Preventing PIH After Fraxel Restore or Repair

While there are many reasons for post inflammatory hyperpigmentation, the easiest way to prevent it is to pre-treat with Retin A and the Obagi System. The Obagi system has hydroquinone in it, which alone can help, but doesn't help as much as when it is in the Obagi program.
The Retin A is always a help and is incorporated within the Obagi system if you purchase that.
Additionally, it is really important to make sure you are the right person for these types of treatments. If you are darker than average or if you are a sunlover, then neither of these treatments are probably right for you as you will probably have problems after them.
Good luck!

In my practice, I try to stay away from these combination regimens, as cortisones are non-selective inhibitors of melanocytes.  I would recommend my patients to start Melarase AM and Melarase PM for the pigmentation.
I would start with an intense skin rejuvenation protocol for age spots that includes fractional laser, Covalent chemical peels, and daily skin brightening creams to improve your skin’s complexion. Laser therapy, he adds, must be combined with a proper skin regimen to enhance and maintain youthful results.
He recommends the following skincare products for dark age spots: Melarase
MelaClenz Brightening CleanserMelarase AM: Day-time skin lightener with SPF 30Melarase PM: Night-time skin lightenerMelapads: Daily Exfoliating PadsReplenish Retinoid Cream: Exfoliating and skin-stimulating night creamBest, 
Dr. Karamanoukian
Realself100 Surgeon

Post-inflammatory hyperpigmentation (PIH) can occur when any type of inflammation is delivered to the skin: laser, peels, dermabrasion, etc. With lasers it is more common with ablative (Fraxel Repair) than nonablative (Fraxel Restore). It is also much more common with Fitzpatrick skin types 4, 5, and 6 and in patients with Pacific Rim heritage. The Fitzpatrick skin type refers to the way your skin responds to ultraviolet light exposure (burn or tan). Generally, patients with darker skin have higher Fitzpatrick scores.
The risk of PIH can be reduced by pretreating the skin with a bleaching cream (hydroquinone) and mild steriod (hydrocortisone). We recommend pretreating with these creams for several weeks before treatment. Also, it is imperative to avoid sun exposure BEFORE and AFTER laser treatment.

Post-inflammatory hyperpigmentation or PIH is a darkening of the skin which can potentially follow any injury to the skin. Scratching a mosquito bite, getting burned with a curling iron, waxing the eyebrow are minor injuries which can result in long lasting darkening of the pigment. How much more the possibility of PIH when more intense medical treatments are applied!
Prevention of PIH starts with matching the patient and their goals to an appropriate treatment. For instance a very dark complected brunette patient might not be the best candidate for a deeper Fraxel Restore treatment at all. Once the patient and treatment have been matched pre-treating the patient with tretinoin, hydroquinone, and sunscreen a month before treatment would be beneficial in preventing unwanted color.

Starting hydroquinones 4% 1 month prior and restarting soon after the procedure will help prevent PIH from Fraxel. There is also a recent paper that suggests pre and post procedure Gentlewaves will decrease the risk of PIH as well. Avoiding the sun for 6 weeks prior to the procedure and good sunscreen also is important.