Hypopigmented macules from Starwalker laser (Photo)

Question

I had been doing monthly sessions of Starwalker laser for hyperpigmentation and acne for almost a year. 9 months ago I started developing hypopigmentation in the jawline and neck after a session I did after returning from a trip where I was out in intense heat and sunlight. It triggered some hyperpigmentation in my jawline which was clear just the month before the trip. I did a few sessions after but the hypopigmentation got worse. Is this going to be permanent?

Anna Chacon, MD, FAAD · Answer

I'm sorry you're dealing with this. I can understand why it's concerning, especially after almost a year of treatments and when your original goal was to improve pigmentation and acne.

From your history, the timing is very informative. You mentioned that the hypopigmented spots began after a laser session performed shortly after returning from a trip with significant heat and sun exposure. That raises the possibility that your skin barrier and pigment-producing cells (melanocytes) were already stressed before the laser treatment.

There are a few possible explanations:

Temporary melanocyte suppression: This is one of the more common causes of hypopigmentation after laser treatments. The melanocytes are still present but have been "stunned" and are producing less pigment. Recovery can occur, but it often takes several months and, in some cases, a year or longer.
Laser-induced pigment loss: If the energy delivered to the skin exceeded what the melanocytes could tolerate—especially in skin that had recently been exposed to intense sun—there can be more significant pigment disruption. Repeated treatments while the skin was already showing hypopigmentation may have contributed to the progression.
Underlying pigment disorder: Less commonly, laser treatments can trigger or uncover conditions such as vitiligo in people who are predisposed. This would typically require an examination to distinguish from post-laser hypopigmentation.

The encouraging part is that not all laser-induced hypopigmentation is permanent. Many patients experience gradual repigmentation over time, although the process can be slow. Unfortunately, because your changes have persisted for about nine months, I would be cautious about predicting a full recovery, but I would not assume that the pigment loss is permanent either.

At this stage, one of the most important things is to avoid additional laser treatments to the affected areas until the cause of the hypopigmentation is fully understood. Continuing laser treatments while pigment loss is progressing can increase the risk of further changes.

Daily broad-spectrum sunscreen is also essential. While sunscreen won't restore pigment, it helps prevent surrounding skin from tanning, making the lighter areas less noticeable and protecting the skin as it heals.

Depending on the underlying cause, treatments such as topical anti-inflammatory medications, topical calcineurin inhibitors, or carefully selected forms of light therapy may be considered to encourage repigmentation. The best option depends on whether the pigment cells are simply suppressed or have been more significantly affected.

The most important next step is determining why the hypopigmentation developed before deciding on treatment. In many cases, the appearance and distribution of the spots, along with your treatment history, provide valuable clues.

While nine months can feel like a long time, pigment recovery often occurs much more slowly than patients expect. I wouldn't lose hope, but I would approach any further procedures cautiously until the skin has been thoroughly evaluated and the underlying cause is clearer.

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

Hypopigmented macules from Starwalker laser (Photo)

Answers (2)

More Laser Resurfacing Questions

Laser Treatment for Chronic Eyelid Swelling ? (Photo)

Can fat loss happen with thermal energy devices?

Is laser the right procedure to fix severely clogged pores under my breast? (Photos)

Not healing properly after laser resurfacing? (Photo)

Under eye rejuvenation/ Sun sensitivity?

Can laser remove the large cafe au lait spots all over my lower body?

WE SEND PRETTY
EMAILS