Melasma and PIH darker after Picofacial (Picosure Focus laser)... is this normal? (Photo)

Question

I recently had a picofacial (Picosure focus laser treatment) to treat my PIH and melasma. My melasma has darkened by a couple of shades since the treatment. I don't see any reviews noting darkening of pigment after Picosure focus. Is this temporary? Should I continue with the second treatment and wait it out? I am a 30 y/o Caucasian female, no children and not taking BCP.

Sheila S. Nazarian, MD · Answer

For now, I would advise you to discontinue your treatments and consult with your dermatologist or surgeon. Melasma is very difficult to treat and though the PicoSure Focus is probably the best laser out there for treatment melasma, I typically start my patients with an HQ product to lighten the skin first before moving to laser treatments. My best, Dr. Sheila Nazarian @drsheilanazarian on Instagram

Raffy Karamanoukian, MD, FACS · Answer

PIH is a process that is quite common after surgery. Known as post-inflammatory hyperpigmentation, PIH can make your scars look far worse than they should be. We can develop PIH after acne scars and after surgery, particularly if you have darker complexions. In clinical practice, we always begin with application of Melarase AM and Melarase PM creams (coupled with Melapads) to help smooth out the color and pigmentation. Once the creams are started, lasers can be used to further reduce the scarring. 
  Best, 
  
Dr. Karamanoukian
  
Realself100 Surgeon

Brian K. Machida, MD, FACS · Answer

There is often temporary darkening of pigmentation after treatment.  Make sure that your treatments are spaced out at least 6 weeks apart in order to get the maximal results.

Omar Ibrahimi, MD, PhD · Answer

Melasma is a challenging condition to treat. As much as I love using laser technology, lasers are never a first line therapy. Lasers can certainly improve melasma but it is possible to trigger flares of melasma as well. The Picosure laser is a newer technology but the risk of flaring melasma with a picosecond laser is definitely possible. I would see your dermatologist to discuss this further.

Evan Sorokin, MD · Answer

I have not seen this happen with my Focus PicoSure.  My best advice would be to get right back in to see your doctor about this.  Sometimes skin needs to be pre-treated and post-treated with skin lighteners (for example hydroquinone but there are others) prior to any laser.  PicoSure is a powerful laser and certainly what you are describing is a risk so get back in to see your doc ASAP.  I wouldn't just wait it out without evaluation...

Melasma and PIH darker after Picofacial (Picosure Focus laser)... is this normal? (Photo)

Answers (7)

Answer: Picosure laser and melasma

Answer: Picosure laser and melasma

Answer: Picosure Focus should reduce, not increase melasma

Answer: Picosure Focus should reduce, not increase melasma

Recommended reading

Everything you need to know about PicoSure

Our mission is to create a world where every investment in modern beauty is Worth It.

Melasma and PIH darker after Picofacial (Picosure Focus laser)... is this normal? (Photo)

Answers (7)

Answer: Picosure laser and melasma

Answer: Picosure laser and melasma

Answer: Picosure Focus should reduce, not increase melasma

Answer: Picosure Focus should reduce, not increase melasma

Browse related questions

Recommended reading

Everything you need to know about PicoSure

Our mission is to create a world where every investment in modern beauty is Worth It.