Just Had Second Ipl Treatment on Hands

Hi just had second treatment on hands with ipl. Doctor said he was disappointed with results of first treatment. Spots darkened but never faded. He said he used max strength and same on second.The spots have gone slightly darker again day after treatment,but i now dont hold up hope for good outcome and the doctor said he wouldnt normally do more than 2 treatments.He said he would consider a chemical peel. All the web sites discussing this treatment say it takes 3 or 4 treatments for improvement, what are my options?

Doctor Answers 3

Skin Preparation Prior To Treatment of Dyspigmentation

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I would agree that a successful series of IPL treatments usually takes 3 - 4 sessions, performed three to four weeks apart. The energy level is usually gradually increased with subsequent sessions to obtain clearance of the red vasculature or brown pigment that was not removed with the prior treatment session. In my experience we are able to provide improvement with energy settings below the maximum.

I don’t know your skin coloration (Fitzpatrick type), but that does influence the selection of treatment parameters for light-based procedures, such as IPL and laser. When treating brown pigments I usually use skin care products, such as bleachers and retinols, to suppress pigment formation before initiating chemical peels, IPL or laser treatments. This helps reduce the risk of post-inflammatory hyperpigmentation (PIH) following treatment. In PIH, the pigmented spots darken as a result of the inflammation caused by the peel or light-based treatment and the subsequent healing process.

I don’t know if you were prepped with skin care products before treatment and I don’t know the spacing between your treatment sessions. Brown pigments often darken immediately or shortly after an IPL treatment session. The brown spots may then improve within a couple of days if the pigment is superficial, or it may take two or more weeks if the pigment is deeper. Following your initial treatment, your spots darkened but never faded. I would have been cautious about administering a second treatment. I would have waited for the spots to fade in color before administering the second treatment; if you were not using skin care prior to the initial treatment, I would have started it and waited the same.

If the maximum IPL settings have been reached, then another option such as chemical peel or laser may be helpful. However, I would definitely prep the skin for four to eight weeks prior to commencing this procedure, and proceed carefully.

Milwaukee Plastic Surgeon
4.9 out of 5 stars 36 reviews

You may need some liquid nitrogen

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The IPL works well when the spots are totally flat.  If there is any texture to the spots it will not work.  This is what I have found to be the biggest barrier when IPL does not work on the hands.  If that is the case, then a peel will not work either.  What I have found works, is that our nurse does the IPL, but on the same day I also spray liquid nitrogen on those textured spots.  They darken for a few weeks then fall off.  I have found this successful.  perhaps your doctor might consider this as well.


Lisa Benest, MD
Burbank Dermatologist

What to do about IPL not improving dark spots

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It usually does take approximately 3-4 treatments for full improvement with IPL.  If the dark spots or age spots are not just pigmentation but for example thin seborrheic keratoses (benign skin growths that can be very flat and pigmented) the IPL will not be as effective in removing them.

Also, make sure you are avoiding sun exposure to the area for one month before and one month after each treatment, as sun exposure can darken age spots and also make it more difficult for the laser to differentiate between your normal skin and the brown spots.

I recommend consulting with a dermatologist to determine what the spots are.

Emily Altman, MD
Short Hills Dermatologic Surgeon

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These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.