Can the same hyperpigmentation and scars come back after laser resurfacing?

Question

I did laser resurfacing. While I was peeling my skin looked great. Bright, clear and my main concerns (hyper pigmentation around my mouth and acne scars) were gone!!. after day 6, everything came back. Whats going on?

Ross A. Clevens, MD, FACS · Answer

Thank you for your question. The goal of all skin resurfacing methods is to minimize the appearance of fine lines and wrinkles. With laser resurfacing, there is less bleeding, bruising and post-operative discomfort than with some of the other resurfacing techniques. I suggest that you move forward and consult with a board certified facial plastic surgeon.Best wishes,

James R. Gordon, MD, FACS, FAAO · Answer

Sorry to hear your laser treatment was not successful. There are many types of lasers on the market and many different methods of using them. Often, Retin-A and Hydroquinone 4% are used in conjunction with the treatment. Different skin types also respond differently to the procedure. With all these variables to consider, you should make an appointment with an experienced physician for full evaluation and guidance.Good luck,

Meghan Nadeau, MD · Answer

I'm sorry to hear your disappointment. Hyperpigmentation can be caused by multiple reasons and unfortunately, is never permanently gone. Occasionally inflammation can cause some pigment to worsen. Prepping your skin with a healthy skin care routine before doing more aggressive treatments is a good way to help prevent this from happening. As far as improvement with textural acne scars, swelling that occurs post treatment can create an immediate softened look and may feel like it returns after the swelling subsides. These initial concerns are common and multiple treatments are typical. Best of luck going forward. Dr. Meghan Nadeau, Seattle, WA

Grant Stevens, MD · Answer

Hello! Sorry to hear about your disappointment in the results of the laser treatment. Its hard to know exactly what happened or why without knowing all the details. However, I can explain the typical process of what we do for laser resurfacing and hyperpigmentation issues in our office. If a patient has a history of hyperpigmentation and/or currently has it, we always pre and post treat with multiple topical products for about a month before and at least 6-12 months after. And honestly, to have your best bet at keeping the hyperpigmentation under control, you will have to remain on some sort of skin lighters, brighteners pretty much indefinitely. These will also help keep your skin rejuvenated and looking fresh overall. Also, you will need to be super consistent with the sunscreen SPF 30 or greater and reapply every 2 hours when outdoors. Once you are prone to the hyperpigmentation, often will need manage it and do things to keep in under control indefinitely. One of the lasers we use in our office for scars and hyperpigmentation is the Halo. See the video below for more information. Best, Dr. Grant Stevens

Jeanne A. Scanland, MD · Answer

There
are many types of lasers used for resurfacing the skin to improve wrinkles,
skin irregularities such as scars and hyperpigmentation.  Each laser functions differently and can be
used to go to different depths of the skin. The deeper you go in the skin
layers the more inflammation you will have but your results will be
better. The deeper you go the better the improvement of wrinkles, scars
and hyperpigmentation. You have to be very cautious not to go too deep in the
skin with the laser energy because this will cause
scarring. Inflammation of the skin is one of the causes of
hyperpigmentation.

First
your doctor has to be very cautious and fully evaluate you to determine if
you are a good candidate for laser resurfacing. Not all patients are good
candidates. On patients that I do not know their genetic background or suspect
they may not be a good candidate because they have a lot of pigmentation in
their skin, I will do a pre-laser skin patch with the laser or an acid product.
I will see them 2 months later to see if they will have significant
hypopigmentation (too much lightening) because you do not want uneven
coloration left on the face or have a line of demarcation of a lighter face and
darker neck skin. It is important to pretreat the skin for 1 to 2 months
before you do laser resurfacing to decrease the chance of hyperpigmentation. I
put patients on a hydroxy acids,   Retin-A type product & hydroquinone
with a low dose steroid. Patients must be very careful to wear sunscreen
before and after the laser resurfacing to help prevent hyperpigmentation.

As
soon as the skin has healed from the laser procedure I get patients back on
products that reduce the chance of hyperpigmentation. It is not unusual for
patients to have hyperpigmentation problems after a laser resurfacing
procedures because of the inflammatory process that is necessary for healing
the skin after a laser procedure. Most often
the hyperpigmentation will improve or go away after six months. Since I do
not want my patients to have this annoying problem I pretreat patients and
then treat them immediately after healing.

Wrinkles and
scars look better immediately after a laser procedure because of the
inflammatory process which causes swelling of the skin. Once the swelling
improves you will see some of the wrinkles and scars returning. You must be
realistic because it is rare that a laser would remove all wrinkles, scars and
hyperpigmentation. These problems can be greatly improved. Since most scars
extend full thickness in the skin they will never be completely removed
with a laser procedure. I tell my patients to expect a 30% to 40%
improvement of scars. Lasers typically do better for wrinkles and
hyperpigmentation problems. Often I will treat deep wrinkles and scars
with multiple treatments of the laser spread out over several
years. It is very important that a surgeon discusses realistic
expectation of laser procedures with their patients.

Many
doctors and medical spas have lasers but it does not mean they are properly
trained in the use of these lasers. I have seen many complications of patients
going to non-trained doctors doing lasers in my career. The most important
thing a patient must do before a procedure is to fully research a doctor and
make sure they are board certified by the American Board of Plastic
Surgery or Dermatology when treating skin problems. Also the doctor
should have extensive experience in the use of the laser which is going to be
used on you.

Morris Westfried, MD · Answer

The scars can look better initially because of swelling although there should be an improvement of 20 or more per cent. Hyperpigmentation is very difficult to resolve. It may need a multi pronged approach including bleaching cream with hydroquinone tretinoin and a steroid cream.

Steven Swengel, MD · Answer

You didn't mention your skin type, but repigmentation after laser resurfacing happens with skin of color is common and almost expected in half of patients treated.  This is something we warn our patients about and offer aggressive skin bleaching both before the  treatment and after as well.  Depending on what kind of laser was used, the depth of treatment and the amount of heat delivered to your skin all has an impact on repigmentation.  Most post laser hyperpigmentation will fade over time but it is best to anticipate and treat ahead of time.

Davin Lim, MBBS, FACD - Account Suspended · Answer

It is a balance. If your hyperpigemantation is due to melasma - it will always return with aggressive lasers such as erbium, co2 or even non ablative lasers like Fraxel. The  mainstay of treatment for melasma is always medical. As for scar, this will depend on the scar type. If one gets 'below the scar' e.g. in box car scars, then the results will be permanent. All the bestDr Davin Lim

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