Will PicoSure treament make pigmented area look darker at the initial stage?

Question

I did 3 Picosure treatment to get rid of pigmentation and melasma. Now my overall skin looks clearer except the melasma and the pigmented area which looks more obvious now. Is this normal?

Monika Soni, MD · Answer

Yes, this occurs with some patients. The treated acne scars or pigmentations spots become darker initially and then they start healing. Give it some time and you will see results. I would say that they will stay that way around one to two weeks. Good luck!

Hardik Soni, MD · Answer

Yes, this occurs with some patients. The treated acne scars or pigmentations spots become darker initially and then they start healing. Give it some time and you will see results. I would say that they will stay that way around one to two weeks. Good luck!

David Boudreault, MD, FACS · Answer

Hi gractlh,Thank you for your question.  PicoSure is great to reduce pigmentation in the skin, but Melasma requires a multi-modality treatment and ultimately will improve but never go away.  If you are not seeing improvement in your melasma after 3 sessions, I would not proceed with additional treatments. Hope that helps.Best,Dr. B

Raminder Saluja, MD · Answer

Melasma is a special breed of its own for treatment.  What is important prior to any treatment for melasma is to make sure Vitamin C serum, retinoic acid (tretinoin for example) and a skin lightening agent are on board prior to treatment.  And of course, all patients must commit to wearing sunscreen.  I typically recommend this 1 month prior to treatment.  Of all the lasers I have used, I do feel that Picosure is the one I go to for possible laser treatment (some patients with melasma, I don't recommend laser at all).  Picosure will certainly darken up solar lentigenes (sun spots) for about 5 days to 1 week, similar to IPL and they will then dissipate and exfoliate off.  IPL does not have as great of an effect on the deeper dermal pigmentation of melasma and that is where Picosure Focus Lens can be tried.  Typically the area will darken for 1-2 weeks and then lighten over 3- 5 weeks.  I usually separate them by about 6 weeks to see if any PIH (post inflammatory hyperpigmentation may develop), if not I proceed on with treatment typically between 4-6 treatments.  It is important to note that while picosure can decrease pigmentation, melasma will forever be an issue so sun protection is very important.  Hope that helps.

Davin Lim, MBBS, FACD - Account Suspended · Answer

That is a frequent response. Ideally you should start HQ before, and a day after your Picosure treatment. This markedly reduces the chances of skin colour changes. All the best, Dr Davin Lim. Brisbane. Australia.

David E. Berman, MD (retired) · Answer

you can pre treat with 4% hydroquinone or other similar agents but stop then 3 days before a treatment. be patient and the area will start to lighten. Pico is the best laser available for melasma. it is vital that you use a sun screen while having these treatments. plan on doing the sessions at least one month apart. of course, you need to be assessed periodically by the physician if you are not getting lighter with time. david berman md

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