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

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?

Doctor Answers 8

Resurfacing for Pigment & Acne Scars

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

Seattle Plastic Surgeon
5.0 out of 5 stars 5 reviews

Laser Resurfacing

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,

Ross A. Clevens, MD
Melbourne Facial Plastic Surgeon
4.7 out of 5 stars 116 reviews

Laser resurfacing scars and hyperpigmentation

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 best

Dr Davin Lim 

Davin Lim, MBBS, FACD
Brisbane Dermatologist
4.7 out of 5 stars 75 reviews

Hyperpigmentation and Scars

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.
Dr. Grant Stevens

Grant Stevens, MD
Los Angeles Plastic Surgeon
4.7 out of 5 stars 145 reviews

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

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.

Jeanne A. Scanland, MD
Chattanooga Plastic Surgeon
5.0 out of 5 stars 9 reviews

Swelling resolved

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.

Morris Westfried, MD
Long Island Dermatologic Surgeon
5.0 out of 5 stars 5 reviews

Hyperpigmentation and scars returning after laser skin resurfacing

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,

James R. Gordon, MD, FACS, FAAO
New York Oculoplastic Surgeon
5.0 out of 5 stars 139 reviews

Pigmentation returns after laser resurfacing

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.

Steven Swengel, MD
Los Gatos Dermatologic Surgeon
5.0 out of 5 stars 11 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.