Prolonged Post Inflammatory hyperpigmentation 8 months post co2 laser - how can I improve this? (Photos)

Hi! Dr. Peterson here —
It sounds like you had a very aggressive CO2 treatment, and unfortunately, settings that are too high or done by someone without proper training can lead to long-lasting redness, hyperpigmentation, and slow healing. Even with excellent sun protection, your skin is still recovering from significant trauma.
At this stage, it’s important to be gentle and avoid anything irritating. Since hydroquinone, tretinoin, and azelaic acid are all causing irritation, you might want to pause those for now and focus on: • Barrier-repair creams (ceramide-rich, fragrance-free moisturizers) • Soothing, anti-inflammatory topicals (niacinamide, panthenol, or green tea extracts) • Sun protection (which you’re already doing consistently)
In addition, in-office interventions by a board-certified dermatologist or dermatologic surgeon may help: • Low-fluence vascular or pigment lasers (like VBeam for redness) • Fractional or low-strength resurfacing for texture, done very cautiously on scarred skin • Prescription-strength anti-inflammatory agents for persistent redness
Because your skin is still fragile and reactive, a personalized in-person assessment is really the safest next step. Over-the-counter treatments alone are unlikely to resolve this at 8 months post-trauma.

This is an unusual situation as most patients will heal before 6 months, even with some hyperpigmentation. Since you have tried several creams I would next try microneedling with either PRP or exosomes, which would be even better. Probably 3 sessions. A laser that can also help with the pigment is a pico laser or Q-switched laser that is commonly used for tattoo removal or melasma. Find a place near you that offers those treatments and when in doubt get the advice of a cosmetic dermatologist. Good luck!

Very aggressive, destructive treatments, such as CO2 laser, conventional dermabrasion, and deep chemical peels are well known causes of this kind of post-infllammatory hyperpigmentation. Without treatment, this problem tends to be persistent
Fortunately, professionally performed manual microneedling (no need for the added expense and risks of RF microneedling) can help to stimulate new collagen and elastic fiber production, which can help to improve this, especially when combined with the application of Rx pigment lightening agents, since the microchannels created allow for greater penetration than can be achieved via topical use alone. Typically, a more penetrating form of microneedling is needed here to achieve the desired results. So, best to seek professional care
You would be wise this time to consult with an experienced, board certified cosmetic dermatologist who can both treat your problem in-office, as well as prescribe a proper at-home treatment regimen to complement the in-office treatments. Best of luck.