Confused About Laser Resurfacing Treatments After Disappointment with CO2

Sorry to hear of your undesirable results. CO2 laser procedures are fraught with risk in dark-pigmented individuals.

Pigmentation problems can often be made better with diligent and patient care in the hands of an expert specialist.

Find someone who specializes in skin rejuvenation and Photo-medicine, usually a Dermatologist. Your treatments will take time, require patience, and involve combination therapy (topical creams or lotions, different light- or laser therapies, and/or peels).

CO2 laser and similarly used dual mode Er:Yag lasers are excellent choices for patients of northern European skin types who have significant age and sun related damage.  Hands-down, nothing gives better results when it comes to wrinkles.  Asian and Hispanic skin types are rarely suited to this type of laser because of the de-pigmentation (and oddly enough opposite hyperpigmentation) that can result.  In addition, darker skin types tend also to be thicker which is less responsive to lasers (though less prone to wrinkles in the first place).

There is probably no cure for your hypo-pigmentation.  If the CO2 laser failed to give you the texture improvement you wanted, I would suspect that no laser (or other treatment) will.  While a fractionated CO2 is unlikely to cause further pigment trouble, I doubt you will find the wrinkle improvement you desire.  I even have less confidence that a non-ablative laser would produce noticable improvement.  Sometimes we have to accept that we don't have a solution to a problem and do the right thing by leaving it alone.

With your ethnic background, treatment around your mouth is a higher risk procedure.  Thus, I would not treat you with CO2 laser there.  You will need a full evaluation with a Board Certified Dermatologist and Plastic surgeon to evaluate what risk profile you present, and your list of options.  Your skin type is high risk so you must go to someone familiar with ethnic skin, and your type of problem who uses lasers that are safe with ethnic skin.*  

I am so sorry that you had such a disappointing outcome from your CO2 laser treatment.   At this point it is important that you consult with a physician with a great deal of experience.  It is difficult to give suggestions without actually examining your skin.  Given that I can say that Fraxel Restore is very helpful and low risk for treating under eye wrinkles.  Loss of pigment and persistent redness after CO2 are much more concerning and difficult to treat.  Skin care options can help even out pigment and diminish red and brown discoloration.  

Unfortunately, it sounds like you have had a bad experience with laser resurfacing.  CO2 laser is great for some skin types, but not for others.  Obviously, it wasn't good for you.  I would recommend that whatever you choose next, you do it very conservatively.  If further laser resurfacing is indicated I would treat very lightly and would proceed from there.  That way you can see how your skin responds.  More treatments may be necessary.

The CO2 laser is the most aggressive of resurfacing laser techniques.  It can produce great results but also significant unwanted collateral.  The results are directly related to patient selection.  CO2 lasering is limited, for the most part, to fair skinned individuals.  Loss of skin pigment is a common side effect and darker skinned individuals can look most unusual after this treatment.  It sounds like you little effect and lots of collateral.  You, perhaps, should leave things alone.

Dark skinned individuals should not be treated with CO2 lasers, flat beam or fractional. The CO2 creates a thermal damage profile that always results in hyperpigmentationj and can also lead to hypopigmentation.

It sounds as though you have persistant hyperpigmentation after laser resurfacing. If you truely have melasma, it is very difficult to treat.

The Fraxel Restore (NOT Repair-it is a CO2) and the Lux1540 are both good non-ablative fractional Erbium lasers which can improve-but not cure-melasma.

They are safe to use on dark skin at lower power settings. They can improve fine lines and skin texture and reduce hyperpigmentation.

You need to find a doctor who is used to treating dark skinned patients with laser--very few know how.

First of all, with your ethnic background, lasers can have greater potential side effects. Hypopigmentation is just one problem which happens to be permanent (in most cases).

The first step is find a facial plastic surgeon, plastic surgeon or dermatologist who truly specializes in lasers and has a variety of lasers at their disposal. Most people have one or two different types of lasers and try to treat everyone in the same way. It takes a wide range of laser devices to treat the even wider range of skin types of skin related problems.

Further, not everything can be effectively treated with a laser. The wrinkles under your eyes, may be better treated with a surgical approach or even with volume augmentation.

Bottom line, go to a doctor who understands and is experienced with the nuances and challenges of rejuvenation of the ethnic face. Though the topic may seem confusing, your doctor should simplify it for you.

Good Luck,

Dr. Karam

I don't blame you for being confused about laser resurfacing since there are many lasers and even more claims about lasers. I no longer use the CO2 laser because many patients develop bleaching of the skin after resurfacing with the CO2 laser. If, on the other hand, you are disappointed because there was not enough correction following the laser resurfacing, then perhaps the energy settings used were too low.

By far the best laser available to treat wrinkles and discoloration of the face is the Contour laser, manufactured by Sciton. The Coutour laser is really two different Erbium lasers in one. When the Contour laser is used in the "ablation" mode, then it functions as a conventional Erbium laser and is quite effective to treat superficial lines. When the "coagulation" mode of the Contour laser is added to the treatment panel, then this laser is effective for the treatment of even very deep facial wrinkles and I have not seen any skin bleaching with the Contour laser. Patients treated with the Contour laser look fine with makeup in a week or less, but without makeup the treated skin can remain pink for weeks. Most patients tolerate this well, and are pleased with the improvement in the texture of the skin which can be quite dramatic.

My experience is that Re:store is the best for skin type IV for both melasma and scars. The settings must be conservative, so more sessions (6-9) would be necessary. Cooltouch has no benefit for melasma, but may help scars. Topical tazarotene and TriLuma may also help melasma and hyperpigmentation. Hypopigmentation is, unforunately, a complication of CO2 lasers, and it can be very long-lasting. I am not aware of any modality that really helps this complication.