By taking a few steps, dermatologists can avoid the sometimes prohibitive side effects of using laser and light therapies to rejuvenate Asian skin.
"This is no longer true, provided that dermatologists use the appropriate parameters, including a long-pulsed laser with compression; advise patients to avoid the sun postoperatively; and prescribe postoperative bleaching agents," Dr. Chan says.
ASIAN SKIN DIFFERENCES
"In Asian patients, photoaging is associated with more pigmentation problems but less wrinkling. Asian patients, however, have a higher epidermal melanin content and are more likely to develop post-inflammatory hyperpigmentation (PIH) following laser surgery," Dr. Chan says.
Although long-pulsed lasers have been a gold-standard treatment for lentigines in Caucasians, the resulting post-inflammatory hyperpigmentation can be a prohibitive issue, especially in Asians. This, however, does not mean that Asians are not candidates for laser and light source treatments, he adds.
LONG-PULSED LASER ADVANTAGES
In a study conducted last year, Dr. Chan and his colleagues found that the use of the long-pulsed laser with a compression window reduces the risk of PIH by reducing the targeting chromophobes (Kono T. et al. Lasers Surg Med. 2006;38:94-97).
"The compression empties the blood vessels and, therefore, allows the laser to focus on the pigment only," Dr. Chan says.
The long-pulsed laser has been shown to produce a similar effect but with lower risk of complication compared with the Q-switched laser when used for the treatment of lentigines in Asians, according to Dr. Chan.
"Since the long-pulsed laser lacks the photomechanical effect of the Q-switched laser, the risk of post-inflammatory hyperpigmentation is further decreased."
MELASMA, HYPERPIGMENTATION TX
Dermatologists also use fractional resurfacing and large spot size QS 1064nm Nd:YAG laser for the treatment of melasma and PIH in Asians.
The use of fractional resurfacing in Asians can be associated with a higher risk of PIH. Dr. Chan says his experience indicates that by lowering the density, such risk can be reduced. The new Fraxel SR1500 (Reliant) also appears to be associated with a lower risk of PIH due to its functioning with an increased spot size and higher energy level, reducing the risk of bulk tissue heating.
Dermatologists should keep in mind when using laser technology for the skin rejuvenation of Asian patients that hypertrophic scarring is a definite risk - especially around the deltoid and chest wall. The scarring that often occurs is similar to what can occur in black skin, he says.
In terms of culture, Dr. Chan says that Asians tend to be more conservative and prefer not to have cosmetic enhancements that are easily recognized by others.
Racial differences also come into play when it comes to facial rejuvenation, he says.
"For example, the use of Botox to widen eyes and narrow the face is most popular in Asian countries," Dr. Chan says.