INFINI RF with PRP for acne scarring. Is it normal/common to get dark spots/hyper-pigmentation after this treatment? (photo)

For for the majority of patients, hyperpigmentation is rare after Infini. However, dark-skinned patients with the history of easy tanning, can develop hyperpigmentation. This can easily be treated with bleaching agents and exfoliation. Do not Retreat until the pigmentation is back to normal. It is important, before your next treatment, to pre-treat the area with bleaching cream so you do not re-develop hyperpigmentation. Find an infini expert. Ask to see photos.

Used appropriately, microneedling should not cause this. I recommend following up with your Doctor about after care and skin care recommendations. PDT therapy can improve inflammation. We suggest all patients follow up with facials like Silk Peel Dermalinfusuion to hydrate, exfoliate and provide the skin with antioxidants. Sun protection is also essential. I always combine microneedling with prp and lasers to get the best outcomes. We do treatments every 3-6 weeks. Hyperpigmentation can be improved with a combination of lasers, Aerolase, microneedling/prp, skin lightening, peels, Cosmelan and skin care. Sun protection is essential. See an expert. Best, Dr. Emer

It isn't "normal" to get PIH but it can occur after Infini. I would make sure you are on retin A and hydroquinone now and throughout treatments. A 1064 laser can also be used to decrease the PIH as can chemical peels.Healite after all laser and Infini procedures is standard in our office and calms the skin down after treatment. I see areas that would benefit from TCA Cross and perhaps subcision as well. Acne scars do best when treated with multiple modalities. I don't like to do lasers on skin with as much pigment as yours but some do. The reasons for this are:
Too much energy usedToo long pulse durationPasses too close together (overlapping)Not enough time between passes to allow for coolingToo superficial with the energy - try to stay 2mm or deeper in dark skinToo many passesOperator removes handpiece before full pulse is given so the superficial dermis gets pulsedThe handpiece is not perpendicular or square with the skin surfaceThe Genius, the next generation Infini, will be FDA approved in near future. I will have impedance monitoring so as to deliver the desired energy regardless of the tissue resistance witch is a variable not taken into account with the Infini. It will also have thinner needles and a better motor to place coagulation zones more accurately. A small ergonomic handpiece will allow the user to more accurately see where the pulses are being placed in the skin.

Occasionally, patients with darker skin can have a transient hyperpigmentation after Infini. I have never seen this be permanent. For these patients, I always pretreat with skin lightening topicals. I would recommend using a topical hydroquinone, Vitamin C and Retinol or Tretinoin (or others-- there are many options) until the hyperpigmentation resolves-- this may take weeks to months, but it will go away. Then continue the topicals through any future Infini treatments to prevent this in the future.

Once again, PIH depends on the treatment settings. Yes, I can treat patients who have skin type 5 or 6- even darker than you WITHOUT PIH, but if the parameters are incorrect, or the needle is withdrawn incorrectly (pulse delivered superficially), PIH will occur. This can be treated easily with HQ, and low strength peels. See your dermatologist for advice. Acne scar revision comprises of specialised procedures. For the best results, one should target the acne scar type with ideal treatments METHODS. Using one device is not optimal. As everyone has a unique pattern of acne scarring, the best solution is a tailored one.  The web reference below will take you to a resource to help you understand acne scar revision at a specialist level. I embedded all the videos in one page to help. 



As an example deep ice pick scars, and narrow box car scars are best treated with TCA CROSS. Deep narrow scars respond better to this treatment than even the most expensive lasers. On the flip side, rolling, and atrophic acne scars can improve with fractional devices such as Fraxel, fractional lasers, ProFractional erbium lasers, Infiini –Intensif –Intracel radiofrequency microneedling. Atrophic scars (depressions) can be treated with either fat grafts, PRP or dermal fillers. Tethered and anchored scars are best treated with surgical techniques such as subcision. Other surgical techniques that I use include punch elevation, surgical elevation, punch excision and traditional excision for focal scars. Early and very mild acne scars respond well to eMatrix and non-energy microneedling, as well as vascular lasers. Skin colour changes such as PIH or dark marks respond best to sun protection, creams, and Q switch lasers in the nano and pico pulse durations. 



The majority of patients will have a collection of different scar types, and hence a tailored treatment METHOD will be best. Careful examination, especially under angled lighting with scar mapping will give you an understanding of what are the best options for your scars. Additionally tactile examination namely touch will give me an understanding of the amount of subdermal fibrosis, as special equipment is needed for this sub-set of acne scars.  In the majority of patients its finding the correct combination that give you best results, and everyone is unique! It is never about the device, its about the specialist behind the equipment that will deliver the best outcomes. All the best, Dr Davin Lim. Acne scar dermatologist specialist. Brisbane, Australia.