2 days post V beam treatment and am very worried!

Question

Areas treated are raised. I understand it would darken but within a few hours? I thought this would happen days later. Is that normal? And are raised areas normal? Is that considered blistering? Is this an indication of overly aggressive settings? All treated areas are raised and very dark compared to before. How long can I expect the discolored areas to fade?

Lillian Overman, MD · Answer

Like Dr. Emer, my first though is that you have blisters from too much energy being deposited by the VBeam. I love the VBeam laser and have only seen this occur once, and thank goodness it was on my own face and not a patient's. I wanted to remove some bruises due to injections and did not choose conservative VBeam settings like I would have for a patient. My blister was tiny and I was fortunate that it cleared up without a scar. My concern for you is that your blisters are larger, there are several and it appears that you have hyperpigmentation (excessive amounts of the pigment melanin). The heat of the VBeam likely stimulated your melanin production to cause the hyperpigmentation. Of course, it is only possible to gather a limited amount of information from a photo so this is a guess. 
My concern for you is that you are at risk of scarring, infection and hyperpigmentation. You need a dermatologist to help you through this and you should not delay in seeking help. The treatments you could ask about include:  
1. Scar prevention: Silagen Gel during the day (an excellent suggestion by Dr. Emer)  and a silicon patch (such as ScarAway) at night. The use of silicon has been shown to help skin to heal while minimizing scaring. 
2. Hyperpigmentation treatment: 4% hydroquinone cream will help suppress extra melanin production. After you have been on this for a month, it may be possible to use the Fraxel Dual laser at the 1927nm frequency to remove the brown spots. I wouldn't risk using the Fraxel without your having been on hydroquinone because the heat could worsen the hyperpigmentation (as likely occurred with the VBeam) and I would suggest that you continue it for a minimum of a month after treatment. 
Ultimately, the choice of treatment would be at the discretion of your dermatologist.
I'm sorry that this has happened to you and hope that you will have a good outcome.
Lillian Overman, M.D.

Jason Emer, MD · Answer

It's difficult to tell from your pictures, but this may be burns. I recommend following up with a cosmetic dermatologist for after care. I recommend Silagen + Bioshield to promote healing. Hyperpigmentation can be improved with a combination of lasers, Aerolase, microneedling/prp, skin lightening, peels, and skin care. Sun protection is essential. See an expert. Best, Dr. Emer

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