Noninvasive Cosmetic Treatments for Fitzpatrick IV–VI: A Narrative Review of Safety and Efficacy Guidelines

Background: With the growing popularity and accessibility of noninvasive cosmetic procedures, the need for safe and proper protocols across a diverse patient population has become increasingly important. When treating patients with varying skin types and tones, it is essential to adopt patient-centered approaches that minimize risks and optimize outcomes. Methods: A narrative review was conducted using PubMed to identify studies highlighting key recommendations and guidelines from recent literature regarding microneedling, radiofrequency microneedling, chemical peels, skin-tightening devices, laser treatments, and nitrogen plasma resurfacing for patients with Fitzpatrick skin types IV–VI. Results: Microneedling and radiofrequency microneedling are generally very safe for Fitzpatrick skin types IV–VI. Superficial chemical peels are frequently used in this population and offer great patient satisfaction. Medium-depth chemical peels, however, require caution, and deep peels should be avoided altogether in patients with dark skin. Regarding laser treatments, the long-pulsed 1064-nm neodymium-doped yttrium aluminium garnet laser is the gold standard in darker-skinned patients for laser hair removal, whereas intense pulsed light lasers capable of skin resurfacing and hair removal should be avoided due to adverse effects such as hyper- and hypopigmentation. Conclusions: Patients with Fitzpatrick skin types IV–VI are at a higher risk for developing hypo- or hyperpigmentation following these procedures, emphasizing the need for tailored treatment strategies.