How can I treat hypopigmentation from Picosure laser?

Question

Hello, I am really hoping I can get a good professional opinion. I have been having an issue for a while now. I am located in vegas and went to a dermatology office for tattoo removal on multiple areas. I have had one of the tattoos in question fully removed, but the skin has hypopigmented due to the picosure wavelength that was used which is 755 nm. The tattoos i have are only black ink. After bringing these concerns up to the derm he kind of just brushed me off and said it would resolve but its been a year and no change... I have ever since searched for ways to fix this as it has caused me so much mental distress. I have discontinued going there. I found many articles written by drs about laser assisted drug delivery using bimatoprost. I am just so upset with this situation it has affected me deeply and i have been looking for a specialist but so far it has been hard to find someone who really understands and is willing to help and not just take my money. Please help.

Anna Chacon, MD, FAAD · Answer

I’m sorry you’ve had to deal with this for so long. I can understand why persistent areas of lighter skin, especially after successfully removing the tattoo, would be frustrating and emotionally difficult.

Hypopigmentation can occur after laser tattoo removal, including with 755-nm picosecond alexandrite lasers such as PicoSure. Although it is often temporary, persistent pigment loss can occur, particularly when the melanocytes have been significantly affected.

Because your pigmentation has remained unchanged for about a year, I would not simply assume that it will resolve on its own. The first step is determining whether you have hypopigmentation (reduced pigment) versus true depigmentation (loss of melanocytes), because the treatment approach can be different.

There are several approaches that a dermatologist experienced with pigmentary disorders may consider:

Bimatoprost-assisted repigmentation: This is one of the more interesting options you mentioned. Bimatoprost is a prostaglandin analog that can stimulate pigmentation, and studies have found promising results when it is delivered with a fractional laser. In one prospective study, fractional ablative laser treatment combined with bimatoprost produced greater repigmentation than the other treatment approaches studied.
Excimer laser (308 nm): There are reports of persistent laser-induced hypopigmentation responding to 308-nm excimer laser treatment. However, treatment may require multiple sessions and results can vary.
Fractional laser treatments: Fractional laser approaches may stimulate repigmentation, sometimes in combination with topical agents such as bimatoprost. The specific laser and settings are important because additional injury can potentially worsen pigmentary changes.
Observation: If there is still some melanocyte activity, gradual repigmentation can occasionally occur, although after a year without improvement, spontaneous recovery becomes less predictable.

I would not recommend having another tattoo-removal laser treatment over the hypopigmented skin simply to try to correct it. The goal at this point is to stimulate or restore pigmentation rather than further target the remaining tattoo pigment.

It is also important to be cautious with bimatoprost. Although the available literature is encouraging, its use for laser-induced hypopigmentation is not a universally established treatment, and the evidence base is still relatively small. A systematic review found promising repigmentation results with prostaglandin analogs but also emphasized the need for larger, better-controlled studies.

Given that this has persisted for a year, I would approach it as a pigmentary disorder requiring an individualized assessment, rather than assuming it is simply a temporary side effect of the tattoo-removal procedure. Photographs, examination under appropriate lighting, and sometimes additional testing can help determine whether there is residual melanocyte function and which treatment is most appropriate.

Most importantly, I would be cautious about anyone promising complete repigmentation. The encouraging part is that persistent laser-induced hypopigmentation can sometimes be improved, and there are documented treatment options beyond simply waiting for it to resolve.

How can I treat hypopigmentation from Picosure laser?

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