By Ashley Weatherford
I've come close to getting laser treatments three times. The first, when I was in college, was after a friend's older sister announced that it was "the greatest thing ever." She explained that hair-removal treatment was expensive but worth every penny, especially since she never had to worry about a messy bikini line ever again. "I've read that black people can't use lasers," I said, hoping that her esthetician might have mentioned it to her, though I knew that was unlikely because my friend was white. But all she said was, "Yeah, you should look into that first."
Like many teenage girls, I saw the first tiny sprouts of hair on my legs as badges of honor -- signifiers of nearby maturity. But when my adorable fuzz became a mutant forest, I wanted to find a way to make it stop. Lasers have been around for many decades, but using them for hair removal didn't begin until about the 1990s. I never considered them as a serious option for hair removal at that point anyway, because of the cost, but I did do a lot of reading about the topic. I learned that lasers don't work for gray hair or on blondes -- the hair is too light and lasers work by targeting pigmentation. Unfortunately, that also meant they couldn't be used on dark skin because it was too hard to differentiate between the darkness in hair and the darkness of the skin. It's an important distinction that if ignored, could lead to permanently charred skin. The ideal candidate was, in fact, fair-skinned, with dark hair -- like a Kardashian.
There's an old chart, known as the Fitzpatrick scale, that classifies skin color. Hair-removal practitioners use it to determine a laser's particular efficacy versus potential danger to a specific skin tone. The chart is based on a study that examined skin's reaction to ultraviolet light, yet lasers use infrared light. The scale is outdated, confusing, and nearly useless. Skin types are subjectively categorized I through VI, where type I is described as pale-white skin that always burns, and VI is dark brown to black skin that never burns. The first lasers catered to types I through IV because of the more significant contrast between hair and skin color. Dr. Fran Cook-Bolden, the founder of Skin Specialty Dermatology, a research and treatment facility in New York known for its targeted treatments for people of color, and who is, I should note, black, like me, attributes the lag in lasers that are useful for dark skin to a disinterested market that chose to ignore the needs of patients with dark skin. "When lasers were first being developed, they were only used on people with lighter skin types. The reality is, lasers weren't initially tested on darker skin because companies were aware of the risks and they didn't want to be bothered. There was enough need with lighter skin types already, so companies thought, Why take on that additional liability?"
When I graduated from college, I revisited the concept of laser hair-removal, in part because of the enticing commercials for Hair Today, Gone Tomorrow, a medispa chain that touts the affordability of its laser treatments. At around $200 per treatment, the service was a fraction of what I would pay in a doctor's office, but reasonable enough for me to seriously consider booking an appointment. The price was alluring, but an esthetician, not a doctor, performed each procedure. Cosmetic laser treatments, for the most part, are under-regulated. The laws vary from state to state; in New York, for example, an unlicensed practitioner can perform a laser service, but in New Jersey, a physician is required. "They don't ask the right questions to prevent injury," said dermatologist Howard Lancer, when speaking about the dangers of medispas. "Some don't even require a licensed physician to educate laser operators." Dr. Roopal Kundu, head of the Northwestern Center for Ethnic Skin, often treats patients who have experienced a faulty laser treatment. "One of the driving principles for physicians is, first, do no harm," she told me over the phone. "There are times when a physician or a spa is not capable of treatment -- they either don't have the technology or the expertise. It's a very challenging situation [to turn someone away for treatment because of skin color], but it's better than causing harm."
A few years ago, at-home laser treatments swooped onto beauty shelves. Tria, the industry leader, was heralded as a much more affordable alternative to the in-office procedure. Drawn to its promise to deliver professional results, I combed Tria's website for a sign that something was different and I could maybe use this tool -- but there, sandwiched somewhere between its FDA approval and glowing reviews, was the old, familiar, disappointing note that Tria couldn't in fact be used on dark skin.
But it's not all doom and gloom for nonwhite people who want to get laser treatments. Progress is being made in small increments. Manufacturers finally perfected ways to make in-office laser treatments safer for darker skin tones, though medical offices and especially medispas have been slow to purchase these newer, more costly machines. The YAG 1064 long-pulsed laser (where YAG is an acronym for yttrium aluminum garnet, the crystallike material within the laser) zaps the hair follicle from a deeper layer under the skin, thereby minimizing the chance of surface damage. Other lasers have emerged, too, with safety features like a tip that cools skin to prevent burns. Dr. Lancer is particularly excited about the Excel V laser, which slowly heats the hair follicle without disturbing skin-color cells. Most recently, skin tool company Iluminage introduced an at-home laser that's FDA-cleared to treat all skin colors. Employing a targeted, proprietary laser -- the first of its kind. With one button and three different settings, it seems like an easy-to-use device. At $295, it's the cost of what a single bikini-zone-zapping session would bring with a physician. I'm looking forward to putting mine to work tomorrow -- just 15 years after I first wanted to.
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