Hypopigmentation, Hyperpigmentation of the Face; Uneven Pigmentation from laser or scar

Raffy Karamanoukian, MD answers: Hypo-pigmentation After Fraxel Repair

I am 12 weeks post fraxel repair and still dealing with hyper-pigmentation issues that are slowly getting better. I recently got another opinion from another PS that is very experienced with CO2 lasers. I was there for another reason, so he was looking at my face with make-up; but, he said it looked like I was still dealing with some prolonged erythema and that the erythema could possibly lead to hypo-pigmentation. I understand that hypo-pigmentation is usually permanent. I am using Triluma for the hyper-pigmentation which tends to make my face more red. I'm so confused at this point. I do have some white patches that have been visible since the day after my treatment. I assumed they were areas that were skipped and never considered that they could be hypo-pigmented. Can hypo-pigmentation come on that fast? Should I lay off the Triluma until all of the redness goes away and then deal with the darker spots? While in the waiting room they had the Reliant video playing and it made my cringe. Their claims of "a few days of redness and no reports of delayed onset hypo-pigmentation" are ridiculous. There is no doubt I had some great improvement in some areas of my skin, but I feel like I traded them for other issues. I feel lucky that I didn't have more damage than I did.


Raffy Karamanoukian, MD
11 months ago
By Raffy Karamanoukian, MD - Los Angeles Plastic Surgeon

Permanent hypopigmentation is generally caused by irreversible damage to the melanocytes.  This can occur as a result of an aggressive immune response or scarring.  Inflammation generally causes a stimulation of melanocytes causing hyperpigmentation.  Inflammation releases many cell mediators that act to stimulate cell response.

In the case of hypopigmentation after laser treatment, it is conceivable that the laser caused considerable damage to the melanocytes, but this is highly unlikely.  A more likely scenario is that the resulting inflammation and post-inflammatory pigmentation caused by the Fraxel actually unearthed damaged skin or even scar that was not apparent to you prior to treatment.

The goal would be to reestablish an even skin tone.  The best thing to do at this point would be to conservatively manage the skin without topical or laser treatments and consult with an experienced physican who is an expert in the physiology  and cosmetic treatment of skin pigmentation.

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More answers to “Hypo-pigmentation After Fraxel Repair”

A: Hypo-pigmentation takes time to show

Michael A. Persky, MD
14 months ago
By Michael A. Persky, MD - Los Angeles Facial Plastic Surgeon

Hi c,

The area that you noticed immediately after your Fraxel re:pair treatment was likely undertreated as you suspected.  Hypo-pigmentation takes some time to develop, at least enough time for the redness from the treatment to go away. 

Certainly seek the advice of your treating physician regarding Triluma, but if it is making your skin more red, 12 weeks after your treatment, stopping should be considered when you have that discussion. Continued redness is a sign of inflammation.  Discuss with your physician what you can do to decrease your inflammatory response.  This may involve a steroid cream and or shot.  Biafine ointment also helps reduce redness.

I have not seen prolonged erythema lead to hypo-pigmentation with Fraxel re:pair.  I hope that your concerns resolve quickly and completely, please keep us informed.  Be well.

Dr. P

 

 

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