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When Christiana Mbakwe, a researcher for The Daily Show, recently dropped by BeyondSkin MedSpa in Los Angeles for laser hair removal, she was turned away because of her skin color. She’s a British woman of Nigerian descent, and the doctor explained that his facility didn’t have the right laser to treat dark skin. The experience unnerved Mbakwe.
“What was most alarming about this particular business was the blunt delivery by the doctor, and the attempts of them to cover up what’s a super-problematic issue,” she told Racked. “On their website, they say they treat all skin types, but they later said they’ve found that particular machine is bad for black skin — and my response is if black/darker-skinned clients were important to you, you’d remedy that and use an inclusive machine.”
Mbakwe said the owners apologized to her, but she’d rather the medical spa purchase a machine that can treat all customers. She wrote about the experience on Facebook, which led to vigorous debate about which patients can get laser hair removal or other kinds of laser treatment. While people of all skin tones can be treated with lasers, using the wrong device on dark skin can cause hyperpigmentation (dark spots), hypopigmentation (light spots), or burns, dermatologists say.
Cesar Caldera Jr., who helps manage BeyondSkin MedSpa, his physician father’s business, said Mbakwe was turned away because the business’s one laser had previously burned a black patient. The spa has just a single treatment room, and the diode laser in use there was marketed as a machine that could treat all skin colors, he said. That didn’t turn out to be the case.
“We got this laser assuming what [the manufacturer] claimed was true, but when Dr. Caldera treated another African-American patient, she got burned. He hasn’t seen a lot of darker-skinned patients since then,” he said.
Caldera said the laser now in use at the medspa can treat white, Latino, Asian, and light-skinned black people. “This has nothing to do with race,” he said of denying Mbakwe treatment. “We cannot treat her for safety reasons.”
He said that since lasers are no small investment — they can cost roughly $100,000 — purchasing another one isn’t easy for a family business. But Caldera explained that the med spa does plan to buy another laser, the Clear + Brilliant pelo, billed as suitable for “most skin types.”
“The Clear + Brilliant laser is a very low-wattage laser,” said Dr. Pearl Grimes, a Los Angeles dermatologist in practice for more than 35 years. “It doesn’t target the epidermis or the pigment cells.”
According to Grimes, the advantage of having highly pigmented skin is that it ages much more slowly, but the disadvantage is that the melanocytes, the cells that produce pigment, or melanin, can be “whimsical.”
“They respond to injury in a different way, and the complications can be a dark spot or a light spot,” she explained. “You do have to proceed with more care; however, [laser treatment] can be done.”
But people of color aren’t the only group for whom laser treatment can be tricky. Grimes said performing laser hair removal on patients with light hair and light skin actually poses more challenges than treating dark-skinned patients. That’s because it’s difficult for the laser to find its target when both hair and skin are pale.
Because lasers are “phenomenally expensive,” Grimes hesitated to point the finger at facilities that lack machines that treat all skin types. But she added that it would be concerning if a practice that made laser hair removal the bulk of its business didn’t have an inclusive range of lasers. Since she treats a number of patients who’ve suffered pigmentation problems as a result of bad laser treatment, the dermatologist said she would prefer doctors who don’t know how to properly treat dark skin spare the patient harm by admitting that up front.
“If a dermatologist does not have the skill set, you’re much better off simply telling the patient, ‘I’m not comfortable treating you’ versus treating the patient and having complications,” Grimes said.
That doesn’t mean practices should just escort out dark-skinned patients who turn up for appointments. Grimes said practices can ask patients about their skin type before they visit. Doing so, for example, may have prevented the uncomfortable exchange Mbakwe had with BeyondSkin MedSpa. The doctor said it would behoove physicians who can’t perform laser treatment on everyone to refer patients to dermatologists who can.
Dr. Carlos A. Charles, a New York City dermatologist, said he does find it surprising that patients of color “are still getting turned away.” He’s practiced medicine for a decade and said that dermatologists should be trained to treat all skin types. He specializes in caring for skin of color, and many of his patients visit med spas from time to time. He said they typically don’t have problems accessing services at such venues.
“Skin of color has been more of a topic and most of the [medical school] programs now specialize and devote some time to how darker skin is going to respond to lasers or chemical peels. There’s been a lot of positive changes in the last ten years, even in the last five years,” Charles said.
Both he and Grimes told Racked that the YAG laser is a great option for dark skin. The National Laser Institute also recommends this laser and notes how people of color, including black, Asians, and Latinx people, have often been discouraged from seeking laser treatment.
Patients of color may believe lasers are off-limits to them, but that shouldn’t be the case, Charles contends.
Mbakwe said that because research indicates black women spend a disproportionate amount of money on beauty, all med spas should have inclusive equipment.
“The fact businesses ... aren’t making it a priority to ensure women of color receive the same level of treatment a fair-skinned woman does speaks volumes about how little they value us as clientele,” she said.