Best laser/treatment for scarring on African American skin? (Photo)

Question

Hello, I am an african american female with severe scarring on buttocks due to complications with folliculitis and picking. In the past I have used hydroquinone 3 % and hydroquinone 4% and it didnt lighten the marks much. I have heard getting a laser treatment would help, but I know it can be difficult finding the right laser for someone of my complexion. I would like to know what is the best laser for people of color . What other treatments should I try chemical peels and or microdermabrasion?

Raffy Karamanoukian, MD, FACS · Answer

Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to decide whether early subcision should be started.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Michele S. Green, MD · Answer

I treat so many patients such as yourself and please stay away from lasers.  The best treatment is Cosmelan or chemical peels combined with a custom 8 percent Hydroquinone and Retinoid product.  Please consult an expert in African American skin and these types of marks for the best cosmetic treatment.  Best, Dr. Green

Kathleen Gilmore, MD · Answer

Individuals with darker complexions, such as asians, hispanics, and those of african ancestry, can experience dark spots following injury or inflammation. Inflammation can be from acne, bug bites, or from a itching or a rash. Because of this tendency in some to develop the darkened areas, caution in selection the right treatments must be exercised. Traditional lasers that use heat injury in the skin to lift abnormal pigment, not only heats the dark spot, but an area surrounding the spot, and can worsen the condition or cause additional or new darkened spots.  Newer techniques and strategies which we have found to be very successful is to use devices which generate and incite less heat into the tissue, but can still target the dark spot.  In laser technology today, that is found in the Picosecond Lasers. Specifically fractionated picosecond pico laser treatments. They allow the laser pulse to be delivered many fractions of a second faster to the spot, meaning less time for heat to sit on the skin. So the treatment quickly and precisely can hit the target with less risk for collateral damage.  Being a safer treatment, it will go more slowly overall, meaning having more sessions for a more significant improvement in appearance. But safety is always first. Another alternative treatment to Fractionated Picosecond Laser is Microneedling which will also require several sessions for maximal benefit.

Anthony Bentley, DO · Answer

First, you need to be on a regimen of skin lighteners, such as hydroquinone, for several weeks prior to any treatment.  Although there are numerous treatments for hyperpigmentation, I tend to avoid lasers, since the heat generated by the laser could incite more hyperpigmentation.  However, picosecond lasers are theoretically less likely to have this problem.  I tend to recommend chemical peels, ideally containing skin lighteners, followed by a light steroid cream to reduce inflammation.  Remember that any modality will likely require several treatments.

Best laser/treatment for scarring on African American skin? (Photo)

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