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

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

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

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.

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.

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 is difficult to treat. I suggest a combination treatment microdermabrasion followed by picosure facial combined with bleaching cream containing treating in,hydroquinone and a steroid. Do a test spot first .

Melasma is a very difficult condition to control, and even with the best laser technology, it is not the answer. I do use the Picosure Focus to treat this condition, however the settings are extremely conservative and only done 2-3 weeks after I have initiated medical therapy. The basics of melasma treatment include the use of bleaching agents (HQ), retinoids, sun protection and gentle chemical peels. As for lasers, I do favour the Pico over the old nano. lasers, but my parameters are very conservative. No end point, 8 mm spot size, 2-3 quick passes, steroid after. Repeat in 2 weeks. Hopefully in your case the melasma should settle. All the bestDr Davin Lim Laser and aesthetic dermatologistBRISBANE, Australia