Performing the Different Types of BBL (And What You Should Know About Them)

Unfortunately, BBL’s biggest strength – its versatility – is also its biggest point of frustration for its users. We have seen plenty of highly capable medical aesthetic practices struggle to figure out why their BBL results simply aren’t adding up to what they see achieved in other practices. There are also many clinics that get great results but aren’t able to use the device to its full capacity. After all, BBL was originally used to provide general correction to the face, but now, there are other modalities like Forever Young BBL, a protocol developed by Dr. Patrick Bitter, and BBL HERO that convolute the best practices and make things even harder to perfect and, frankly, understand. We’ve provided countless offices with practical in-person training on how to operate the BBL device, and we’ve even developed an entire virtual training program that covers every aspect of BBL implementation, from marketing to hands-on technique. But, understanding the differences in the types of BBL treatment – specifically between the traditional corrective, Forever Young, and HERO – still pose some of the biggest hardships to practices, so we’ve decided to break down some of the key approaches and techniques for each type. Here’s the basic rundown: BBL therapy uses high-intensity light to induce regenerative changes in the skin. This particular approach is particularly effective for general tonal correction, addressing issues such as uneven pigmentation, light scarring, and general skin dullness. Many people already know this much, though, so here is some more advanced information for you to consider.

You Should Tailor Your Treatment to Each Skin Type

Your first step prior to any BBL treatment should always be to assess your patient’s Fitzpatrick Skin Type. This classification helps predict how the skin reacts to UV light, which is critical in setting the energy levels of the BBL device. 

As a general rule of thumb, Fitzpatrick Types I and II (lighter skin) can tolerate  higher energy levels. Types V and VI (darker skin) require more conservative settings and need careful handling to avoid hyperpigmentation, burns, and blisters. While skin color plays a part in the Fitzpatrick scale, it is not safe to determine settings based on the skin alone. For example, Asian skin generally presents lighter. This is due to the fact that Asian cultures tend to prioritize skin protection although they still have a strong ability to tan. Avoiding sun exposure keeps the melanin deep within the skin instead of bringing it to the surface. Considerations like eye color and natural hair color can give more accurate indicators of the most appropriate Fitz type to select. . It is critical that you tailor the treatment specifically to how your patient’s skin is reacting to treatment. We love to ask the question, “When you were a teenager, trying to get a tan, how quickly did you burn?”  This question is great because it does not reflect on their skin practices now which may affect the quality of the responses you receive. Yet, teenagers rarely wear sunscreen and find themselves in high sun exposure often in the summers. This question causes the client to stop and think about the answer. If they developed a sunburn within an hour, they would typically fall into Fitz I or II. Fitz III’s have to think for a minute, and usually respond with something along the lines of: “Oh, I don’t know, maybe a few hours, but only at the beginning of summer.” Around Fitz IV, patients state that they did not tend to burn. This question gives us a great place to start when choosing the safe start settings, and then we are watching how the skin responds to see if we need to adjust the fluence, pulse-width or temperature throughout the treatment.

It’s important to note, if a client falls between two Fitz types, always assume they are a higher Fitz type. This will give you safer start settings that can then be adjusted specifically for the client  as you see how their skin responds to the treatment, to ensure we are achieving clinical endpoints.

Corrective BBL

Corrective BBL alone is simply correcting only the reds and the browns in the skin. A corrective treatment may be used when combining with another modality such as HALO or Moxi. You may choose to do corrective only in this case due to the topical numbing cream. To avoid decreased efficacy of the numbing, you will want to quickly and efficiently complete the BBL to maintain as much numbing as possible for the more intensive fractional device.