My scar is darker after having CO2 fractional laser. What are my options?

Thank you for sharing your experience. It’s not uncommon to develop darkening of a scar (post-inflammatory hyperpigmentation, or PIH) after CO2 fractional laser, especially on the legs or in individuals with medium to darker skin tones. This can be distressing, but there are effective strategies to help improve the pigmentation.

Here are some options to consider:

Strict sun protection: This is crucial. Use a broad-spectrum sunscreen (SPF 50+), reapply every 2 hours, and keep the area covered when possible. Sun exposure can worsen and prolong hyperpigmentation.
Topical lightening agents: Products containing hydroquinone, azelaic acid, kojic acid, tranexamic acid, or cysteamine can help fade the darkened area. Combining these with a gentle retinoid at night can enhance results.
Short-term topical steroids: A brief course (up to 2 weeks) of a mild topical steroid can help reduce inflammation and the risk of further pigmentation.
Procedural options: If topical treatments are not effective after a few months, consider superficial chemical peels (like glycolic or salicylic acid) or low-fluence pigment lasers (such as Q-switched Nd:YAG). Microneedling is another option for persistent cases.
Improvement can take several months, especially for deeper pigmentation. If you see no change after 3–6 months of consistent treatment, or if the pigmentation worsens, it’s best to consult a dermatologist for a tailored approach.

With the right regimen, most cases of PIH do improve over time. I hope this helps clarify your options and next steps.

Our office has many different treatments for scars depending on the depth of atrophy or hypertrophy. Scars require a combination approach using our HI DEF protocol which uses a combination of lasers, topical scar modulation, and RF treatments to pixelate scars, improve contour, reduce hyperpigmentation, and improve the visibility of the scars so that they are no longer visible in ambient light. Everyone has a unique pattern of scarring and we employ our HIDEF technique to improve texture, color, contour, and topography. We often use a combination of treatments that begin with a careful examination to examine the micro texturing of the acne scars. Atrophic scars and indented scars can benefit from injectable fillers such as Radiesse, Sculptra, and Restylane with or without subcision to remove tethered scars and atrophic depression. Hyper-redness in scars can be improved with V beam laser, Excel V, BBL, IPL, and Venus RF to improve the redness and reduce the visibility of deep scars. Fractional Thulium laser and clear & brilliant can also reduce the inflammation and redness of the scar when combined with topical therapy. Fractional lasers such as Fraxel, erbium, and CO2 laser can be combined with radio frequency and also fractional RF to improve textual issues and microtopography. Subcision and TCA cross are also used for deep ice pick scars and narrow valley scars in order to improve the micro texture. Above all, our combination approach with our clinical nurses and board-certified plastic surgeons can improve the quality of your skin by using at home Melarase creams combined with PRP treatments in our office to improve your skin quality and tone. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your scarring.

Finally, hyperpigmentation of scars can be improved with at-home Melarase AM, Melarase PM, and Melapads to help reduce active PIH and melanin deposition.

Best,
Dr. Karamanoukian
Realself100 Surgeon