Should I do more PicoWay sessions and how do I get rid of the pigment? (Photos)

Hyperpigmentation needs a combination approach of peels like cosmelan, lasers (exp: clear and brilliant and/or aerolase, laser genesis), and sun protection. Bi-monthly facials (silk peel/dermal infusion) are also essential to hydrate, exfoliate, and infuse vitamins/antioxidants into the skin. I recommend getting a formal evaluation with a cosmetic dermatologist. Best, Dr. Emer

Hi,From the images, it looks like you have had an aggressive session, may have been a high energy 1064, or an aggressive 532. In ethnic skin, aggressive sessions do have a chance of producing PIH - post inflammatory hyperpigmentation (PIH), so it is best to start with lower energies, and then build up. Also, I would discourage 532nm Zoom, unless the spot size is 2-3 mm, with no overlap, for ethnic skin.For now, sunscreens are mandatory, and your doctor may put you on bleaching agents as well. Going forward, it would be good to go with 1064 Zoom, low fluence. Was there any melasma considered in the biopsy? That would influence the outcome, too.Best,Dr Renita Rajan, (India KOL - Picoway)

Thanks for your question and posting pictures.  We have been using the PicoSure FOCUS for 4.5 years.  We have never had a patient look like your picture #2.  The PicoWay rejuvenation treatments are not the same.  I have seen numerous PicoWay bad outcome pictures on this site.  I don't know why your face looks bad after a treatment.  It looks like your birthmark reacted to the heat of the laser to give you the PIH.  At this point, we would probably follow our Melasma protocol with a low FOCUS pulse count and using a chiller to blow cold air.

I will tell you that I've had a handful of patients who got worse pigment for about a month after PicoWay and then everything resolved and settled down, and they look great. This occurs because the PicoWay actually causes the pigment to surface and rise up - which means darken. We did do multiple treatments and the inflammatory response only occurred after the first one. Now with that being said, I've never treated anyone to the degree and redness to which you were treated. I certainly would have sent you home with hydrocortisone to apply immediately and for a few days, and may have post treated you with some kind of HQ as well. But, I have had patients with an inflammatory response who later actually had a great response. I would assume this is not the first time your provider has used the PicoWay system and that they have good experience and know what they're doing. I would suggest follow up with your treating office to make sure this is what they were expecting. "This answer has been solicited without seeing this patient and cannot be held as true medical advice, but only opinion. Seek in-person treatment with a trained medical professional for appropriate care."