changes.^1,2 This risk can deter patients from considering laser treatment, and without awareness of safer, tailored therapies, it may lead them to pursue suboptimal options that fail to address their needs effectively.

Exploring Alternative Treatment Options
Lasers are broadly categorized into ablative and nonablative therapies, each with distinct indications. Ablative lasers are particularly useful for addressing wrinkles, scars, and textural irregularities by targeting the outermost layer of skin (epidermis) to stimulate collagen remodeling.³ However, their use in higher Fitzpatrick types often requires adjunct treatments, such as pre- and post-laser regimens with depigmenting agents, anti-inflammatory therapies, and moisturizers, to mitigate risks of PIH, hypopigmentation, and scarring.⁴

Nonablative lasers, which penetrate the dermis while sparing the epidermis, are safer for darker skin colors because they reduce pigmentation risks, but they are less effective for surface-level issues like fine lines or shallow scars.^3,5 As such, achieving optimal outcomes requires a personalized approach to balance safety and efficacy.

Addressing Patient-Specific Costs
Most cosmetic laser treatments are considered elective and are not covered by insurance, leaving patients to bear the full financial burden. While costs can vary significantly depending on the type of treatment, the treatment area, and the number of sessions required, additional adjunct treatments required for these cosmetic procedures can further exacerbate costs in darker-skinned patients. This disparity highlights inequities in cosmetic dermatology, reinforcing the need for transparency in cost discussions and equitable access to safe, effective treatments.

Closing Remarks
The challenges faced by patients with darker skin colors in cosmetic dermatology highlight broader health care inequities. While advancements such as laser technologies designed for all Fitzpatrick types and improved educational resources on skin of color represent meaningful progress, these efforts often fall short of fully meeting the needs of diverse populations. Bridging these gaps requires health care professionals to prioritize inclusive, patient-centered care by tailoring treatments to minimize risks, promoting research that reflects population diversity, and empowering patients with clear, accessible information about their options and potential outcomes.

References:

1. Alam M, Warycha M. Complications of lasers and light treatments. Dermatol Ther. Nov-Dec 2011;24(6):571-80. doi:10.1111/j.1529-8019.2012.01476.x
2. Davis EC, Callender VD. Postinflammatory hyperpigmentation: a review of the epidemiology, clinical features, and treatment options in skin of color. J Clin Aesthet Dermatol. Jul 2010;3(7):20-31.
3. Duplechain JK. Ablative laser therapy of skin. Facial Plast Surg Clin North Am. Nov 2023;31(4):463-473. doi:10.1016/j.fsc.2023.05.002
4. Gold M, Alexis A, Andriessen A, et al. Supplement individual article: algorithm for pre-/post-procedure measures in racial/ethnic populations treated with facial lasers, nonenergy devices, or injectables. J Drugs Dermatol. Oct 1 2022;21(10):Sf3509903-sf35099011.
5. Mirza HN, Mirza FN, Khatri KA. Outcomes and adverse effects of ablative vs nonablative lasers for skin resurfacing: a systematic review of 1093 patients. Dermatol Ther. Jan 2021;34(1):e14432. doi:10.1111/dth.14432