Darkened skin under eyes after laser for wrinkles. Treatment done 3 weeks ago, is this permanent? (photo)

Question

It is about 3 weeks since I had laser for wrinkles under my eyes. I have darkening under the eyes which wasn't there before and it's not getting any lighter. Is this permanent? Seeing my doctor soon, but kind of freaking out. I have to wear makeup all the time now to cover up the dark. The skin almost look like it has been bruised, but it's not getting any better.

John J. Martin, Jr., MD · Answer

This is called post inflammatory hyperpigmentation. It can occur after any laser treatment, but is seen most commonly in darker skinned individuals.  You look fair, but even in fair skin it can occur.  It is usually seen about 3-4 weeks after the treatment.  It will resolve.  Using some bleaching creams which have hydroquinone and kojic acid may help to speed up the resolution.  These creams/solutions can also be irritating, and may cause more redness and flaking of the skin.  Use sunblock.  If you still have it after a couple of weeks you can start doing some other lasers to help decrease the pigment.

William Groff, DO · Answer

As other doctors here have said, this is post-inflammatory hyperpigmentation or PIH. It is relatively common after this type of laser treatment and typically resolves without intervention. However, it can take a few months to see full improvement. When you follow up with your doctor, you may be told to use a topical lightening cream to speed up the healing process. But rest assured it is not likely permanent and you will see improvement in the following weeks.

David S. Felder, MD · Answer

As stated previously, this is PIH or post-inflammatory hyperpigmentation. It is not uncommon, and we saw it more frequently with fully ablative CO2 vs. fractional CO2 laser. It usually begins about 3-4 weeks after laser resurfacing. We use bleaching creams such as Hydroquinone to treat the PIH. It may take a couple months to disappear. It is not permanent. Best of luck.

Rebecca Fitzgerald, MD · Answer

There is always a risk of new pigmentation following laser. Each person's skin responds to laser heat and injury differently. Skin with more pigmentation potential (those with genetic backgrounds such as Asian, Middle Eastern and South American, etc.) run a higher risk. Sensitive skin can retain redness and a bruise-like appearance for several months.For brown pigmentation, your doctor will likely use some lightening creams. It will take time. Be particularly vigilant with sunscreen as the treated area will be more prone to over-respond to sun exposure.Be gentle to your skin, use fragrance free moisturizers and if you use concealers, be sure to remove them carefully so there's no tugging or friction on this fragile skin.

James R. Gordon, MD, FACS, FAAO · Answer

Thank you for sharing your question and posting your photograph. You might have post laser hyperpigmentation of the skin. Sometimes the best approach is to just monitor the area without treating it. If it worsens or does not resolve, Hydroquinone or topical steroid might help. Your doctor will be able to advise you. Good luck,

Jason Emer, MD · Answer

A combination approach will give the most improvement. Fillers, lasers, and microneedling/PRP can improve under the eyes. My patients try to get non surgical treatments to avoid surgery. We use PRP and stem cells there often. I suggest consulting with an expert to develop a treatment plan best suited for your short and long term goals. Best, Dr. Emer

Robert M. Lowen, MD · Answer

This is a combination of a lot of laser energy that will take a while to recover from, and perhaps some post laser hyperpigmentation.  My approach is to use some hydroquinone, a lot of sunscreen, and perhaps a short course or two of a mild steroid. Then follow.  This can take many months to resolve fully.

Yael Halaas, MD · Answer

This question is best answered by your treating physician during your follow up visit as soon as possible. Your would be able to examine and determine whether you are having some redness which is common post procedure or some pigmentation issues which can then be treated.

Robert G. Aycock, MD, FACS · Answer

The skin may be pink up to 3 months after resurfacing. Some patients do have some hyperpigmentation under the eyes that can be addressed with prescription topical lighteners. Every office has different protocols but your doctor will be able to evaluate you closely.

Darryl J. Blinski, MD · Answer

This is an example of laser induced PIH (post inflammatory hyper pigmentation). Best to see the treating MD ASAP for initial use of quiniones around 4-8% and other external lotions, steroids creams, sunscreens, sunglasses. If after 6 weeks still no improvement might consider specialized external lasers for hyper pigmentation (KTP 532nm wavelengths). I also use PRP/PRF micro injections to area to sped lightening effect (those sessions are $800 per session).

Darkened skin under eyes after laser for wrinkles. Treatment done 3 weeks ago, is this permanent? (photo)

Answers (10)

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