Help, I have hyper and hypopigmentation on my face. Is this plan right for me? (photo)

This needs a combination approach of lasers and microneedling. It should be tailored by an expert.  Please get a formal consultation.  Best, Dr. Emer.

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser. Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.
Best,
Dr. Karamanoukian
Realself100 Surgeon

Thank you for your question! You did not mention your diagnosis but it looks like you are developing melasma. It is tricky to treat melasma since there is no cute for it, just treatments that improve look of your skin. Some lasers trigger even worse outcome. Chemical peels are safe treatment for the beginning while I would suggest you do be careful with laser treatment. It is important that treatments are spaced out enough. Obagi nuderm system is good home care regimen. Best of luck!

You did not mention your diagnosis but it looks like you are developing melasma. It is tricky to treat melasma since there is no cure for it, just treatments that improve the overall appearance of your skin. Some lasers trigger even worse outcome. Chemical peels are safe treatment for the beginning while I would suggest you do be careful with laser treatment. I advise you to look into Vi Peel. It is important that treatments are spaced out enough. Obagi nuderm system is good home care regimen. Good luck! 

I do a ton of Fraxel laser in my office but Fraxel does not appear to be the laser that would be best for you.  You appear to have melasma and scarring.  I would opt for chemical peels with hydroquinones for pigmentation or Cosmelan with V-Beam for redness.  Please consult a board certified dermatologist.  Best, Dr. Green

This looks to me like melasma. I'd be cautious at first. I would use the Obagi, and chemical peels for 3-4 months. Afterwards, consider Fraxel or Spectra QS laser treatment. This is a difficult problem to fix you must know. Lasers can cause worsening of this problem so trying conservative measure is always the safest. Chemical peels are the mainstay of therapy in most cases. I don't have experience using PRP for this problem but other docs recommend it. I do recommend Heliocare as well as absolute sun protection. Antioxidants are also recommended because this is felt to be an inflammatory process.

Honestly, your case is complicated with a mix of acne, hyperpigmentation (melasma?), post inflammatory erythema, hypopigmentation, and scarring. It is hard to give you a treatment plan without seeing you in person. What I can tell you is that it would be beneficial for you see an experienced physician for an in-person consultation.