Fraxel Repair or Total FX PIH Risk on Skin Type 4?

Hello, I'm considering Fraxel Repair or Total FX (Active FX/Deep FX) for acne scarring. I have skin type 4, Middle Eastern skin. Will I get PIH after treatment? Is one laser better at preventing pigment problems over the other? In the past, I've had full face Erbium, chemical peels, and dermasanding with no pigment problems. Is fractionated co2 at deep levels safe on me, or am I for sure going to get post inflammatory hyperpigmentation? What about hypopigmentation? Thank you!

Doctor Answers 1

Fraxel Repair or Total FX PIH risk on skin type IV

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Hi SanJose in LA,

Fraxel repair is indicated in patients with Fitzpatrick skin types I to IV. The risk of post-inflammatory hyperpigmentation (PIH) does go up as skin color gets darker, and in Asian skin. We have treated many patients with darker skin types with Fraxel repair for acne scarring. Their skin is pre-treated with Nia-24, and then post treated as well. Many practices treat aggressively with bleaching agents before and after laser. There is no guarantee that you won't develop PIH, only that if it should occur, it will fade over time. You need to weigh how badly your acne scars trouble you versus how comfortable you would be living with PIH until it faded eventually. I have not personally seen or heard of hypopigmentation with Fraxel repair. I would suggest that you treat your entire face, including your eyelids if you do go ahead, as then your color with be uniform. Another thing to keep in mind, although many acne scar patients are very satisfied after one treatment, they all should be told from the start that 2 to 3 treatments may be necessary for optimal results. I do not believe that there is a difference in PIH rates with Total FX and Fraxel repair, both excellent fractionated CO2 lasers. Good luck and be well.

Dr. P

Encino Facial Plastic Surgeon
4.8 out of 5 stars 37 reviews

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