What's the best minimally-invasive treatment for hyperpigmentation caused by chemical peels?

Two weeks after a chemical peel is a very short period of time in relation to healing. The first thing I would recommend is patience in terms of the color variation. You should be using a sun block of at least SPF 30 during this time. Most physicians will not intervene for pigment problems until at least 4-6 weeks post-treatment. This rule is based on the natural time frame of wound healing.

Wound healing occurs in 3 stages:

1. The immediate phase which lasts about a week
2. The proliferative phase (where new cells and blood vessels come into the area) takes 4-6 weeks
3. The remodeling phase, which may last up to 1 year

The timing of various treatments and interventions in plastic surgery are based upon this scientific principle. Oftentimes, the body does a better job of healing a problem than anything we can do medically.

That being said, the best treatment for you depends on whether the lesions are brown or red.

• If they are red and it has been at least 4 weeks since the peel, then it is likely a problem called prolonged erythema (redness) due to increased blood flow to the areas in question. Certain lasers (such as a pulsed-dye laser) may be effective in treating that problem and are safe in pregnancy. In patients not currently pregnant and not actively trying to get pregnant, steroid cream treatment for 1-2 weeks often solves the problem.

• If the areas are brown then it may be truly a problem of hyperpigmentation. Hydroquinone, with or without retin-A and a combined steroid (again, for non-pregnant patients only) is the best topical therapy. A variety of other lasers may also be effective.

At this moment in time, I would try to wait a few more weeks, be diligent about using sunscreen and staying out of the sun. If the problem persists, then rest assured there are multiple treatments to solve your problem.