PIH Post-Active FX

8-9 weeks post active fx, with no pre-treatment, have developed PIH on both cheeks. I am light skinned, a touch of olive. Compounded 8% hydroquinone/tretinoin is way too irritating for my skin. Someone suggested IPL, but I am just not sure. Also heard it can take 3-6 months to resolve. I have hydroquinone 4% which does not irritate, but does not seem to be doing anything, either. I think my skin is very sensitive. Does any doctor have any hope to offer? THANK-YOU!

Doctor Answers 7

PIH Post-Active FX

Thank you for your question. In So. Cal and no pretreatment??  In the Bay area, here everyone (our patients) gets pretreated 1 month before laser resurfacing, or no treatment.  Our PIH events are nearly zero or very mild transient for 2-3 weeks. Yours may also be transient and you will have to wait until he inflammation subsides and then things will resolve.  Also try some 2% Salicylic toner twice a day, if not irritating.  Also try some Elure which is not very irritating, but works slower. I hope this helps!

Bay Area Dermatologist
3.9 out of 5 stars 12 reviews

Melarase creams twice daily and Melapeels for hyperpigmentation

Hyperpigmentation after Active FX should be treated early with monthly MelaPeels and topical Melarase cream twice daily. 


Raffy Karamanoukian, MD FACS

Los Angeles, CA

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 94 reviews

Post treatment pigmentation after laser resurfacing

While pretreatment for ethnic skin prior to fractional co2 laser resurfacing can minimize post-treatment pigmentation, there is no guarantee. When post-treatment pigmentation does happen, combination of hydroquinone, prescription strength topical retinoid, sun protection should be part of the therapy. Superficial chemical peels, microdermabrasion, and Q-switched Nd:Yag laser can be quite helpful. IPL should be avoided for post-inflammatory hyperpigmentation as it can make it worse.

William Ting, MD
Bay Area Dermatologic Surgeon
4.8 out of 5 stars 12 reviews

Post-Inflammatory Hyperpigmentation after Active Fx

In my experience with Active FX, hyperpigmentation is rare, but always a possibility. It is typically more frequent with the Deep FX component or with an aggressive Active FX. The good news is that post-inflammatory hyperpigmentation is reversible over time. It can take between 3-6 months and can be easily concealed in the meantime with makeup. Hydroquinone 4% is effective in speeding the recovery time. I often recommend a combination of hydroquinone 4%, retinol, and a mild steroid (TriLuma). You will not be able to see the effects immediately, but should speed your overall recovery. I reserve light peels and IPL until the hyperpigmentation is very superficial. 

Frank Agullo, MD
El Paso Plastic Surgeon
4.9 out of 5 stars 141 reviews

Hyperpigmentation after Laser

While pre-treatment can help lower the incidence of post-inflammatory hyperpigmentation, there is always a small chance of this developing. The good news is it  should resolve with time, and you can speed it up with some good skin care. 4-6% hydroquinone should suffice and physicians may also prescribe topical retinol 0.025-0.1% which may help by allowing the hydorquinone to penetrate and also by increasing cell turnover in the skin.

Roy A. David, MD
San Diego Facial Plastic Surgeon
4.5 out of 5 stars 23 reviews

Pigmentation after laser treatment: will it go away

given the color of your skin this is always a possibility. In my hands, it is as high as 20% in selected patients. The good news is it does go away! It may take 3-6 months. We use a combination of similiar topical medications, light peels and IPL ( when it becomes more superficial).

Jeffrey Kenkel, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 6 reviews

Peels can help PIH after Active Fx laser resurfacing

The touch of olive in your skin type plus possibly a little sun may have predisposed you to pigmentation after laser resurfacing (Active Fx, Fraxel or others).  The best treatment I have found is a combination of retinol plus 4% hydroquinone (brand name TriLuma is a prescription that fulfills this criteria), sunscreen daily, at least 30SPF (plus active sun avoidance) and light peels such as glycolic acid done at 3 to 6 week intervals.  Of course, in almost all cases the pigment will resolve on its own although that can take as long as a year. As always the truly ideal treatment is prevention. Before resurfacing it might be advisable to pretreat with retinols, hydroquinones and active sunprotection.  Given proper prevention the risk of pigment can be quite low.

Susan Van Dyke, MD
Paradise Valley Dermatologic Surgeon
4.5 out of 5 stars 35 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.