Any resurfacing technique can cause hypopigmentation if its effects extend deep into the dermis, the permanent layer of the skin. As the damage goes deeper and deeper, more and more pigment cells are lost. Dermal elements are also lost, resulting in an abnormal smooth appearance of the skin as well. Healing with deep resurfacing techniques is prolonged, sometimes greatly.
Here is the paradox: the deeper the resurfacing, the more wrinkles are removed. However, the deeper the resurfacing, the more whiteness, waxiness and chance for scarring. Resurfacing techniques are therefore a balance between results and complications.
I don't personally believe there is a way to restore lost pigment cells, although there is some research on various creams ongoing.
We have found a happy balance in our practice by using medium depth CO2 resurfacing, and never performing deep CO2 resurfacing ever (i.e. 4 passes at high settings). The results are beautiful and long-lasting. Some wrinkles typically are left behind, and patients understand this ahead of time. However, they are pleased that they retain near normal pigmentation and skin appearance.
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