Deeper skin tones are not more difficult to treat, but they do behave differently. Skin with more active melanocytes responds to inflammation by producing pigment, which means that a procedure that causes controlled injury the mechanism behind most resurfacing carries a risk of leaving a brown mark where it healed. That complication is called post-inflammatory hyperpigmentation, or PIH.
This does not rule out anti-ageing treatment. It changes how treatment is chosen, how aggressively it is performed, and how the skin is prepared and protected around it. This article explains the biology behind that, what the published evidence does and does not establish, and the questions worth asking before agreeing to any resurfacing procedure.
What the Fitzpatrick Scale Actually Measures
The Fitzpatrick scale classifies skin from type I to type VI based on how it responds to ultraviolet light — specifically, how readily it burns and how readily it tans. It was designed in 1975 to help predict dosing for phototherapy, not to describe ethnicity or skin colour as such.
| Type | Typical response to sun |
|---|---|
| I | Always burns, never tans |
| II | Burns easily, tans minimally |
| III | Sometimes burns, tans gradually |
| IV | Burns rarely, tans readily |
| V | Burns very rarely, tans profusely |
| VI | Never burns, deeply pigmented |
Most Indian skin falls into types IV and V, with some type III and some type VI. The scale is a useful shorthand, but it is a blunt instrument. It correlates only loosely with actual melanin content, and it says nothing about an individual history of pigmenting easily after spots, insect bites, or minor injuries, which in practice is often a more informative predictor than the phototype alone.
Why Pigment Responds to Injury
Melanocytes sit in the basal layer of the epidermis and produce melanin, which they transfer to surrounding keratinocytes. In deeper phototypes, these cells are not more numerous, but they are more active and more readily stimulated.
Inflammation is one of the things that stimulates them. When skin is injured by a laser, a peel, a needle, a burn, or even a spot, inflammatory mediators released during healing can drive melanocytes to overproduce pigment in that area. The result is a flat brown patch that appears days to weeks after the skin has otherwise healed, and which can persist for months.
PIH is not scarring. The skin architecture is intact; it is a pigment disturbance. That matters because it usually does fade, though slowly, and because it is treatable in its own right.
What the Evidence Establishes and What It Does Not
It is worth being precise here, because this area is frequently oversimplified in both directions.
PIH is a well-recognised and commonly reported complication of ablative carbon dioxide laser resurfacing, and it is one of the main reasons clinicians approach deep resurfacing cautiously in pigmented skin. However, a 2024 review of PIH following CO2 laser found that reported incidence varies substantially between studies, that study quality is generally limited, and that Fitzpatrick phototype did not consistently predict risk across the literature reviewed. The authors specifically noted a lack of adequately powered studies on incidence and risk factors.
The honest summary is this: the biological rationale for greater caution in deeper phototypes is sound and widely accepted in clinical practice, but the precise numerical risk for any given skin type and device is not well established. Anyone quoting a specific percentage with confidence is over-reading the evidence.
Two practical consequences follow. First, no procedure should be described as guaranteed safe for a particular skin type. Second, individual assessment matters more than category, because pigmentation history, current sun exposure, medication, hormonal factors, and the specific device settings all influence outcome.
How Risk Varies by Procedure Category
Broadly, risk tracks with how much inflammation and how much depth a procedure creates. The table below describes general tendencies discussed in clinical practice, not fixed rules; settings, technique, and operator experience change the picture considerably.
| Procedure category | Depth of injury | General pigmentation risk consideration |
|---|---|---|
| Superficial peels (e.g. mandelic, lactic, low-strength glycolic) | Epidermis only | Lowest of the resurfacing options; commonly used in deeper phototypes |
| Medium-depth peels (e.g., TCA) | Upper dermis | Higher; usually approached conservatively and with priming |
| Non-ablative and fractional lasers | Dermis, surface left intact or partially spared | Intermediate; fractional delivery leaves untreated skin between zones, which aids healing |
| Ablative CO2 resurfacing | Full removal of the outer layer | Highest; the most frequently reported setting for PIH |
| Injectables (toxin, hyaluronic acid fillers) | Minimal needle punctures only | Low; pigmentation is not the primary concern with these |
This is why injectables are often less complicated in deeper skin, while resurfacing requires more thought. For a fuller explanation of peel depths and the acids used at each level, see our guide to types of chemical peels and their depths, and for how light energy remodels collagen, see how laser skin resurfacing works on ageing skin. Where you are weighing whether a peel is the right tool at all, what chemical peel treatment involves and what it will not treat is a useful starting point.
How Risk Is Reduced in Practice
Several measures are routinely used. None eliminates risk.
- Priming. Preparing the skin for several weeks beforehand with topical agents intended to calm melanocyte activity is a long-standing approach and is considered particularly relevant in pigmented skin.
- Conservative depth and settings. Choosing a shallower procedure, or a lower energy setting with more sessions, in preference to a single aggressive treatment.
- Test patching. Treating a small, discreet area first and observing how it heals over several weeks before committing to the full face.
- Strict photoprotection. Rigorous sun avoidance and sunscreen use for several weeks before and after treatment, since ultraviolet exposure during healing is a well-recognised aggravating factor.
- Treating active inflammation first. Resurfacing skin that is currently inflamed from active acne, eczema or a recent reaction increases the chance of a pigmented outcome.
Timing also interacts with sequencing more broadly. If you are considering more than one procedure, the interval between them matters, and pigmentation risk is one of the factors that lengthens it. We cover that in what order anti-ageing treatments should be done in.
If Pigmentation Does Occur
PIH after a cosmetic procedure is usually self-limiting, but it can take several months to fade, and it responds better to early management than to waiting. Sun protection becomes non-negotiable, because ultraviolet exposure will darken and prolong it. Topical treatment is commonly used, and further procedures are generally deferred until the pigment has settled.
The important point is that PIH is a recognised complication rather than a sign that something went wrong. It should be discussed before treatment, not explained afterwards.
Questions Worth Asking Before Resurfacing
- What is my Fitzpatrick type, and do I have a personal history of marking or darkening after spots or injuries?
- What specifically is being treated: pigmentation, texture, laxity, or lines, and is this device the right tool for it?
- What depth and settings are planned, and why those rather than something more conservative?
- Will the skin be primed beforehand, and for how long?
- Is a test patch appropriate in my case?
- What is the plan if PIH develops?
A clinician who answers these readily is a better sign than one who describes the procedure as risk-free.
Where a fractional or ablative device is being considered, our page on fractional CO2 laser treatment describes what that procedure involves, though whether it is appropriate for any individual with a deeper phototype is specifically a matter for assessment rather than a general recommendation. Our overview of how anti-aging treatment is selected for your skin explains how that assessment is approached.
Frequently Asked Questions
Can people with dark skin have laser treatment at all?
Yes. Lasers are used across all phototypes. What changes is device selection, settings, depth and preparation. The relevant question is not whether laser is possible but which laser, at what setting, for what purpose.
Is a chemical peel safer than laser for Indian skin?
Not inherently. A superficial peel is gentler than ablative laser resurfacing, but a deep peel can be more aggressive than a light non-ablative laser. Depth of injury predicts risk better than the category of the procedure does.
How long does post-inflammatory hyperpigmentation take to fade?
It varies widely — often several months, sometimes longer. Epidermal pigment tends to resolve faster than pigment that has dropped into the dermis. Continued sun exposure is the most common reason it persists.
Does melasma change what treatments are suitable?
Yes, significantly. Melasma is notoriously prone to flaring after heat and inflammation, including from some laser treatments, and it requires a distinctly different approach from ordinary sun-related pigmentation. It should be identified before, not after, any resurfacing plan is made.
References
- Post-inflammatory hyperpigmentation after carbon dioxide laser: review of prevention and risk factors. PubMed, 2024. PubMed 38205425
- Hang J, et al. A Novel Peel to Prevent Post-Inflammatory Hyperpigmentation After CO2 Resurfacing for Acne Scars. Journal of Cosmetic Dermatology. 2025. PMC12309148
- Fitzpatrick TB. The validity and practicality of sun-reactive skin types I through VI. Archives of Dermatology. 1988;124(6):869-871.