IPL or CO2 laser: which is better for correcting hyperpigmentation and broken capillaries?

Our office has many different treatments for scars depending on the depth of atrophy or hypertrophy. Scars require a combination approach using our HI DEF protocol which uses a combination of lasers, topical scar modulation, and RF treatments to pixelate scars, improve contour, reduce hyperpigmentation, and improve the visibility of the scars so that they are no longer visible in ambient light. Everyone has a unique pattern of scarring and we employ our HIDEF technique to improve texture, color, contour, and topography. We often use a combination of treatments that begin with a careful examination to examine the micro texturing of the acne scars. Atrophic scars and indented scars can benefit from injectable fillers such as Radiesse, Sculptra, and Restylane with or without subcision to remove tethered scars and atrophic depression. Hyper-redness in scars can be improved with V beam laser, Excel V, BBL, IPL, and Venus RF to improve the redness and reduce the visibility of deep scars. Fractional Thulium laser and clear & brilliant can also reduce the inflammation and redness of the scar when combined with topical therapy. Fractional lasers such as Fraxel, erbium, and CO2 laser can be combined with radio frequency and also fractional RF to improve textual issues and microtopography. Subcision and TCA cross are also used for deep ice pick scars and narrow valley scars in order to improve the micro texture. Above all, our combination approach with our clinical nurses and board-certified plastic surgeons can improve the quality of your skin by using at home Melarase creams combined with PRP treatments in our office to improve your skin quality and tone. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your scarring.

Finally, hyperpigmentation of scars can be improved with at-home Melarase AM, Melarase PM, and Melapads to help reduce active PIH and melanin deposition.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Thank you for your question marci.c. I understand your concern. An IPL photofacial is an
outstanding treatment for facial rejuvenation. It works by using bright light
to target and destroy pigment and redness in the skin. It is difficult to make an assessment without a
formal exam in the office where I can directly view the skin. However, I hope
the information provided here is useful.Melasma is a challenging condition to treat. It is characterized by the appearance of dark patches on the skin. Common areas of involvement include the forehead, cheeks, and upper lip. It is caused by an internal imbalance of hormones which makes the skin more sensitive to the sun, leading to pigmentation. Since the source is internal, on matter what is done on the surface, the condition will usually recur. Therefore continuous maintenance is required. The pigment in the skin can be deposited in the surface layers, the deeper layers, or most frequently both. While topical products and IPL photofacial treatments can help with superficial melasma, deep melasma requires a more aggressive treatment such as a fractional laser.For my patients with melasma I always start them on a skin care regimen including hydroquinone, kojic acid, retinoic acid, salicylic acid, vitamin C, vitamin E, hyaluronic acid, and sunscreen for one to three months. Then a combination treatment of IPL along with full surface resurfacing and fractional resurfacing is performed. The fractional resurfacing works by creating thousands of microscopic holes in the skin that act as channels through which the deep pigment can be extruded. Often times topical hydroquinone is applied immediately after the fractional laser treatment, which allows the product to pass through the channels and target the deep pigment. If using a fractional CO2 laser it is important to decrease or minimize the dwell time or pulse width. This is because longer swell times can generate heat which can exacerbate the melasma. I have used IPL and fractional CO2 lasers on skin types I-V. But caution is advised in those with darker skin types.For broken capillaries fractional laser to do not work. However IPL works well. Thus in the combination described above redness and broken capillaries can be treated along with discolorations from sun damage and/or melasma.Please consult with a doctor for specific
recommendations. Good luck!

Hello,Glad you asked this question. I have seen some patients gone through different treatments and either didn't work or caused disfiguration as a results of treatments.I agree with Dr Tirgari's suggestions.in-person consultation with an experienced physician and second opinion before even deciding what to do.since I have not see any photo, it is hard to give specific answer but overall you could have other potential methods for treatment aside from IPL and CO2.Best -- Dr Ray

Both can be excellent options for most of what you've listed, although there is a wide range of factors to consider, most importantly your skin type and whether you truly have melasma.  If you do have melasma you will actually want to avoid both treatments as these could likely make your melasma worse.
It's hard to say without a photo, but I would strongly encourage an in-person consultation with an experienced practitioner.  Make absolutely sure that they are capable of treating melasma and are up to date on the latest treatment protocols.  You do not want your melasma getting worse.
Hope that helps.

Intense pulsed light is non invasive light treatment specifically designed for pigmentation and telangiectasias.  It is very effective especially in conjunction with skin lightening agents such as hydroquinone and topical tretinoin.  Sometime the vessels are too large for the IPL in which case a vascular laser, such as the KTP diode, is necessary to accomplish the job.

IPL would be the better option for color correction as it targets both brown and red pigmentation, but it can make melasma worse. CO2 will not affect red vascular concerns. CO2 is primarily for brown pigmentation, fine lines and wrinkles and overall texture. Both IPL and CO2 are recommended for skin types I-III. If you decided to move forward with IPL I would avoid the areas of melasma and treat that with a differnt treatment such as Cosmelan which is safe for all skin types.
I recommend that you schedule an in person consultation with a reputable and board certified physician.
Best Wishes,
Dr. Sadrian

Thanks for your question.  After an in person consultation in a physician's office, you may get different advice.  Based on your description, we would probably recommend an IPL PhotoFacial for color correction.  IPL is only safe for Skin Types I-III.  As a word of caution, Melasma can be made worse with any light energy device.  If the melasma does not respond to the IPL or is made worse, try a PicoSure FOCUS or Flat lens treatment.  It works really well on brown pigment, but does not treat redness.  Look for a facility that has several treatment options and excellent reviews.  Best of luck.

The IPL laser will remove your broken capillaries but may not be great for your melasma. I would do a combination of lasers. First spot treat for the broken capillaries with a vbeam laser or the Excel V laser. Then do a fractionated non ablative laser such as the Fraxel or the Halo laser. They would help with your melasma as well stimulate collagen, help with fine lines. I highly recommend seeing a board certified dermatologist for the most optimal results.