Question
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.
Answers (3)
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1
September 28, 2008
Prolonged inflammation can lead to pigment changes
To really answer this question, I'd need more information about your skin type and the settings used for your Re:pair treatment. In general, the healing time for an aggressive Re:pair will be weeks and not days. The redness can last for 2-3 weeks routinely, but if it persists beyond that, the risk of prolonged complications exist. The Triluma is only good for HYPERpigmentation, and the tretinoin may be adding to the redness. I'd discuss the possible need for a very brief course of corticosteroid cream to act as an anti-inflammatory. Perhaps also a course of sub antimicrobial doxycycline and oral nicomide may be beneficial. Definitely see a dermatologist well versed in these pearls to treat resurfacing complications. Good luck.
2
September 28, 2008
Hypo-pigmentation takes time to show
Board Certified
Facial Plastic Surgeon
Facial Plastic Surgeon
Answer by Michael A. Persky, MD
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
3
September 27, 2008
The real story about Fraxel Re:pair
You have just found out the greatest lie in laser surgery and one that is unfortunately perpetrated by the laser companies to physicians and from physicians to patients. It makes me mad as well when I see the laser information that states recovery is that quick.
It simply isn't that quick if the physician does the laser with the goal of improving your wrinkles. If the recovery time is short, the results will be as well. So, hopefully your results will be good since you are experiencing ongoing redness. On the other hand, management of the problems after a laser procedure can be quite challenging and that is why, as a dermatologist, I feel that laser procedures are best performed by dermatologists rather than other specialties. But, as a proviso, I also think that the dermatologist actually needs to be the one in their office that is actually doing the procedure as many of them pass it off to a PA or nurse.
The summary of this question is: buyer beware! Laser companies that promote lies about their equipment and recovery times won't get repeat business so it is important for the physicians to check out claims like this and go over a 'real' timetable of recovery with the patient before the procedure rather than waiting to see if the patient realizes that what they were told bears no resemblance to what actually occurs.
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10/12/08
I think Triluma is a mistake. That is inflammatory and the steroid will increase your chances of developing hypopigmentation in my opinion because it interferes with the healing of the skin.
10/13/08
Thanks to all of you for the advice. I've stopped everything. I'm cleaning my face with CeraVe Hydrating Clenser and using CeraVe moisturizing lotion...that's it. I've been doing this for a few days and things seem to be claming down. All the pigment issues are gone from my neck, so I'm hoping my face will totally heal in time too. I've kept a picture diary which I plan to post with my review once I feel like I'm totally healed.
CB