Post-Inflammatory Hyperpigmentation Due to Photo Facial Treatments

I am now 40, 3/4 Asian & 1/4 Caucasian and my skin is probably a medium Type 3. In Oct 2008, I purchased/started a package of 6 photo facial treatments (they call it IPO? not IPL), 2 Microdermabrasion treatments, and 2 Alpha peel treatments at a spa owned by a doctor, hoping this time, hyperpigmentation on my face would start fading. I couldn't see any noticeable effects after 3 photo facial treatments & 2 microdermabrasion treatments. Then, at my 4th photo facial treatment, the technician went very aggressive to see optimal results (She told me after the 4th treatment).

I was also recommended for a peel a week after that, and I did. It's been 3 weeks after the 4th Photo Facial session, and now I'm pretty sure I have PIH by my eyes as well as on my cheeks. Although a very, very heavy concealer can camouflage them to some degree, I would want to hide and cry every single day. During the course of my treatments, I was using 2 levels of bleaching cream (containing 5% or 8% hydroquinone & tretinoin) every other day and stopped using it 4 days prior to the next photo facial treatment. In addition, I've been using either SPF 45 or 58 every single day.

I have 2 Photo Facial treatments left at this doctor's spa. Is it still possible for the Photo Facial treatments at this spa to improve my PIH, or should I discontinue right away? If I should discontinue, what would be the effective treatment options left for me, given I have already tried Photo Facial, TCA peel, hydroquinone/tretinoin and Microdermabrasion? I desperately need professional help/opinions.

Thank you so much in advance for sharing your knowledge and experience.

Doctor Answers 4

Hyperpgimentation or Melasma

First let's address the issue of whether you should continue with IPL treatments or not. The answer to that is NO. The safest treatment for hyperpigmentation caused by IPL is hydroquinone bleaching cream. Another available option is q-switched laser treatments. This type of laser treatment should only be undertaken by a practitioner with extensive experience treating PIH with this laser. Going too high on the fluence (energy) can cause more damage with this laser so extreme caution and experience is necessary.

We're wondering if what you describe as "hyperpigmentation" for your initial condition is actually Melasma. If the original condition you were being treated for is Melasma, the IPL will make the condition worse. In addition, if you have Melasma, you would also not consider q-switched laser treatments for the PIH. You should stick with hydroquinone bleaching creams.

First step is to wait for the PIH to resolve (using hydroquinone) and then find another more experienced practitioner to address the underlying issue you were being treated for (melasma?).

Los Angeles Facial Plastic Surgeon
4.3 out of 5 stars 6 reviews

Post inflammatory hyperpigmentation is a difficult situation

I'm sure that what you are describing is PIH (post-inflammatory hyperpigmentation).
First, an SPF of 45 or 58 is not what you need. You need a sun BLOCK, not a sun SCREEN. A block contains micronized zinc oxide and / or titanium dioxide and truly blocks the sun's rays. This needs to be worn daily from sun up to sun down. I can't stress the importance of sun protection more.
Secondly, I have found that IPL or IPO (whatever that is) is inadequate in treating PIH. In the past, I have treated patient's with daily hydroquinone, 4% or 8% DAILY as long as it doesn't cause irritation. The tretinoin is helpful, but if irritation occurs, it would be the first thing I would tell you to quit using. Recently, we have been using BBL, or broad band light, a type of IPL from Sciton that seems to work much better than the older IPL we used to have. I treat PIH with BBL now and have good results.
Nothing will make the pigment disappear quickly. It is a combination of sun protection (the most important), hydroquinone, and possibly BBL, plus a fair amount of time (maybe 6 months), and your skin should be looking great again.

Andrew Campbell, MD
Milwaukee Facial Plastic Surgeon
4.7 out of 5 stars 26 reviews

Hyperpigmentation after IPL not uncommon for Asian skin

Hyperpigmentation after IPL, or photofacial treatment is not uncommonly seen among Asian-American skin. Therefore, IPL should not be used a first line therapy for pigmentary disorder and when used, the parameters should be much more conservative for Asian-American or Hispanic skin types.

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


If indeed you have post-inflammatory hyperpigmentation, you should use hydroquinone bleaching cream.  I would not recommend any more photofacials   

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 221 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.