Best Minimally-invasive Treatment for Hyperpigmentation Caused by Chemical Peels?

What is the best treatment for hyperpigmentation? I just did a TCA 20% chemical peel about 2 weeks ago and now how really bad hyperpigmentation in the areas where the doctor went deeper. I don't want anything too invasive since I are trying to get pregnant.

Doctor Answers 4

Dispigmentation after TCA peels

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Two weeks after a chemical peel is a very short period of time in relation to healing. The first thing I would recommend is patience in terms of the color variation. You should be using a sun block of at least SPF 30 during this time. Most physicians will not intervene for pigment problems until at least 4-6 weeks post-treatment. This rule is based on the natural time frame of wound healing.

Wound healing occurs in 3 stages:

  1. The immediate phase which lasts about a week
  2. The proliferative phase (where new cells and blood vessels come into the area) takes 4-6 weeks
  3. The remodeling phase, which may last up to 1 year

The timing of various treatments and interventions in plastic surgery are based upon this scientific principle. Oftentimes, the body does a better job of healing a problem than anything we can do medically.

That being said, the best treatment for you depends on whether the lesions are brown or red.

  • If they are red and it has been at least 4 weeks since the peel, then it is likely a problem called prolonged erythema (redness) due to increased blood flow to the areas in question. Certain lasers (such as a pulsed-dye laser) may be effective in treating that problem and are safe in pregnancy. In patients not currently pregnant and not actively trying to get pregnant, steroid cream treatment for 1-2 weeks often solves the problem.
  • If the areas are brown then it may be truly a problem of hyperpigmentation. Hydroquinone, with or without retin-A and a combined steroid (again, for non-pregnant patients only) is the best topical therapy. A variety of other lasers may also be effective.

At this moment in time, I would try to wait a few more weeks, be diligent about using sunscreen and staying out of the sun. If the problem persists, then rest assured there are multiple treatments to solve your problem.

Manhattan Facial Plastic Surgeon
4.9 out of 5 stars 55 reviews

A good treatment for hyperpigmentation after TCA peels...

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A good treatment for hyperpigmentation after TCA peels is the use of hydroquinone. Unfortunately, it is a pregnancy category C, meaning that the safety of the medication during pregnancy has not been established.

A safe alternative may be IPL treatments. These are safe during pregnancy but the use must be balanced against the healing skin and possible lack of efficacy.

I would suggest speaking with your physician about your concerns before proceeding with any other treatments.

D.J. Verret, MD
Dallas Facial Plastic Surgeon

Pearl laser is better for sun damage discoloation than peels.

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I have found that the Pearl laser is an excellent alternative to chemical peels for sun damaged skin.  It is less painful, requires less of the patient during convalescence, and usually involves only about 4 days social downtime.  It is not for freckles and probably melasma.  It is not good for deep wrinkles.  But when used on the properly selected patient, it seems to give very good results.

Undoing the pigment after peeling

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If the doctor only used 20% TCA (this is really not very strong) much of this should improve with time and sun avoidance/ sun screens (SPF 30 plus). Bleaching creams and/or dilute Retin A may help but I am not sure I would recommend them when you are trying to get pregnant.

What does your surgeon say? Are you still seeing him or her? Hyperpigmentation after peeling really requires a doctor's continued examination to change to the things that work well for you. People vary.

Best Regards

John P. Di Saia, MD
Orange Plastic Surgeon

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.