We are learning that many patients have some levels of transient hyperpigmentation following the deeper fractionated CO2 lasers
Your genetic background determines how much pigmentation you get from heat induced melanocyte activity. Those with mixed ethnic or ethnic backgrounds are most frequently pre-treated with a melanin suppressor and often afterward too.
Why does laser cause hyperpigmentation in the first place?
Melanin (pigment) production is most frequently caused by a direct response of the skin when exposed to sunlight (a tan).
The same thing can occur when the skin is inflamed from a wound or intense or repeated heat. This is referred to as post inflammatory hyperpigmentation or PIH. People get PIH from bug bites, working in a hot environment such as a commercial kitchen, from saunas, tanning booths, accidental burns and treatment procedures that are heat based - and most certainly this includes the heat from lasers.
Who is more prone to PIH?
Patients who tan quickly, are prone to dark marks after any skin trauma or are of southern hemisphere or Asian backgrounds all will have greater tendency for PIH following laser treatment. This is one reason these patients are carefully vetted as to their background and counseled as to the increased likelihood of post treatment Hyperpigmentation and the need for pre-treatment.
With proper sun protection (crucial) and some calming hydrating moisturizers, the Hyperpigmentation will eventually resolve. To hasten the resolution, a prescription level hydroquinone product can be added.
The final effects of the Fraxel Repair generally are not fully realized until about 6 months after the treatment. In the meantime keeping your skin hydrated, both with proper moisturizing and staying hydrated with fluids, will certainly lessen any roughness or dry skin wrinkles.
Fat grafts should not be affected since the fat in the skin should have been placed at such a depth the laser would not reach it. Once your skin is "over the hump" you should find that your skin tone, texture and any wrinkling are improved from your pretreatment condition.
Your treating physician can and should provide you with post treatment moisturizers and pigmentation treatment that are geared to your skin type and sensitivity.