Does FRAXEL Dual 1927 Treat Dermal Hyperpigmentation?

The Fraxel Dual laser has 2 wavelengths: 1550nm for deeper pigmentation, wrinkles, and acne scars, and 1927nm for more superficial pigmentation, sunspots, rough texture, and milder sun damage.  True dermal pigmentation is usually caused by melasma or occurs after trauma to the skin, especially in people who have darker skin or tan easily (post-inflammatory hyperpigmentation or PIH).  This type of pigmentation can be very difficult to treat and, in some cases, can be exacerbated by laser therapies including Fraxel.  My approach to a patient who has melasma and/or PIH is to pre-treat them with a bleaching cream such as hydroquinone for at least 2 weeks prior to treatment with the Fraxel.  I often will use both wavelengths in a treatment session to target the superficial and deeper pigmentation.  If you truly have dermal pigmentation, the 1927nm wavelength alone may not penetrate deep enough to target it and may cause it to worsen.  Once the patient is healed, the bleaching cream should be continued to prevent PIH.  In certain patients, a short course of topical anti-inflammatory creams can also be used to prevent PIH.  There are risks involved with any laser treatment, so make sure that your physician is skilled in using both Fraxel wavelengths on all skin types.