I'm Hispanic and considering PicoSure for hyperpigmentation caused by Fraxel. Can this make it worse?

I would be cautious, the pico can also cause depigmentation. I suggest a formal evaluation.  post inflammatory hyperpigmentation from lasers is best treated with low level peels or microsecond lasers (like genesis) and skin lightening creams.  Best, Dr. Emer.

Treating hyper pigmentation takes a multi-prong approach. Yes, the PicoSure is probably the best thing on the market for this. Typically, I start my melanoma/hyperpigmentation patients on some kind of HQ treatment first. Then, 1-2 laser sessions at least. And always, lots and lots of sunscreen. My best, Dr. Sheila Nazarian @drsheilanazarian on Instagram

PicoSure, and in particular PicoSure Focus, although new,
is probably the newest and best approach to unwanted pigmentation, but treatment still needs to be gentle, and
gentler the darker the color of your skin. You probably have melasma, and yes
PicoSure Focus treatment is being used to help with increased, or rebound hyper
pigmentation made worse with Fraxel treatment.

Picosure can lighten dark areas.It is designed for tattoo removal and hyperpigmentation. A combination of bleaching cream composed of hydroquinone, treating in and trial incline could be used for weeks prior to laser for about 4 weeks followed by microdermabrasion followed by photorejevsntion with picosure .A test spot can determine that your skin tolerates the laser

Like Dr Emer says, you have got to be cautious. Yes, the Picosure is my go to laser for PIH, but I would use it in the Focus setting, 8 mm spot, then 6 mm. I like to start my patients on HQ before treatments. SPF +++++ of course. You will require 2-3 sessions. All the bestDr Davin Lim Laser, Surgical and Cosmetic Dermatologist. Brisbane, Australia.