Happy new year, Readhead readers! Today I’d like to talk about one of the topics I get asked about most frequently – hyperpigmentation and lasers.
First, let’s get a few basic vocabulary terms out of the way that will make this review easier to understand:
Epidermis: made of up five layers of skin (although there are many cells stacked upon each other within those layers) that provide protection. This is what you see on your face, arms, etc. This is constantly sloughed off and renewed as cells from lower levels come up to the top. Light peels, scrubs and retinoids help to turn these cells over faster resulting in brighter, smoother skin. Most procedures (unless done in a medical setting) treat the epidermis.
Melanocytes: the melanin (dark pigment) producing cells that give skin its color and darken to protect the dermis from UV rays and trauma. When you freckle, have a dark mark after a pimple or melasma, this is caused by scarring and melanocytes. These are located in the very bottom layers of your epidermis.
Dermis: below the epidermis and includes your collagen matrix, elastin, fibroblasts and other skin-supporting organelles. It is very slow to generate new components and haults over time and hence we get wrinkles, permanent dark marks, lax skin, etc. This is where your “recovery team” is that creates collagen and other components when you damage the skin to help repair it. Over time with age, repeated damage from trauma and free radicals, the recovery team and its support breaks down and we start looking like an old bloodhound.
Hyperpigmentation: darkening of the skin (those melanocytes!)
Hypopigmentation: whitening of the skin (absence of melanin)
Whew OK enough with the nerding out on the integumentary system (sorry, I couldn’t help myself with one more nerd reference) but I bet you learned something! And that’s what Readhead is here for.
Ok back to the photofractional. But first, some more terms.
IPL: Intense Pulse Light. A laser that uses heat and light to essentially obliterate those over-producing melanocytes. This is called a photofacial (note: not photofractional)
Fraxel: non-ablative lasers that penetrate into the dermis by causing concentrated channels with heat, stimulating the repair mechanisms in the dermis into doing all the things its younger self used to do a lot better. This helps with collagen and elastin, pushing out wrinkles from within to help reduce the look of fine lines, acne scaring, and uneven skin texture.
Non-ablative: means that it does not disturb the outer layers of the skin. You may have seem examples of lasers that create a white crust as the laser zaps across it. That is ablative. Non-ablative is overall gentler and less downtime. More on that in a moment.
Review of Photofractional Facial
You’ll see that I called this a photofractional facial. This is because it combines both the IPL and the fraxel laser. You can opt for just one part or the other depending on what your skin concerns are.
The type of IPL and fraxel used on me was the Lumenis ResurFx M22 which boasts a more gentle approach of only needing one pass and cooling technology to help with downtime.
My wonderful provider and overall skin rejuvenation expert walked me through everything and answered all of my questions. Because I have natural freckles and my melanin pigment is very light on the surface, but lower in the skin (I’ve been doing peels, microneedling and serums for years so most of what is left is very stubborn pigment in the dermis), she mentioned that I will see a gradual fading vs. dramatic results on my stubborn brown spots.
I’d like to point out that this is a serious treatment. You’re talking about heat, lasers and a requirement of expert knowledge in both the equipment and the Fitzpatrick scale. Not everyone is a candidate for a laser and sometimes a conservative approach is better. We both opted for conservative since I’ve been burned by an ill-wielded IPL machine many years ago at a different practice. There are always risks but to limit those make sure you go to someone who really knows their stuff.
What a photofractional facial targets:
As mentioned in the vocabulary test above, IPL is targeting my hyperpigmentation that I’ve experienced due to my years in the sun and acne. Also as a natural redhead, I am prone to freckling. I have a few couperose veins (those pesky red veins) around my nose and general redness in my cheeks. I personally don’t like to wear a ton of makeup and agree that dark spots make you look older than wrinkles so I wanted to blast them away.
For the ResurFx fraxel part of the facial, I am hoping to build and maintain my dermis’ structure with more collagen, tighter skin and overall rejuvenation. Combined with natural aging, I’ve lost some weight since moving to NYC which is great in everything except my decrease in volume due to fat loss and decrease in skin elasticity. This has caused some sagging in my lid/lower face and neck which is what typically shows age first. I guess we can’t have it all.
Since I am a 1-2 on the Fitzpatrick scale I am an ideal candidate. Those on the darker end may not be a laser candidate. Those prone to hyper or hypopigmentation may also opt to go for something like microneedling.
Please check with a certified professional to discuss expectations and contraindications.
I took a very bland skincare approach the week before my photofractional. No scrubbing, no actives and no retinol. You also have to make sure you are out of the sun for at least a month because the laser targets the difference between clear/lighter and darkened skin. If you are tan you won’t see favorable results because the laser cannot as easily differentiate between what it should be targeting….and shouldn’t you be staying away from the melanin-producing sun anyway if you’re opting for laser treatment?
I took two extra strength Tylenol (only Tylenol so as not to encourage bruising) and applied topical arnica that night and the day of my treatment. This helps with pain and bruising. No caffeine or alcohol the night before either for me.
My provider put some ultra-cool glasses on me to protect my eyes (replaced by little pads when we got closer to my eye area. She first put the ultrasound gel all over my face. There was no numbing cream because it can cause irritation to the skin and create redness. This makes it harder for the IPL laser to determine between darker and lighter pigment.
She did one pass on me which wasn’t terrible, but it wasn’t a walk in the park, either. The closer you are to your time of the month will also add sensitivity. It felt like a rubber band zinging me and the light made me jump. Areas like above my lip and the corners of my nose were pretty sensitive, but others like the side of my face I felt hardly a thing. It was done in about 10-15 minutes. My face felt a little warm and grumpy, but nothing bad by any means. I’d rate it at about a 3-4 on the pain scale and you can do anything for 10-15 minutes.
Next came the numbing cream for the fraxel session. She slathered it on like she was glazing a donut and let me sit. Ahhh. Once I was numbed up, back on the glasses/pads went and she went to work. When I say you need an expert, it is not only because of the machine and your skin, but she went in a pattern that was least sensitive first and did the more sensitive parts that had more time to numb, last. Bless you!
Every few seconds there was a zap of what felt like a hot buzz of concentrated needles into my skin. Some areas felt less hot and more buzzy, others felt pretty hot. She went on a grid across my face (another reason why you go to someone who knows what they are doing so that you don’t look like a wicker basket afterwards or do too many repeat passes to damage the skin). This was more zingy than the IPL. I would rate this at about a six on the pain scale for me. I have a fairly high pain tolerance but I do have sensitive skin. It only lasted for 10-15 minutes and then I was done. Beauty is sometimes pain. Zing away, girlfriend!
When I left my face felt really warm like a prickly heat. I’d had many sessions of microneedling and this treatment felt more intense. The winter air felt great although I needed to protect my skin barrier. I was red like a sunburn very similar to microneedling.
Over the next few days my face swelled. It wasn’t a swelling like my eyes were shut and I look like I went a few rounds in the ring, but IPL/Fraxel targets water in the skin. I looked like I ate 3 week’s worth of high salt and slept face down for a week. I was pink and water-logged. Undereye bags were more pronounced, my face looked rounder and my jowls more pronounced. I didn’t look terrible, but I definitely looked like I did something. The redness could be covered up, but the swelling would be noticeable to someone who sees you regularly. I didn’t get any weird stares on the train, though.
First few days:
The pink irritation lasted about two days and began to subside into a slightly darker coloring that showed where the laser passed over my skin similar to microneedling. My darker areas started looking more blotchy as discoloration was coming to the surface. If you looked close you could see the texture of the laser dots in the very top layer of my skin as it began to harden and crust.
I called this my “baby turtle growing a shell” or “stuffed soft shelled crab” phase as I was still swollen, and my skin started to feel a bit crunchy which is indicative of healing and preparing to peel.
The first picture is right after the treatment. The second is my attempt at a smile while my face was swollen. The third, if you look closely, you can see where the pigment has darkened at a very fine texture where the laser penetrated my skin is starting to form. I also apparently live in workout gear. At least you can never say I didn’t keep it real with you, readers!
It look about the whole 10 days for the swelling to completely subside but I will note that I was retaining extra water because of my cycle. Those who have dermal fillers made with hyaluronic acid or already have edema under the eyes or in the face may see prolonged swelling which is completely normal.
Unlike microneedling which created a light peel in about 2-3 days and took about a week to subside, my skin really held on before it started peeling. It felt like sand paper due to the tiny holes the laser created. It came off in what felt like little grains instead of light flakes like microneedling or a chemical peel.
This was a test of willpower for me because with all of my skin woes, I generally have very smooth, soft skin. I wanted nothing more than to exfoliate it but YOU SHOULD NOT. It is your skin’s natural healing process. Removing skin before it is ready to come off can damage it, causing inflammation and hyperpigmentation. That’s right, the very thing you just went through all of this to get rid of because you got too excited.
I purposefully didn’t bring many skincare items on my holiday trip back home. I felt like I was getting the shakes to find the nearest place for microdermabrasion, though.
Makeup was basically pointless because it looked like makeup on top of light-grit sandpaper. I suggest moisturize, moisturize and moisturize some more. Don’t waste your good active serums because a) your skin will be sensitive and needs to heal and b) you’re just treating dead, crusty skin.
Expectations vary depending on how aggressive you go with the laser and how deep the pigment is. Those with lots of surface pigment will see their spots turn darker and look like coffee grounds within a few days before sloughing off. This was my experience the first time many years ago when my damage was at the surface.
Those with damage deeper will see a more gradual decrease and over multiple treatments because it’s deep in the dermis. It takes time to make it up and out through all of those layers. That is what I’ve experienced this time. I peppered in a few surface freckles but those areas that have been there forever (under my eye and lower jaw) noticeably moved closer to the surface two weeks in. As per the expectations that were set, I will need to treat them multiple times as they ratchet up the layers of my dermis/epidermis and out. As the redness calmed and the swelling subsided my skin bounced back to an overall clearer look than before. Since collagen takes 4-6 weeks to grow, I haven’t seen those results yet.
Those last two points are a major key point to your satisfaction with this treatment. This requires proper pre and post-treatment care, a change of lifestyle for making a conscious effort to stay out of the sun and use SPF, multiple treatments that are conservative if needed, and a good at-home skincare regimen. Photofacials range from $150+ per treatment, and photofractional $500+ per treatment. It is not without its risks and should only be done in the hands of a professional at a medical facility. Damage that is done in the dermis may not show for years, so this isn’t a one and done treatment. It can take some time to see the full effects of both the IPL and the skin resurfacing. It also requires some planning – no sun for a month before or after, a week or two of downtime and proper research + consultation beforehand.
So far I’ve been very pleased with the results I’m seeing and is a treatment I highly recommend for those who meet the criteria. I plan to do my neck and chest. But I will take this one slow to give my skin plenty of time to recover and make sure I don’t have anything that may require some glam within a month.
I’ll update this in a few weeks when the results have run their course.
Have you done a photofacial or photofractional? Drop us a line in the comments!