Energy-based devices like lasers, intense pulsed light (IPL), and radiofrequency treatments have revolutionized the field of aesthetics, skincare, and dermatology. These technologies have been proven effective in treating common skin concerns such as hyperpigmentation, vascular lesions, textural irregularities, hair removal, and skin rejuvenation. However, the safety and efficacy of these treatments rely on a crucial aspect of assessing clients – the Fitzpatrick Skin Type (FST). In this post, I will explain why it is essential to determine a client's FST for treatments that involve energy-based devices. We will also highlight the risks of neglecting this crucial step and examine other critical factors that can impact patient outcomes.
Why Fitzpatrick Skin Type Matters
The Fitzpatrick Skin Type scale categorizes skin according to its color and reaction to UV exposure, ranging from Type I (very fair skin that burns easily) to Type VI (very dark skin that never burns). Understanding a client's FST is so important because it predicts the skin's response to light-based energy, which in turn influences both the risk of adverse events and the likelihood of achieving desired results. One thing that I always point out to patients and providers I train is that FST is not only based on what someone looks like; you have to look at many different factors, including ethnicity and family traits - looking into their underlying potential for pigment. Skin type is also important when using radiofrequency devices. Contrary to the belief that this type of energy "doesn't see color." While correct to an extent, when using radiofrequency, some skin types are more prone to pigmenting, including those with melasma, and there is still a danger of causing post-inflammatory hyperpigmentation from these treatments.
Patient Assessment & Screening
A thorough patient assessment is essential before proceeding with any treatment using energy-based devices. Here's how providers can ensure they are gathering all necessary information:
Detailed Medical and Skin History: First and foremost, understanding the client's previous experiences with sun exposure, tanning habits, and any history of skin diseases or reactions to prior treatments. As an example, skin conditions like a history of keloids can affect treatment plans as they are generally not candidates for these therapies, as we are causing micro-injuries to the skin and can exacerbate current keloids and even trigger new ones.
Visual and Instrumental Skin Evaluation: In addition to a visual inspection, tools such as spectrophotometers can provide objective data on the skin's melanin density, which helps in more accurately determining the FST. Unrelated to FST but extremely important, checking for irregular and suspicious lesions is essential. If you are unfamiliar with recognizing suspicious lesions, please don't treat them.
Questions to Ask:
Have you ever had any laser treatments before, and if so, what was your experience? We want to know what happened to their skin in the past and if they had positive or negative outcomes from treatment.
How does your skin typically react to sun exposure? Do they burn, blister, peel, tan? Always remember, tanned skin is injured skin. While we all love the look of a fresh tan, this impacts results. Energy-based devices are causing injury to the skin, and if we are injuring already injured skin, our outcomes are very unpredictable.
Do you have any ongoing skin or medical conditions, or are you currently on medication? Uncontrolled autoimmune issues like Diabetes and HIV can potentially cause a poor healing response to treatments. Medications that cause photosensitivity can cause unwanted outcomes, and guess what? You guessed it: Lasers are light to the skin, and if the skin is now photosensitized, the result may not be pretty.
What are your main concerns and expectations from this treatment? There are many concerns a patient may have, but sometimes, especially with darker skin types, there is a provider/patient conversation to be had about risk vs. reward. For example, if I have a darker skin type patient that is wanting to treat acne scars, sometimes hyperpigmentation can occur in treating the acne scars. In those instances, you can possibly treat the hyperpigmentation after the acne scars have been treated, but it is all a question of priorities.
These questions help in forming a comprehensive understanding of the patient’s skin health and expectations, which guides the treatment planning.
Risks of Inaccurate Skin Type Assessment
Failing to accurately determine a client’s FST can lead to several adverse events:
Burns and Scarring: Incorrect settings on high-energy devices can cause severe burns, particularly in darker skin types.
Pigmentation Issues: Both hyperpigmentation (darkening) and hypopigmentation (lightening) are potential risks when the energy settings do not match the patient's skin type.
Dissatisfaction and Additional Costs: Ineffective results might necessitate further treatments, increasing costs and potentially leading to patient dissatisfaction.
Other Critical Considerations
Several additional factors must be taken into account when planning treatments with energy-based devices:
Patient’s Lifestyle and Sun Exposure: Sun habits and exposure levels can affect the skin's sensitivity to treatments and the recovery process. Again, tanned skin is injured skin. If the skin is tanned, the outcome is not always predictable. It can lead to both burns and hyper- or hypopigmentation.
Pre and Post-Treatment Care: Providing patients with detailed instructions on caring for their skin before and after treatment can prevent complications and enhance the effectiveness of procedures. I probably say, "Healthy skin yields better results" at least a few times every week, and it is 1000% true. Skin responds better to treatments, reacts predictably, and heals better when it is healthy. More importantly for patients, protect your investment! There is no one and done miracle treatment. Treatments do their job, but invest in homecare to improve the results; after all, you can't expect to see a trainer once and never go to the gym again.
Continuous Education and Technology Updates: Providers must stay informed about advances in technology and continually update their methods and practices to ensure optimal patient safety and outcomes.
Conclusion
Determining the Fitzpatrick Skin Type is not just a procedural necessity but a cornerstone of patient safety and treatment effectiveness using energy-based devices. By carefully assessing this and other patient factors, providers can maximize the benefits of these devices, minimize risks, and achieve superior patient satisfaction. As always, visit knowledgeable service providers who educate themselves and ensure that their use of cutting-edge technology is safe, effective, and tailored to meet individual needs, reinforcing the significance of precision in modern aesthetic treatment.