White scars from laser, why?

Question

I had Palomar erbium non ablative fractional laser 6 months ago and I am left with white fine slightly raised scars, a dent in middle of forehead by hairline(widows peak area) and throughout skin slight dents and griding still why?

Rebecca Fitzgerald, MD · Answer

Your situation can only be addressed completely by your treating physician. But I will take this opportunity to provide a little bit of caution regarding laser treatments for everyone except those with Nordic backgrounds. I mention Nordic because truly white skin usually responds the best to laser.Laser heats up various components in the skin - Resurfacing lasers are directed at the water content. The heat response causes the skin to create new collagen and in some instances provides a bit of tightening. Because the laser beam passes through the skin layers where melanin resides, those who have genetic backgrounds that include Asian South AmericanIndian - both American and East IndianMiddle EasternSouthern European  African have to weigh the benefits against the risks. The above mentioned skin types are at higher risk for hyperpigmentation (over abundance of pigment) - and in some instances hypo pigmentation (loss of pigment). This could be the cause of your persistent visual grid and the white scars. There are alternatives such as IPL, eMatrix and fractional laser wavelengths that are specific for pigmentation problems. Anyone with "ethnic" skin should make sure their treating physician has a variety of technology that can be chosen on a skin-type-specific basis. And if not, either bypass technological procedures or look for another practice which does treat multi-ethnic skin on a regular basis.Ask to see before/after photos of patients who have been treated at that practice - who have a similar skin type as yours. Find out what your genetic background is and always share that with your physician and ASK how that will impact your treatment choices. If your grandmother was from Sicily or Puerto Rico, then you have "ethnic" skin and a higher risk of pigmentation response to heat devices.Some people with ultra sensitive skin should avoid lasers and devices that generate heat altogether. There are many product alternatives that do a find job of keeping your skin pretty and smooth.Anyone considering laser treatment should be doing a fair amount of homework. Is the technology right for your skin? Is the proposed technician well trained, certified and experienced? Does the practice you are thinking of going to treat a lot of patients with your similar skin type? Have you taken the time to consult with a physician? There's nothing wrong with asking as many questions as you need.

F. Victor Rueckl, MD (in memoriam) · Answer

White scars would be hypopigmented spots where the skin actually has no more pigment or melanocytes in that area. This is usually a result of overtreatment/too high of settings. However, the raised part leads me to believe you actually have hypopigmentated keloid scars. I would recommend you follow-up with whomever treated you because this is not common and needs to be reviewed by your physician. "This answer has been solicited without seeing this patient and cannot 
be held as true medical advice, but only opinion. Seek in-person 
treatment with a trained medical professional for appropriate care."

White scars from laser, why?

Answers (2)

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