Can skin texture and pigmentation be improved 2.5 years after chemical peel? (Photos)

Question

Voici le texte prêt à copier-coller : --- Subject / Titre : White scarring and fibrosis 2.5 years after combined TCA/phenol peel – persistent skin changes Message : Hello, I’m writing from France. About 2.5 years ago, I had a chemical peel that combined TCA 20% and phenol 10%, applied in two consecutive passes, spaced about 4–5 minutes apart. Since then, I have developed persistent white marks (hypopigmentation) and some areas of fibrosis, where the skin feels rigid or plastified, with an altered texture and a sort of loss of normal skin relief. In some spots, the surface looks almost like a thin plastic film over the skin, lacking flexibility and natural texture. I have seen two dermatologists, but they have different opinions on the condition and treatment options. I would greatly appreciate your opinion on the following: – Is there any hope of improving the skin texture or pigmentation after 2.5 years? – Have you treated similar cases, and what approaches (if any) were effective? – Can very gentle treatments such as low-energy fractional lasers or microneedling help in remodeling this type of fibrosis or white scarring? – Are there any topical options (like Melarase, or others) that could help soften or improve the appearance of these zones? I’m attaching a photo for context (if applicable). Thank you sincerely for your time and any insight you can offer. Best regards, Ourgaud Isabelle

Raffy Karamanoukian, MD, FACS · Answer

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser.  Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.  
Best,
Dr. Karamanoukian 
Realself100 Surgeon

Anna Chacon, MD, FAAD · Answer

Thank you for reaching out and sharing your experience. Addressing skin changes such as hypopigmentation and fibrosis after a chemical peel can be challenging, but there are potential options to consider:

Improvement Potential: While 2.5 years is a significant amount of time, there may still be room for improvement in both texture and pigmentation. The skin's ability to remodel and heal can vary greatly among individuals.

Treatment Approaches: In similar cases, treatments like low-energy fractional lasers and microneedling have shown promise. These modalities can help stimulate collagen production and improve skin texture. However, they should be approached cautiously and performed by an experienced professional to minimize risks.

Topical Treatments: Topical options such as those containing ingredients like hydroquinone, retinoids, or peptides might help improve pigmentation and texture. Products like Melarase could be considered, but their effectiveness can vary.

Consultation and Customization: Given the complexity of your case, a personalized treatment plan is essential. It might be beneficial to seek a dermatologist with specific experience in post-peel complications for a tailored approach.

I hope this information is helpful, and I wish you the best in finding a solution that works for you.

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