Will a Photo-facial be able to fade the brown PIH that has developed as a result of bike accident 8 months ago. (photos)
Doctor Answers 4
Pigmentation after injury
I agree with using topical agents first. Hydroquinone 4% seems reasonable. Tri-Luma is ok as well. From picture it seems you do have an scar some form of resurfacing is needed. Non ablative resurfacing in higher skin types (darker skins and asians) may be safer than fractional ablative. QS or pico machines are great for pigment reduction specially in above mentioned population. with fractional ablative you can get faster results but sometime they can paradoxically cause PIH in darker skin types and some times even Asians. clearly an in person consult is needed but from the information you provided I would go with combo therapy with topicals and non ablative lasers plus or minus IPL (photofacial). Talk to a local expert in person.
HQ + treatments like fractionated CO2
Pigmentation after an injury can be more difficult to treat. Although IPL can help with the post-inflammatory hyperpigmentation, I would agree that fractionated CO2 is a great idea. Q-switched or pico-second lasers could also help with texture and pigmentation. Regardless of which resurfacing options you use, I recommend a course of hydroquinone 4% with or without tretinoin depending on your skin type.
Topicals and Halo
PIH is first treated with topicals such as Hydroquinone 4% along with Tretnoin. If the area is really stubborn then switching to Tri-luma would be beneficial. Then, when the pigment is lightened, Halo is a great treatment to help smooth out your skin and clean up the rest of the pigment that is left.
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Treatment of PIH
Thanks for your question. Before proceeding with ANY of the treatments you have mentioned, you should be on a skin conditioning program for about 12 weeks- including 4% Hydroquinone and Retin A (tretinoin) 0.05 to 1.0%. ZO Skin Health by Dr. Obagi is a great line (Melamin, Melamix, Tretinoin). If you do not pre-condition your skin in this way, there is a HIGH likelihood that these procedures will induce ADDITIONAL post inflammatory hyperpigmentation. It does appear that in addition to the pigment you have some textural changes in the skin as well. Consider fractionated radiofrequency (example- Infini RF by Lutronic)- this in my opinion would be preferable to fractional CO2 in a skin type 4 which is what I expect you are based on the photos. TCA spot peel- I bet you would end up with a line of demarcation (lighter skin where the peel solution is placed, versus your surrounding skin- not a great plan and, again, I wouldn't touch your skin with TCA until it was pre-conditioned.
Lisa Vuich, MD
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