Hyperpigmentation from Co2 Laser, After 1 Month Not Fading. What Options Do I Have?

All of my fractional CO2 laser patients use Melarase AM and Melarase PM starting three days to five days after the procedure to reduce the risk of hyperpigmentation.Raffy Karamanoukain MD FACSLos Angeles

You must stay out of the sun!  Wear sunscreen with SPF 50+, makeup and a hat.  Return to your doctor who can determine if a fading cream is necessary.  If the hyperpigmentation is still present after the summer, you may be a candidate for light chemical peels that can help with fading.

The skin will often times respond to Laser Energy treatments with red or brown skin discoloration. First and Foremost you should get a second opinion from a Facial Plastic Surgeon or Dermatologist who performs similar treatments to confirm diagnosis and treatment options.

For redness protective barrier moisturizers, time, and topical steroids will help heal the skin. For brown discoloration treatment mirrors the above during the initial healing phase (usually first 2 to 3 weeks). At 4 weeks if the skin is less irritated looking, but still has a brownish discoloration, that was not present before the procedure, one may be dealing with PIH (post inflammatory hyperpigmentation) which will require on average 12 weeks of therapy using Retin-A, Hydroquinone, and a topical steroid (prescription item,  Triluma). These can be compounded or prescribed separately to customize the patient's treatment regimen. Obagi Nu Derm should also be considered for long term reduction in recurrence with Retin-A. 

Laser treatments for "stubborn" hyperpigmentation can include IPL or long pulsed 532nm laser treatments. This resistant hyperpigmentation also may require a series of treatments with these or similar wavelengths 4 to 6 weeks apart.

 Hyperpigmentation is not uncommon, especially if you are of Hispanic or Mediterranean origin. I have never seen permanent pigmentation and I have been doing laser resurfacing since the 1990's. Still, it can be distressful. Use a strong sunscreen daily and reapply it every 2 hours. Also us a bleaching agent and consider intense pulsed light treatments.