Correcting Hypopigmentation from CO2 Laser Treatments

Any resurfacing technique can cause hypopigmentation if its effects extend deep into the dermis, the permanent layer of the skin. As the damage goes deeper and deeper, more and more pigment cells are lost. Dermal elements are also lost, resulting in an abnormal smooth appearance of the skin as well. Healing with deep resurfacing techniques is prolonged, sometimes greatly.
Here is the paradox: the deeper the resurfacing, the more wrinkles are removed. However, the deeper the resurfacing, the more whiteness, waxiness and chance for scarring. Resurfacing techniques are therefore a balance between results and complications.
I don't personally believe there is a way to restore lost pigment cells, although there is some research on various creams ongoing.
We have found a happy balance in our practice by using medium depth CO2 resurfacing, and never performing deep CO2 resurfacing ever (i.e. 4 passes at high settings). The results are beautiful and long-lasting. Some wrinkles typically are left behind, and patients understand this ahead of time. However, they are pleased that they retain near normal pigmentation and skin appearance.

Hypo and hyperpigmentation after CO2 laser resurfacing are best avoided, of course, with meticulous patient selection and preparation ahead of time. Preparation can include some topical pre-treatment regimens, but mostly involves avoidance of the sun or any other pigments stimulation leading up to the procedure.A disciplined physician will not perform this type of resurfacing if there is obvious "tanning."Once the pigmentary changes are there, there are ways to improve them, but usually it is time that does the trick. For hyperpigmentation there are bleaching creams which tend to work fairly well if used consistently, but then you are also adding time into that equation. Hypopigmentation is tougher to deal with intends to be longer-lasting/more permanent. Stimulation with a fractional laser has been reported, but you need to make sure you are in the most highly trained hands to undergo such an attempt. To ensure you are receiving the highest level of care, seek out a dermatologic surgeon, oculoplastic surgeon, facial plastic surgeon or plastic surgeon who is board certified and fellowship trained in one of these "core four" cosmetic specialties.

This is a very poignant question.  Hypopigmentation is a difficult problem to fix. However, we have seen excellent stimulatory responses to hypopigmentation with our use of fractional co2 in our office. Raffy Karamanoukian, Los Angeles