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Hyperpigmentation 7 Weeks After CO2 Laser Removal of Sebaceous Hyperplasia

I Am 7 Weeks Post Op for Co2 Laser Removal of a Sebaceous Hyperplasia Under my Right Eye. The settings of the laser were 1 pass, 4 watts P22. It was bright red 2 weeks ago and is now a darker red. My PS said it is not hyperpigmentation. I have used aquaphor, hydrocortisone 1%, hydrocortisone 2.5%, cutivate .05% and a pack of oral steriods. My PS will not prescribe Group 1 or Group 2 topical steroids due to thinning of the skin. His ARNP stated today that it will clear up with "time." I am not seeing much progress at 7 weeks and would like to know your opinion regarding this.

Doctor Answers (5)

Hyperpigmentation After Co2 Laser Resurfacing

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Hyperpigmentation is a common complication after fractional Co2 laser resurfacing. It is referred to as PIH or "Post inflammatory hyperpigmentation" and it can happen to any individual getting this treatment. Generally speaking, it will subside over time in my experience.

Treatments for PIH that can be helpful are topical steorids, vitamin A derived skin care products (Tretinoin), and Hydroquinone. All these are included in a cream called Tri-Luma, which is my preferred topical for PIH.  One can prescribe these creams in various concentrations and formulations individually as well.

Beyond topical agents and time, the other two treatments I have seen helpful are the use of pulse dye lasers and various types of Q-Switched lasers, the type that are used in tatoo removal. Here the physician experience and technology availability are very important.  


Albuquerque Facial Plastic Surgeon
4.5 out of 5 stars 13 reviews

Hyperpigmentation of the face after laser

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Melarase AM and Melarase PM work well in our office to reduce pigmentation associated with aggressive laser treatments. Use the creams twice daily to acheive maximal response. 

Raffy Karamanoukian MD FACS

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
5.0 out of 5 stars 47 reviews

IPL for post laser redness

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Dear laser patient from Florida,

From your photo this appear to be inflammatory and usually will resolve with time as redness and inflammatory reactions are usually not permanent after this type of procedure.  You may want to inquire about an intense pulsed light treatment that may take the redness out.  Best of Luck

Mark Ginsburg, DO
Media Facial Plastic Surgeon
5.0 out of 5 stars 1 review

Topical lightening agents plus Retin A is useful for hyperpigmentation following laser resurfacing

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Topical lightening agents plus Retin A are useful for hyperpigmentation following laser resurfacing of the face.

Edward Lack, MD
Chicago Dermatologist
3.0 out of 5 stars 5 reviews

EpiQuin Micro for post-CO2 pigmentation

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I like to use a high quality hydroquinone in follow-up after CO2 to prevent dyspigmentation.  I do appreciate the benefits of erbium lasers for cutting with less heat in treating things like sebaceous hyperplasia.  Still, when you want skin tightening Fractionated CO2 is the best we have.  I think you will get away fine with time and I don't believe high potency steroids will benefit the pigmentation at this point.  Adding a high quality hydroquinone such as EpiQuin micro or Lustra may be beneficial.  Good luck.

Michael Howard Swann, MD
Springfield Dermatologic Surgeon
5.0 out of 5 stars 6 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.