Is an IPL facial effective if you don't get the raised brown spots that eventually fall off?

Hello,Thank you for your question. Because you had such a strong reaction to the first treatment you may have not needed as much of a correction for the following treatments. The spots can fade and still get better. You may want to ask them what machine they have and compare it with what your other doctor used so that you can understand why they need to use a lower setting. Good luck! 

Thank you for your question sspotten. I understand your concern.
IPL is a great treatment for facial rejuvenation. When pigment is close to the surface a coffee ground appearance may be seen after the treatment. If pigment is deeper, this is not necessarily seen. Superficial pigment is easier to treat and often resolves after one or two treatments. Deeper pigment takes longer. Adding a fractional laser step may help. Please consult with a doctor for specific recommendations. Good luck!

While the most effective treatment will cause brown spots to become dark and crusty and flake off, they can still lighten without crusting. At this point, IPL is probably not the best treatment to remove your dark spots. The spots the machine is not picking up are likely much deeper and will need a different type of laser to remove. Without seeing photos I could not make any real recommendations, however I would advise speaking to your provider to see what other options they have available.

Repeat IPL treatments tend to be less effective as the remaining pigments are the the most resistant to IPL treatment. It is true that some skin types are at higher risk of pigmentation changes if the energy is too high, particularly in those with darker skin or skin that tans easily. For these patients, it may be better to supplement the IPL with a tretinoin and hydroquinone regimen as well to target those last remaining spots. Hope this helps!Johnson C. Lee, MD Plastic Surgery