Why the Fitzpatrick scale is not enough to set parameters
A phototype tells you how skin reacts to sun. It does not tell you how much melanin sits under the beam today — and that is the question you answer when you set the energy.
Written by Olena Yantsova · Współzałożycielka Gangsta Lasers · prowadząca
In short
- A phototype describes a reaction to sun, not the melanin under the beam this week.
- Six checks in a fixed order — tan, medication, previous treatments, barrier, scars, pigment.
- One uncertain answer means moving the appointment, not choosing gentler parameters.
The Fitzpatrick scale was built to predict whether somebody burns in the sun. That is all it does. It describes a reaction to UV radiation; it does not measure the melanin in one particular person's skin in one particular week. When you set the energy on a laser, the question is different: how much melanin will the beam meet on its way to the pigment, and what happens to that heat.
So the phototype is a starting point, not a decision. Someone with phototype II who has spent two weeks in Egypt has skin that will behave like a IV today. Someone with phototype IV after a Polish winter behaves the other way round. Same card, same parameter table, two different treatments and two different risks.
In consultation I check, in this order: current tan and when the last exposure was, photosensitising medication and supplements, previous treatments in that area and what they were done with, the state of the skin barrier, the presence of scars and keloids, and last of all the pigment itself — its colour, its depth, and whether it looks layered.
On top of that sits something the scale does not cover at all: the history of the pigment. A twenty-year-old tattoo lies differently from a two-year-old one, and permanent make-up that has been corrected with a remover is often two or three layers of different substances, each responding to a different wavelength. The phototype is then the least important line on the card.
A phototype describes how skin reacts to sun. You are answering a different question: what the beam meets on its way to the pigment.
The mistake I see most often is reaching for the manufacturer's table and setting the energy to the phototype written on the client's form. The table is a starting point for a device, not a protocol for a person. Without a patch test and without answers to those six questions, you are setting parameters based on how somebody reacts to a holiday.
There is one more question almost nobody asks: what is the client doing over the next four weeks. A trip to the coast, a sunbed before a wedding or a course with a bare forearm change not only the risk of hyperpigmentation but the sense of the whole series. Better to push the start by a month than to run a series where every second session lands after sun exposure.
The practical consequence is simple. If any one of those answers is uncertain, the treatment does not happen that day. Moving the appointment by two weeks costs one visit. A burn and post-inflammatory hyperpigmentation cost a series, the trust, and sometimes a review online.
The phototype stays on the card and stays in the conversation — just in the right place. It is one of six inputs into a decision about parameters, not a shortcut for it. Once you stop treating it as a result and start treating it as one premise, the consultation gets a few minutes longer and the following six months get a great deal calmer.
Subjects
- Fitzpatrick phototype
- laser parameter selection
- skin assessment before treatment
- pigment removal