Laser Genesis and Medlite for the treatment of PIH from laser burn, feels like a waste of money. Should I try Fraxel or Ruby?

laser burn on a bruise (bbl) under my eyes, 2 moms ago. can't use topicals bc hq and lytera cause redness. tried neucutis lumixyl but no results. i have no choice but to use laser. two weeks ago i had medlite at light settings. today i had genesis for the redness (i have brown and redness ). it feels like a waste of money. they tell me it may take 6 months, may not go away completely.. etc. shall i try fraxel or ruby? please help. nyc drs are welcome. need second opinions and or new dr. .

Doctor Answers 3

Treatment for Post Inflammatory Pigmentation ( PIH )

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Treatment of PIH is one of the most challenging tasks that we face as Dermatologists.  The problem is that any injury can cause further darkening - especially overly strong laser or IPL treatments.  Even irritation/allergy to creams that you are using, or sun exposure will worsen the problem.  It is also going to be affected by your skin colour.  If you are a person of color you are even more prone to severe PIH.

Fortunately in most cases PIH will go away by itself (90% plus of cases), however this could take up to a year.
The logical implications of the above are that any aggressive treatment runs the risk of making it worse.

My best advice to you is to sit it out and cover with makeup and strictly protect the area from sun exposure use UVA, UVB rated sunglasses and sunscreens, even when you are in a motor vehicle.  A mild cortisone cream as approved by your dermatologist would be reasonable if there is redness.  I also believe that you should be under the care of an experienced Dermatologist - it is essentially a skin disorder not a plastic surgical problem.

In my experience. low fluence 1064 Medlite and Laser Genesis in competent hands would be safe but are not reliably effective as you seem to suspect. They might be worth considering as a last resort, only if you see no improvement after 12 months.  I do not believe  the data and experience supports the use of any type of Fraxel (remember there are 3 types of Fraxel 1550, 1927 and CO2 (the latter being out of the question),). Also most of us are aware of 1550 and 1927 making the problem worse in some patients.  I would regard Ruby Laser as contraindicated with few exceptions.

If the problem does not settle, it may be worth your Dermatologist performing a biopsy as occasionally, following bruising there can be the deposition of Iron pigment from haemoglobin which will respond to Medlite (QsND:YAG on 1064).

My best advice is to be patient and sit it out, sometimes impatience is dangerous.  Best of luck!

Melbourne Dermatologist

Treatment for PIH

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Treatment of post-inflammatory hyperpigmentation can be difficult, especially if you cannot tolerate either hydroquinone or Lytera. My recommendation is that Fraxel would be your best option, although whatever laser you have multiple treatments may be required. Regards Dr Charles Cope

Charles Cope, MD
Sydney Plastic Surgeon
5.0 out of 5 stars 5 reviews

Laser Discoloration

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Discoloration from the laser is difficult to treat and the choice of lasers really depends on skin type. It does not sound like the type of discoloration which Fraxel would help. This may take time and may not be so simple. For the best cosmetic results please consult a board certified dermatologist with experience with lasers. 

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.