Can IPL make brown spots on hands worse? (photos)

Question

Top picture is before. Bottom picture is 19 days post IPL. I have more spots than before I started treatment. I used Retin-a for the first 2 weeks and have used sunscreen daily since treatment.

Jennifer Greer, MD · Answer

Thank you for your question. IPL (also known as Broad Band Light, or BBL) works by bringing the pigment to the surface of the skin. So immediately after a treatment you will notice more pigmentation and sunspots than you had prior to the treatment. Over a 3-4 week period this pigment will lighten up or even flake off. Since you are not even three weeks out from your treatment, I would expect you to have more brown spots at this time.

Raffy Karamanoukian, MD, FACS · Answer

Our office has many different treatments for scars depending on the depth of atrophy or hypertrophy. Scars require a combination approach using our HI DEF protocol which uses a combination of lasers, topical scar modulation, and RF treatments to pixelate scars, improve contour, reduce hyperpigmentation, and improve the visibility of the scars so that they are no longer visible in ambient light. Everyone has a unique pattern of scarring and we employ our HIDEF technique to improve texture, color, contour, and topography. We often use a combination of treatments that begin with a careful examination to examine the micro texturing of the acne scars. Atrophic scars and indented  scars can benefit from injectable fillers such as Radiesse, Sculptra, and Restylane with or without subcision to remove tethered scars and atrophic depression. Hyper-redness in scars can be improved with V beam laser, Excel V, BBL, IPL, and Venus RF to improve  the redness and reduce the visibility of deep scars. Fractional Thulium laser and clear & brilliant can also reduce the inflammation and redness of the scar when combined with topical therapy. Fractional lasers such as Fraxel, erbium, and CO2 laser can be combined with radio frequency and also fractional RF to improve textual issues and microtopography. Subcision and TCA cross are also used for deep ice pick scars and narrow valley scars in order to improve the micro texture.  Above all, our combination approach with our clinical nurses and board-certified plastic surgeons can improve the quality of your skin by using at home Melarase creams combined with PRP treatments in our office to improve your skin quality and tone. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your scarring.
 
Finally, hyperpigmentation of scars can be improved with at-home Melarase AM, Melarase PM, and Melapads to help reduce active PIH and melanin deposition.

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Jason Emer, MD · Answer

Yes, this can be typical. It can take several weeks for IPL laser results to settle. I usually recommend a combination of treatments with IPL for best results. I suggest adding microneedling/prp, peels and skin care to improve skin quality and tone. I recommend following up with a cosmetic dermatologist about appropriate after care. Best, Dr. Emer

Alex Eshaghian, MD, PhD · Answer

Thank you for your question JTB TX. I understand your concern.
IPL is a great treatment for facial rejuvenation. It works well for pigment on and off the face. For my patients I recommend a series of 6 monthly treatments followed by one maintenance treatment every 3 months thereafter. Applying retin-A can make the skin red and peeling. If this occurs I recommend that my patients back of and use less of it and/or use it less frequently. For my patients I prefer products such as hydroquinone and vitamin C for the hands. Please consult with a doctor for specific recommendations. Good luck!

Faiyaaz Kalimullah, MD, FAAD · Answer

Thank you for your question and for submitting photos.  After a typical IPL treatment, dark spots on the skin typically become darker - like coffee grounds sprinkled on the skin.  The dark spots typically flake off over the next few days to weeks - this process can take up to 3-4 weeks on the hands.  I'm glad you're using sunscreen daily - that's a great idea in general and especially after any laser or light procedure.  I don't typically recommend using Retin A immediately after IPL, as it can increase irritation and redness and delay the healing process.  
Looking at your photos, it appears that the brown spots on your hands are a combination of lentigines (commonly known as sun or age spots), which respond well to IPL, and seborrheic keratoses, which do not.  You may need a touch-up treatment with liquid nitrogen or a different laser to address the seborrheic keratoses in the future.  I would recommend discussing your treatments with a cosmetic dermatologist to determine the best treatment plan for you.

Parham Gharagozlou, MD, FACP · Answer

Darkening is the response you want to see that means it is working. Give it 2-3 more weeks. 
I am not sure if immidiately before or after IPL I would recommend Retin A. 
Ask the supervising physician at your clinic. 
Best Parham Gharagozlou MD FACP

Michele S. Green, MD · Answer

I have an IPL, Fraxel, and other lasers in my office but I prefer Candela's Alex-Trivantage laser for these brown spots.  It generally takes only one treatment to remove the brown spots and there is just a few days of down time.  Depending on your skin type, IPL can make brown spots or pigmentation worse.  Please consult an expert in cometic lasers and brown spots for the best results.  Best, Dr. Green

F. Victor Rueckl, MD (in memoriam) · Answer

The brown that is surfacing is known as coffee grounding. This is actually the pigment rising up, which is the purpose of the treatment. It is essentially breaking up the pigment. This is why a series of IPL are needed. However, with that being said, several of the spots on your right hand are seborrheic keratoses which are aggravated by IPL and cannot be treated by it. Those will be need to be treated via cryotherapy (liquid nitrogen). In my office if you are receiving IPL treatments I also treat patients for SKs in the area at no charge so the area is fully treated. Consult a cosmetic dermatologist if your area if that's not who is doing your IPL treatments. I have found that many offices that just do IPL don't realize the differences in "brown spots". "This answer has been solicited without seeing this patient and cannot be held as true medical advice, but only opinion. Seek in-person treatment with a trained medical professional for appropriate care."

Can IPL make brown spots on hands worse? (photos)

Answers (8)

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