Hyperpigmentation Looks Worse After Photofacial

I have now had 11 photofacial's and my face looks worse than it ever did.  The dark spots have just gotten darker and the last time I went in, I actually receieved a 2nd degree burn from the treatment.

My question is, will this treatment really and truly remove my hyperpigmentation?  Or is it going to continue to make it worse?

Doctor Answers 8

Stop having photofacials!

Dear R C,

If a treatment is not helping you and is harming you, please do yourself a favor and don't do it again. Your body is smarter than your doctor and it is trying to tell you something.

Generally, if you get a burn while having a photofacial, this is hands down a great reason to find another doctor. By the way, were you treated by a physician or a non-physician? Most states require that the treatments be performed by a physician or a registered nurse under direct supervision of a physician. That means that the doctor who examined you is a physican present in the office when his/her nurse does your treatment.

These services are sold as relatively benign treatments but in fact, if not properly done, they can cause significant harm. Please get the message. Find another office and don't do more photofacials.

Los Angeles Oculoplastic Surgeon
4.9 out of 5 stars 23 reviews

Time to consider another treatment option.

Photofacials CAN make your pigment worse if you have melasma, or hormonal hyperpigmentation. A hydroquinone and retin-A blend can fade your hyperpigmentation, and prepare your skin for what probably should have been done to begin with -- a TCA chemical peel. Consider having a TCA peel 6-8 weeks after your skin has been treated with hydroquinone.

Definitely no more Photofacial treatments

We would definitely not recommend having any more treatments. Whenever we hear a story like this, we immediately start thinking one thing...Melasma. Many patients mistakenly think that their Melasma is sun damage or hyperpigmentation.

Hyperpigmentation is a very general term and can be related to multiple different conditions, but what is consistent about Melasma is that it gets worse with IPL treatments for almost all patients.

We suggest that you stop IPL treatments, get a diagnosis of your pigment to determine if it is sun damage or Melasma. If it's sun damage, consider q-switched laser treatments and if it is Melasma, consider Hydroquinone bleaching creams. If it's sun damage and it's not gone after 11 Photofacial treatments, it never will be (at least with that practitioner).

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.5 out of 5 stars 8 reviews

11 is too much

when you do something ten times and you do not get the desired result, eleven is not the magic number. einstein said that insanity is doing the same thing over and over again and expecting a different result. your doctor, if you were actually examined, failed to make the right diagnosis and worse yet stubbornly failed to see the results were actually negative. do yourself a favor change practitioners, stop IPL and get the right diagnosis before any further treatment. in addition to melasma, facial hyperpigmention can be a sign of a systemic disease like Lupus. good luck

Rafael C. Cabrera, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 1 review

Understanding Hyperpigmentation/Melasma is the first step to how to treat it

Whether an intense light, such as Photofacial, or a specific laser is used to treat the skin for dark spots, it is important for the operator of the laser to be aware as to whether or not the spots are from Melasma.  Melasma is a skin condition in which blotchy pigment is created and deposited in both the upper layer (epidermis) and/or the lower layer (dermis) of the skin.  Melasma is much more common in women, has been linked to estrogen use (e.g. hormone replacement, birth control pills, etc..) and during/after pregnancy known as the “mask of pregnancy”.    The skin of Melasma patients is easily stimulated to pigment, to the point that even when these patients avoid direct sun on their face, they will still obtain uneven, blotchy pigment just from getting sun on other parts of their body, or getting into a hot environment.  The treatment of these dark patches with laser or intense light (Photofacial) creates brief but intense heat in the skin, and depending on the depth of the pigment these treatments may be contraindicated, or else experiencing results similar to the one you are describing.  An older technique to help determine the depth and nature of the pigment was using a Woods Lamp (think black light…)  However, state of the art assessment involves using the  computerized VISIA skin imaging system which is the standard in our office.  This allows assessment of pigment in the deeper layers of the skin, thereby expanding and better customizing the specific treatment for each individual patient. Important information your physician or aesthetician will need to know is what medications you are on, and when you go out in the hotter months or even just work out do you notice that pigment just comes up in certain areas of the face and not overall?  There are methods to treat Melasma (it is not curable), however excessive heat to the skin is not advised.  Typically, Melasma is treated during the cooler months of the year.  Significant improvement can be achieved, but since the underlying condition still exists, the pigment will usually recur during the warmer/sunnier months, resulting in routine annual treatment to maintain the best look for your skin.  If so Melasma may be what you are dealing with and just needs to be treated in a different manner.  If one is not careful in the assessment of a patient’s skin, pigment from Melasma may be thought to be solar lentigines  (“freckles”).  The latter is from sun exposure and the pigment confined to primarily the epidermis.  Success rate of “freckles” is very high, and doesn’t recur to a great degree when basic sun precautions of sun block and shade are followed afterward.  However, its treatment with laser/photofacial creates heat and if Melasma pigment is the actual reason for the brown spots present, the treatment will create a worse situation. 

Hope you found this answer helpful.  All the best!

Burke Robinson, MD, FACS
Atlanta Facial Plastic Surgeon
4.7 out of 5 stars 51 reviews

Hyperpigmentation worse after multiple photofacials.

Photofacials can darken areas of pigmentation or cause hyperpigmentation.  Melasma (facial pigmentation often associated with pregnancy) can darken with photofacial treatments.  Sun exposure during treatment can also cause hyperpigmentation.  Darker skin types (Asian, East Indian, Black) can burn, resulting in blisters and hyperpigmentation.  In most cases the hyperpigmentation reduces over a very long time.  High energy settings for the skin type or errors in assessing the skin type can result in worsening of the hyperpigmentation. Topical pre or post treatment with a topical skin lightner (hydroquinone) may be helpful. I would advise no further photofacials.

Robert Sleightholm, MD
Brampton Plastic Surgeon
5.0 out of 5 stars 9 reviews


I would encourage you to stop these treatments.  I recommend that you see a board certified dermatologist or a board certified plastic surgeon to get a diagnosis and proper evaluation.

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 209 reviews

Using IPL and photofacials for hyperpigmentation

This is a wonderful question that addresses the limitations of phototherapy.  If you have underlying excitation of pigment cells, you will need to topically reduce melanocyte stimulation simultaneously with the IPL.  I would recommend the Melarase AM and PM creams before treatment.

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 93 reviews

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.