I am type 3 skin. Dark hair & dark eyes. Caucasian. I had the normal restore (not the new added thulium laser) done on my face. I did not hyperpigment. Energy set to 20. I did a second test patch overlapping the first & it would appear there are a few orange pigmented flecks developing. I am on day 5 after Fraxel. I did not pre or post treat with hydroquinone. Will hydroquinone really help prevent hyperpigmentation when I do my whole forehead? Could hydroquinone create more hyperpigmentation?
Does Hydroquinone Prevent Hyperpigmentation Pre- and Post-Fraxel Restore?
Doctor Answers 2
Skin Preparation Prior to Fraxel Laser Treatments
Following Fraxel laser treatments, patients may experience some bronzing discoloration as the microthermal zones (MTZs) of coagulative tissue necrosis are sloughed. This may be accompanied by some flaking or a slight rough surface texture. This should resolve when all healing is complete a few days later.
I would definitely prep all skin type III patients before any laser procedure. We typically use retinol and/or 4% hydroquinone for 4 – 8 weeks prior to beginning any laser procedures. This will suppress pigment formation and help to reduce the risk of post-inflammatory hyperpigmentation (PIH). These products may be used for short periods between each treatment session, which we usually perform about 4 weeks apart.
Any skin care product that causes significant irritation of the skin could induce PIH, but we have not seen any significant problems with 4% hydroquinone.
Best wishes, Kenneth Dembny MD
Fraxel and hyperpigmentation
Hydroquinones do not prevent hyperpigmentation in all people who are prone to this side effect. In fact, some patients become irritated from hydroquinone and any irritation can cause hyperpigmentation. Retinols and corticosteroids may have to be added to hydroquinone for some patients. Lately, a new product Lumixyl, which is a non-irritating topical cream (non-irritating from most patients) has been introduced into the market. Both hydroquinone and Lumixyl work by blocking the pathway of the mechanism that produces pigment in the pigment cells. Even more recently, Elure, has been manufactured and distrubted to doctors' offices by Syneron, and helps lighten pigment by directly targeting the pigment itself, rather than blocking its pathway. The lightening effect is much more rapid than the other lightening products. Please remember to use your UV A and UV B sunscreen every day.