Dr. Naderi,
I would like to seek your advice on a laser procedure I underwent in December of ’09. My dermatologist recommended AFT laser resurfacing to me on 3 occasions while visiting his office. I was seeking his advice on how to maintain a heathy skin regimen as I approached my 40s.
I’m Caucasian and have very fair skin and light freckling from sun exposure and possibly from 2 recent pregnancies. After reading and researching the procedure and this physician, I decided to proceed with the procedure. Unfortunately, I dearly regret this decision. My light freckles are much more pronounced and the hyperpigmentation below the eyes and on my cheek bones seems abnormal now; it resembles a coffee spot on a napkin. I’m very disappointed and upset for not seeking multiple opinions from dermatologist in this area. Nevertheless, what’s done is done.
I returned to the physician prior to a 2nd round of AFT out of fear that more laser resurfacing would create even more damage and problems. I explained my concerns and pointed out the areas of increased/abnormal pigmentation. The doctor looked at them and stated the pigmentation was subtle and really gave me no explanation for the problem, only stating that AFT did not have a mechanism to “increase” pigmentation and more resurfacing was necessary to eliminate more freckling/sun damage. I left his office practically in tears because I was offered NIA 24 skin regimen samples (which hasn’t helped in the least) In your opinion is his statement about AFT not causing new pigmentation or problems true? Are you familiar with AFT laser resurfacing and the risks involved with patients who have high sensitivity to the sun? Without seeing pictures before or after this procedure of me, can you tell me if I have options for improving my skin again? I really had a nice complexion before this procedure because I’ve spent the last 10-15 years out of the sun and protecting it daily to avoid sun damage. I really should have deferred from lasering and used a lightening cream for the light freckles on my face.
Thank you for your professional feedback and advice.
Answer:
Hi,
Don’t panick. It should be correctable.
AFT or Advanced Flourescence Technology is simply a fancy marketing-driven way of saying IPL or Photo-therapy or Photo Rejuvenation or Intense Pulse Light. These are all the same thing. None are actual “laser.” The technology uses a bright warm flash of white light combined with various filters to treat red vessels and rosacea as well as brown spots, freckles and hyperpigmentation.
These devices are safe in most patients with fair skin. We have the same technology in my office. It should not be used or used with caution on Asians, Latinos, Middle eastern patients, African American patients.
However, even some caucasian patients will tend to have “post inflammatory hyperpigmentation” which sounds like what you have. Irritation or stimulation of the skin with lasers or IPL or chemical peels will result in hyperpigmentation and dark spots.
To avoid this, the skin should have been “prepped” with 4% hydroquinone cream for 4-6 weeks before the actual treatment and after. NeoCutis’ Blanche is a great fast acting form of Hydroquinone (bleaching cream).
Furthermore, it is normal for freckles and brow spots to get darker initially with the 1st AFT or IPL treatment. Three to 4 treatments are needed for a full course of treatment. The settings should also be checked on the device to make sure its not too strong or too weak. Each will cause issues.
At this point, you need to see a good Dermatologist or Plastic Surgeon (and I have seen many dermatologists make this same mistake yours made). You need bleaching creams, microdermabrasion, time, possibly more IPL/AFT and possibly light chemical peels like a Vi Peel or Vitalize Peel. I cannot make any recommendations without seeing you and knowing your medical history but these are some options to explore. Dont be depressed but it will take some time to reverse this in many occasions.
Good luck
