Will Erbium Laser Around Mouth and Undereyes Cause Uneven Pigmentation?

What you describe is done very commonly.  Fraxel Repair can be done on the perioral and periorbital areas while the rest of the face is blended with Fraxel Restore, Fraxel Dual, Chemical peel or other mild resurfacing. Compared to ablative non-fractional carbon dioxide laser resurfacing, there is much less chance of developing hypopigmentation in the segmented areas with the fractional CO2 laser treatment. Erbium, specifically, such as Fraxel Restore, and non fractional erbium can also be done around the eyes and mouth, but in this cirucmstance and Fraxel Repair, it does depend on your coloration and susceptibility to developing post inflammatory hyperpigmentation.

There are several variables to consider, especially your skin color type (Fitzpatrick I-VI)  as well as the depth of the treatment around the eyes and mouth. The more sun damage one has and the darker one's skin is, the more likely that there could be a demarcation line between the deeper and more superficially treated areas. On a positive note,  unlike the occasionally seen complication of hypo-pigmentation with CO2 ablative resurfacing,  undesirable dramatic depigmentation with erbium resurfacing is not generally a concern.  Also, having a micro-peel over the rest of the face at the same session is a good strategy to help with blending.

Whether you will have uneven pigmentation or the extent of uneven pigmentation will depend on the starting point of your skin, the settings utilized, and the skill and technique of the practitioner.

Make sure you are seeing an expert to do this treatment.  The micropeel on the face and the deeper peel around the mouth and lower eyelids are two totally different levels of peel.  If the peel on the upper lip and lower eyelids is too deep you could have permanent hypopigmentation and scarring that cannot be fixed!

The best way to prevent pigmentary problems is to pretreat the skin with retinoids & hydroquinone.  This is necessary in darker skinned individuals, but not usually fair skinned.  

 

Your question regarding whether erbium laser around the eyes and mouth will cause differences in color or texture with or without a microlaserpeel depend upon what your skin looks like and the settings of the laser. If you have a lot of sun damage you may notice a "step-off" in color or texture even if the edges are blended and even if you have a microlaserpeel. These type of laser treatments are individualized to each patients needs and experienced practicioners can judge the depths and settings necessary to avoid these "step-offs". That said - deep resurfacing around the mouth and eyes with a micropeel on the rest of the face will work for many patients.

Having portions of the face lasered is usually not a problem if it is done properly and the edges are blended and placed in appropriate areas. Some issues that might possible create a color or texture difference between lasered and non-lasered areas are if you (the patient) has a darker skin tone or is prone to hyperpigmentation, if your skin has a lot of wrinkles or a lot of pigment change (dyschromia) from sun damage.  Usually, if you are looking to smooth out some fine or moderate lines in these areas then it isn't a problem. 

You are correct that having a "microlaser treatment" (I assume you mean  fractionated laser or light laser peel) will blend skin tones and textures better and receive an overall better result.

For isolated concerns of Periocular or Perioral aging, laser resurfacing is a good option.  Currently, we prefer to do a series of Fractionated CO2 treatments.  This procedure is safer, less down time, and there is no line of demarcation that can be seen with fully ablative traditional CO2 Laser. 

Traditional fully ablative CO2 laser is still the most powerful modality, but the higher risk of scarring, permanent pigmentary changes, and the development of lines of demarcation have caused this treatment modality to fall more out of favor.  In cases where fully ablative CO2 is employed, I prefer to do one full face pass, with additional passes over the areas of concern.  I find this superior than attempting to blend with the Erbium laser.  The Erbium can be a good choice to blend the very edges (hairline, jawline/neck) of the CO2 treatment.