Will Laser Resurfacing Make PIH Worse from Prior Laser Resurfacing?

Post laser hyperpigmentation is a common problem following laser resurfacing and is not necessarily related to the "burn" that you experienced. That said, the greater the injury the greater the degree of PIH. Laser resurfacing is just that, in that is smooths out the skin and has the additional benefit of evening out darker skin tones. It is not specifically designed to treat browns, though, but more to smooth out wrinkles. There are different opinions in the industry regarding whether to pre-treat the skin with hydroquinone or not before laser resurfacing. Not pre-treating risks increasing the possibility of PIH. The good news is that it typically responds to topicals and bleaching creams.I would continue to use your topicals and "bleaching cream" and give it a good 3 to 6 months before trying another light source therapy if at all. It takes time for these to work, especially if you are young or have any degree of melasma or of darker skin ethnicity.  

Please consult a board certified dermatologist to treat your postinflammatory hyperpigmentation.  Laser is not recommended.  You must avoid the sun. Fading creams and light chemical peels may be appropriate.

Post-inflammatory pigmentation is the term given to darkening of the skin after injury or inflammation whether intentional (laser) or unintentional (road rash).  It is more common in people with darker skin types.  This type of pigment sits deeper in the skin and is more difficult to treat.  The most helpful thing you can do at this point is to apply a zinc containing sunscreen (SPF > 30) daily and every 2 hours when outdoors, continue the bleaching cream nightly (I prescribe hydroquinone 4-7% combined with tretinoin .025%), and wait about 3 months to assess your progress.  As another doc pointed out, light chemical peels with salicylic acid or Jessner's can be helpful during this period every 2 weeks or so for a series of about 5 peels.  While additional laser including the fraxel restore dual or intense pulsed light devices may help, these would not be my first line treatment.  Given your propensity to hyper pigment, I recommend lower-than-average settings (which equals more treatments) for any future laser treatments.

I treat postinflammatory pigmentation with mild chemical peels or bleaching agents.  I have gotten excellent results with this approach.   I would be very cautious using a laser for postinflammatory change and recommend that you are evaluated by a board certified dermatologist for specific treatment recommendations regarding your problem

I would be very wary of using laser resurfacing to treat PIH (post inflammatory hyperpigmentation). I love laser resurfacing and probably do as much or more then anyone in the US. At our office we have a lot of experience treating difficult skin problems and our first line treatment for PIH is always chemicals/skin care. The best thing is to make an appointment at a place that really deals with these issues. 

Treating PIH can be a challenging and slow process. It is difficult to say exactly what I would recommend without seeing your skin. In general, I treat my PIH patients with a few different treatments, Laser Resurfacing being the very last treatment I would recommend. First, I would recommend starting a topical treatment regimen in order to prep your skin. This would include retinols, glycolics, sunscreen, lightening treatment (such as a product with Hydroquinone.), and moisturizer. Please see the link below for additional information about a scientific approach to skin care. After you have been on the topicals for a month, I would recommend a series of light chemical peels, advancing to stronger chemical peels. Lastly, if your skin has tolerated the chemical peels and topicals well, and there is improvement in your hyperpigmentation, I would possibly consider a series of Intense Pulse Light (IPL) treatments.