I had CO2 laser treatment done 4 months ago and now I have hyperpigmentation (Photo)

Thank you for your question. I understand you had CO2 laser treatment done four months ago, and since then you feel like your skin has gotten worse, and there are persistent redness and other discolorations. You also say you are a smoker.I can give you some guidance to the best of my ability regarding this issue, in absence of a proper physical examination. I’ve been using CO2 laser since the mid-90s, and have been in practice for over 20 years as a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon.Based on the photos, it appears to me you’re young, and I suspect you underwent the CO2 laser treatment for something like acne or discolorations. When treating acne scars, usually the goal of the laser is to try to make the scarred skin look less obvious in comparison to the adjacent skin, and what this means is high temperatures are used to ablate the surrounding skin around the scars in order to create a more even surface, and to tighten the. Naturally, the deeper and more aggressive the laser, the longer the redness and discolorations last. In my practice, I prefer to be more conservative when it comes to using lasers on younger people.I’m sure your doctor probably discussed this possible outcome with you as part of the risks and benefits of laser treatment. I would be surprised if your doctor didn’t recommend any type of bleaching or skin lightening creams to help with the pigmentation issues. Even a steroid cream can help address the redness and the pigmentation. I would also suggest you stop smoking. I’m sure you’ve heard this before, but when you smoke, you’re essentially breathing in carbon monoxide formaldehyde, which results in the generation of free radicals. In other words, it literally chokes the oxygen away from your tissue. Smokers also tend to have issues with healing and experience longer periods of inflammation. I understand it is hard to stop smoking, but I would tell you to do the best you can, as nothing good can come of it. Interestingly, according to medical studies, within 30 days of stopping smoking, the human body can heal itself in a way that’s comparable to someone who’s never smoked in their life.In my practice, we always emphasize the limitations of what we can do in terms of cosmetic procedures for smokers compared to non-smokers. In some cases, such as face lifting, I will not do surgery at all on someone who smokes. An exception to this, however, is eyelid surgery, wherein even smokers are able to do well due to the dual circulation of the eyelid area.In my practice, we use platelet-rich plasma to stimulate collagen and blood supply, and improve overall skin quality and texture. Platelet-rich plasma is derived from your own blood and is made up of a concentration of growth factors that help with wound healing and new blood vessel formation. This treatment could be of value to you, however its benefit could be outweighed by the negative effects of smoking. So stopping smoking is certainly a key factor, especially when you want to improve your appearance.That said, I suggest you go back to your original doctor to discuss these issues and try to get a better understanding of the treatment strategy. Sometimes people will say, “wait it out”, and sometimes this is fine because pigmentation and redness eventually does fade away. Try to gain some additional information to guide you moving forward.I hope that was helpful and I wish you the best of luck!This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

Our treatments use combination therapy to improve the epidermis and dermis. We see atrophic and hypertrophic scars, as well as scars that have hypo and hyperpigmentation. 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 discuss the best treatment options for your type of skin. .

Best,
Dr. Karamanoukian
Realself100 Surgeon

It is difficult to provide you with an accurate assessment without knowing your medical history and from the photos you provided.  I recommend you keep all of your scheduled follow up appointments with your practitioner and share your concerns.  Your provider should educate you on proper post-care following a laser treatment, including sun avoidance and the continual use of broad-spectrum SPF and skin care to maintain the results from your procedure.  An experienced and skilled physician would know to have you prep the skin properly prior to treatment to potentially prevent the pigment problem from occurring.  Fortunately, if you are experiencing true post-inflammatory hyper-pigmentation, your provider can prescribe topicals to lessen the appearance of your concerns.  Good luck!