Dark Spots Recurring After IPL Treatment

Question

I just had my third IPL treatment done and after the first week my skin looked really nice and free of the dark spots... finally.

	On the third week some of the dark spot started to reappear. My doctor prescribe hydroquinone to treat them. I'm on my fourth week after the last treatment. Should I go for another treatment or should I just wait and see if the hydroquinone would help fade the spots?

	At this point I just don't want to damage my skin or make it worse. Also is this pigmentation normal? I've been away from the sun all of this time. Would there be any other factor that may be causing this problem? Or is this normal on this Laser treatment? Thanks a lot for your help.

Raffy Karamanoukian, MD, FACS · Answer

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

Don Mehrabi, MD · Answer

Thanks for your question.
The answer to your question hinges on whether the dark spots represent melasma (not amenable to any kind of laser treatment to-date) or lentigos / sun damage (very amenable to laser treatment). Both of these hyperpigmentation conditions will worsen with sun exposure, and while melasma is known to come back after treatments, lentigos treated with laser usually do not.
Assuming that you simply have sun damage and lentigos, it is very possible that the sun exposure has highlighted newer lesions not noted before, or that you did indeed get new ones. The addition of hydroquinone is always a plus and should only help any of your IPL treatments. I do NOT believe that doing further IPL treatments will hurt you or your results. In fact, when treating for photodamage, some patients need up to 6 treatments depending on the severity, resistance to treatment, and the results.
If I were you, and you were happy with the first set of results, I would likely continue, use the hydroquinone, and of course, make sure that there is no melasma component.
I hope this helps!

Arnold R. Oppenheim, MD (retired) · Answer

IPL does a wonderful job at removing sun damage and reddness to the surface of the skin.  If it is superficial it does a great job, if its deep or possibly a case of melasma it helps but usually doesn't wipe it completely.   It will lighten up the pigment in the areas but you may notice after time the areas will appear to show some darkening again.   It is vital that you wear sunscreen an antioxidant and probably a product with hydroquinone to keep your skin results following our IPL looking great.  It will not hurt your skin to use sunscreen and antioxidants always.  It will protect your skin from further damage if used daily.

Theodore Katz, MD, FACS (retired) · Answer

Now that you are on the hydroquinone you could procede with another session or two of IPL.  There are varying results of the treatment of melasma with the Fraxel re:store and I have had some good results, some mediocre, but none worse.  If it is not melasma, and just sun damage I have seen good to excellent results with the Fraxel re:pair.

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Dark Spots Recurring After IPL Treatment

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Answer: Recurrent "Dark spots" after IPL

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