I am interested in Fraxel Repair for acne scars and eyelids. I am Mexican and Native American with olive skin. Is this procedure recommended for darker skin tones?
Fraxel Repair on Darker Skin Tones?
Doctor Answers 1
Fraxel Repair for acne scarring on darker skins
Fraxel Repair can be used on darker skins, but only when there has been some kind of melanin suppression in place first. This is typically hydroquinone applied daily for 4 to 6 weeks prior to the procedure.
Ablative lasers tend to be more friendly to the lighter skin tones and those with northern European ancestry. Thus far, those with South American, Mediterranean and Asian ancestry are at much higher risk for pigmentation responses.
Your particular ethnic mix GUARANTEES some level of post inflammatory hyperpigmentation (PIH) with this type of procedure, so you should be prepared for corrective post-procedure treatments which could include salicylic acid peels as well as hydroquinone. You’ll also need to stay out of the sun for 6 months and be absolutely married to sunblocks of at least SPF 30 and with titanium dioxide of minimum 3% (6% or more is better).
Why is there such probable complication with CO2 lasers on dark skin?
Because there are intense heat levels with Fraxel Repair laser, skin with high melanin factors are at much higher risk for heavy hyperpigmentation. This heat triggers the melanin producing cells to go into hyperdrive. Even with suppression agents, the melanin levels of your unique skin type will “win”.
Some patients are willing to deal with the pigmentation to get improvement in acne scarring. Just be aware that this is a procedure that will for sure create some short term pigment issues (6 months or more) and potentially some longer term correction issues that take even more time. Even then you may have some residual pigmentation irregularities on an ongoing basis.
Anyone with a history of hyperpigmentation following any skin injury or exposure to the sun should be sure their treating physician is aware of their skin response. It's also a good idea to make sure your treating physician knows your particular ancestry. Genetic makeup plays a big part in what options a physician will be able to offer. Knowing all the potential issues is important, so ask lots of questions first.
Fraxel-ed skin is super sensitive to UV exposure. Patients who disregard this fact put themselves at risk of pigmentation problems that may take quite some time to clear up.
I have many patients of various ethnic origins and we have had a few instances of hyperpigmentation following Fraxel Repair that have required post procedure treatment. Recognize that any use of a heat application (even standing over a hot stove) can trigger unwanted melanin production. The most effective measure is to adequately pre-treat and then, if required, post treat with hydroquinone and other pigment lifting treatments