Understanding Your Patients’ Skin

One of the most frequently asked questions from laser technicians and practitioners is, “Does skin type matter for laser tattoo removal?” The answer is yes.

Skin type is one of the most important factors in determining the success of a laser tattoo removal treatment, and yet, it is often overlooked. Specific protocols must be used accordingly on certain skin types to ensure safe treatment, effective results, and minimized risks of side effects.

The Fitzpatrick Scale is the most commonly used system to date and is used by skin care specialists to classify a patient’s skin type. The scale was created in 1975 by Thomas B. Fitzpatrick, a Harvard Medical School dermatologist, who studied complexions and reactions to sunlight, such as burning and tanning. Today, the Fitzpatrick Scale is used worldwide by dermatologists, estheticians, and skin specialists to determine protocols for cosmetic and aesthetic procedures such as laser tattoo removal.

As a laser tattoo removal provider, it is your responsibility to administer safe treatments so that your patients receive the best results for their skin. It’s best to take careful consideration into assessing your patients’ skin type so that the correct protocols are implemented.

This article was written to provide information on why skin type matters for laser tattoo removal and how it affects protocols for treatment.

Skin Types
The Fitzpatrick Scale classifies skin color, or tone, into six types that range from light (Skin Type I) to dark (Skin Type VI). The scale measures various elements including genetic disposition, reaction to sun exposure, and tanning habits.

 Skin Type
 Tanning Ability
 Type I
 Caucasian; blonde or red hair, freckles,  fair skin, blue eyes
 Always burns, never tans
 Type II
 Caucasian; blonde/red hair, freckles,  fair skin, blue/green eyes
 Usually burns, then tans
 Type III
 Darker Caucasian, light Asian
 May burn, tans well
 Type IV
 Mediterranean, Asian, Hispanic
 Rarely burns, tans well
 Type V
 Middle Eastern, Latin, light-skinned  African, Indian
 Very rarely burns, tans well
 Type VI
 Dark-skinned African
 Never burns, tans well
Why Skin Type Matters
Skin color is a direct result of the amount of melanin in a person’s skin. The more melanin a person has, the higher protection they have against the sun and ultra violet radiation. Likewise, the less melanin a person has, the more likely they are to burn. Why does this matter? Different skin tones require different protocols for effective treatment. There is no such thing as a universal protocol for removing unwanted ink from the skin.

Similar to tattoo pigment, melanin can absorb or reflect laser light. During a laser tattoo removal treatment, lasers emit light energy into the skin and target ink pigment. If protocols are set incorrectly, the surrounding melanin and skin cells may be harmed in the process, resulting in unwanted side effects such as pigmentation changes. 

Common side effects of laser tattoo removal are temporary hypopigmentation and hyperpigmentation, two types of skin discoloration. Hyperpigmentation is a result of excess melanin in the skin and causes skin to darken. This is most commonly experienced in patients with medium skin tones and usually heals over time. Hypopigmentation typically occurs in darker skin tones and is the result of a reduction in melanin. Although it takes longer to heal, this side effect is also temporary and can be restored with proper aftercare.

Because there is less melanin in lighter skin, a laser’s energy is able to focus primarily on the tattoo pigment and is minimally absorbed by melanin. Conversely, darker skin types contain higher levels of melanin and are more sensitive to the penetrating light energy, with a greater risk of experiencing unwanted side effects. It is very important to use lower fluence settings on patients with darker skin types, whereas patients with lighter skin types may be treated more aggressively.


Choosing the Right System
Although various types of lasers are used for numerous procedures, not all lasers are cleared to use on all skin tones. Finding a laser that effectively treats all skin types is important for treating a wider range of patients. The safest tattoo removal laser that is safe to treat all skin types, especially darker skin types, is a Q-switched Nd:YAG laser. Other lasers such as Q-switched alexandrite and ruby lasers can also be used, but incur greater risks of unwanted pigmentation issues. 

Laser tattoo removal is a procedure that requires a multitude of factors to achieve successful results on various tattoo inks and skin types.

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