Fraxel Pigmentation Side Effects

I had three fraxel treatments done starting february, march, and april - all went well - but last month i noticed spots on the sides of my cheeks - now i am reading about pigmentation which was never mentioned by my doctor - is this a common side effect and do these spots usually go away or they for ever? They were never there before fraxel. What could cause this?

Doctor Answers 7

Any laser or chemical resurfacing can causes skin...

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Any laser or chemical resurfacing can causes skin darkening and discoloration that show up as spots, or as large patches on face or body. This is because cells that normally produce brown pigment of your skin go into overdrive. This happens because of an inflammatory.

Although this side effect can occur in all skin types, it is more common in people of Africa, Asia, Latin, and indigenous Indian background.

This increase pigmentation will in many cases fade over time on its own. However, there are treatments available that can speed up the process.


Hydroquinone products can be purchased by prescription at 3% to 4% concentrations. One scientific study demonstrated that 80% of individuals who used a 4% hydroquinone product combined with glycolic acid had an improvement in their PIH after 3-months time.

Glycolic acid
Glycolic acid products are available over the counter and are also used as a treatment for PIH. These products work by gently exfoliating (removing) the upper-most layer of the skin and the dark marks with it.

Chemical Peels
Chemical Peels are a more intensive treatment used in cases of more persistent PIH or to hasten the lightening effects of the topical prescription products. Peels work by exfoliating the upper-most layer of your skin and the dark area with it.

Microdermabrasion is a cosmetic procedure in which fine crystals are sprayed onto the skin’s surface to gently sand away the upper-most layers of the skin. As with chemical peels, microdermabrasion works by exfoliating the upper-most layer of your skin and the dark area with it. This procedure is particularly well suited for individuals who have sensitive skin (many individuals with brown skin) or those who have had a previous reaction to a chemical peeling agent.

Beverly Hills Facial Plastic Surgeon
4.1 out of 5 stars 34 reviews

Fraxel Pigmentation Side Effects

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Depending on your skin type, hyperpigmentation after Fraxel can occur if you are not careful about staying out of the sun or if you are using any products containing alcohol or retinol within the first week after your treatment. It is difficult to comment without pictures. You can use a hydroquinone based lightening cream at night to help fade the new spots. Typically hyperpigmentation after laser procedures is not permanent.

Tim Sayed, MD, MBA, FACS
Newport Beach Plastic Surgeon
5.0 out of 5 stars 22 reviews

Pigmentation after fraxel treatments

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Pigmentation seen after fraxel treatment can be 1) secondary to inflammation, so called post-inflammatory hyperpigmentation, most commonly seen in medium toned and darker toned skin types; 2) a return of melasma, the pigmented 'mask' traditionally seen with pregnancy and birth control pills, but occuring without those also; or 3) new brown spots arising with ultraviolet exposure in the spring.

Given your noticing the pigment only after your final treatment in April, not before, I suspect it was due to Spring sun exposure without adequate sun protection which can cause new lentigines ('age spots') or a recurrence of melasma.

I recommend that you return to your treating physician and review your photographs from before and after treatment.  You may find that all that is needed is a better sun protection regimen and perhaps some topical anti-pigment products.

I hope this helps answer your question.  Best wishes.

Heidi A. Waldorf, MD
New York Dermatologist
5.0 out of 5 stars 10 reviews

Melarase and Melapeels for Fraxel pigmentation

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Begin with topical Melarase creams followed by MelaPads for the pigmentation.  If you do not see full improvement, I would recommend a MelaPeel once monthly. Raffy Karamanoukian, Los Angeles

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 95 reviews

Fraxel Restore can help hyperpigmentation but can cause it too in some patients

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postinflammatory hyperpigmentation can occur with any trauma on some skin. It can be caused by acne, a burn from a curling iron, a sunburn, a waxing, laser hair removal, chemical peels and other treatments, and even a laser designed to improve facial darkening, Fraxel! Sunblock is important and your doctor may prescribe lightening creams and even chemical peels.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

Sun protection AFTER Fraxel is essential

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Fraxel has been a great success story in the quest for skin rejuvenation with little downtime. The laser targets water in the dermis to stimulate collagen production and it also removes microscopic islands of epidermis improving discoloration.

It can be used in all skin types, but the energy settings must be decreased for darker skin or those prone to pigmentation.

Deep heating can lead to inflammation that can stimulate pigmention, especially in darker skin types.

No matter what your skin color, the use of a broad spectrum SPF and avoidance of direct, intense sun is imperative to prevent pigmentation and to maintain the benefit from your treatments.

Pigmentation can usually be improved with the use of prescription retinoids and bleaching agents in conjunction with sun avoidance.

Mary P. Lupo, MD
New Orleans Dermatologist
5.0 out of 5 stars 18 reviews

Brown Patches May Develop After Fraxel, but always resolve.

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Brown Patches May Develop After Fraxel, but always resolve. After fraxel, as with chemical peels, dermabrasion,etc, the skin remains with some redness and mild swelling for a few days. It is crucial to avoid sun exposure for two weeks after Fraxel in order to reduce the chance of developing brown patches. With these precautions, brown spots uncommonly develop after Fraxel. If however they do occur, they always fade with proper use of bleaching creams and sun protection.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.