Can Pixel laser be too aggressive?

The Pixel laser is a 2940 nm Erbium laser used to achieve fractional resurfacing of the skin. It comes with a 7x7 handpiece and a 9x9 handpiece - the 7x7 is most commonly used for most areas and the 9x9 primarily for the areas around the eye/eyelid. The power settings range from 600-1400 joules - so the 600 joule setting you mention is the lowest possible power setting. The pulse width most commonly used is long, but your provider used the medium width for the double pass over your entire face (which is more conservative than the long pulse width), and reserved the long pulse width for the stacking of pulses over the areas of acne scarring only. And finally, the amount of stacking - 3 pulses is the minimum used. Generally speaking, I would use energy settings of 1000-1400 joules, long pulse width, stacking of 3-7 pulses of acne scars or wrinkles, etc. (whatever the area of concern I am treating with the aggressive resurfacing might be), and then at least a double pass over the entire face. Individuals with darker skin types are at higher risk for dyspigmentation with any type of resurfacing laser, but I have not had this problem with any of the patients I have treated. I do not treat black skin with the Pixel laser, though I know other providers who do so cautiously with good results. Sun protection is important for minimizing the risk of pigment alteration after treatment.