Getting PicoSure Focus laser for a pigment but the pigment comes back in a few days. What can I do?

Although hyperpigmentation and inflammation after your laser procedure is common, it may signal another condition. Typically, after PicoSure or any laser resurfacing treatment, skin care, including sun protection will help improve this.  In general, hyperpigmentation from any type needs a combination approach of peels like cosmelan,  lasers like clear and brilliant and aerolase or laser genesis, radiofrequency like venus viva, and constant skin care and sun protection.  Bimonthly facials with silk peel dermalinfusion is essential to hydrate, exfoliate and infuse vitamins and antioxidants into the skin. If it’s Melasma, it needs a combination approach to get the best improvement and will need a series of treatments. In our practice, we combine Clear + Brilliant, peels, microneedling/PRP, Aerolase, and sometimes Erbium (Cool Laser) to get the best results. See an expert for a formal evaluation. Best, Dr. Emer

Hi LC.  The answer to your question is probably not.  If the pigment flakes, peels and then returns it’s not likely to be removed permanently with the Picosure. When sun damage is treated and it peels, flakes and falls off it does not typically return.  When Melasma is treated and it flakes and/or peels it almost always returns and in many cases worse than it was before.  We’re you diagnosed with Melasma?  If so it is a chronic condition that will improve only temporarily with lasers.  It will always return and yes it’s a deep dermal type of pigment and it’s caused by hormonal changes.  Because you are an olive skin type it’s much more likely but posting photos would help confirm.

Although hyperpigmentation and inflammation after your laser procedure is common, it may signal another condition. Typically, after PicoSure or any laser resurfacing treatment, skin care, including sun protection will help improve this.  In general, hyperpigmentation from any type needs a combination approach of peels like cosmelan,  lasers like clear and brilliant and aerolase or laser genesis, radiofrequency like venus viva, and constant skin care and sun protection.  Bimonthly facials with silk peel dermalinfusion is essential to hydrate, exfoliate and infuse vitamins and antioxidants into the skin. If it’s Melasma, it needs a combination approach to get the best improvement and will need a series of treatments. In our practice, we combine Clear + Brilliant, peels, microneedling/PRP, Aerolase, and sometimes Erbium (Cool Laser) to get the best results. See an expert for a formal evaluation. 

Thanks for you question.  We tell our patients not to be surprised if their brown spots appear darker after treatment.  It is the pigment moving closer to the surface.  Sometimes they get larger or new spots appear.  We recommend a series of 4 PicoSure FOCUS treatments with every patient.  Look for prescription strength 4% Hydroquinone (HQ).  Do not buy it over the counter or off the internet. Keep up with the HQ and use a quality, broad spectrum sun screen every day.   If you are concerned, please contact your treating physician.Unfortunately, your pigment will always likely return.  Once your melanin production has been accelerated, it's hard to keep those cells turned off.  You will likely need a follow up every 6-12 months.  HQ and sun screen daily will help.  Best of luck.

it can take at least 3 treatments (my wife needed 4 and sometimes women will need even more). i believe that using a 4-9% HQ cream is very helpful. you must also use an excellent sunblock. don't give up. the picosure is an excellent laser. also suggest that your laser technician call Cynosure (who makes the Picosure) to make sure that they are using the latest protocol.david berman md