Posts Tagged ‘hyperpigmentation’
I have been getting a lot of emails from people all over the world that have received burns from an aesthetic laser or IPL (photofacial) treatments. I should clarify, that these are not people that have been treated by me. The question I am always asked is “what should I do to treat laser burns?” I can’t really give an accurate treatment protocol without seeing someone in person. What I will do, is tell you what I usually recommend to clients I have seen that have been burned. I also want to explain why burns occur.
How to tell if you have been burned?
It is normal for skin to feel hot during laser and IPL treatments, but you should expect the skin to cool down quickly. Your laser technician can give you an idea how long you should expect the skin to feel hot. For example if you are having a laser hair removal treatment or a photofacial, your skin should cool down almost immediately. It should feel something like a hot rubberband snap, without any lingering pain or heat. If it feels extremely hot and is not cooling down you should alert your technician as they are doing the treatment. This will allow the technician to adjust the treatment settings. The technician can also take immediate action to cool the skin and possibly prevent a burn, or reduce the severity.
If you suspect that you have been burned, be sure to discuss it with your Esthetician or Laser Technician before you leave the office. Make sure you understand what to expect and how to treat your skin at home. Schedule an appointment for a post treatment follow-up, and never hesitate to call the office if you have questions or concerns.
Usually, you will know almost immediately if you have a burn. In some cases however, the skin may not feel that hot until you go home. As soon as you suspect a burn, you should call your and speak to the laser technician.
If you are not satisfied or confidant with the post -treatment care you are receiving from the laser technician, ask to speak to the medical directer. Hopefully, there is a doctor is the office. If you have gone to a med-spa chain, there may be a medical directer for several locations. You should first make every attempt to work with the staff at the clinic where the laser treatment was provided. If you are not satisfied with the level of care, then seek a second opinion. You want to get professional treatment as soon as possible. Information provided here or anywhere on the internet can not replace personal treatment by a skin professional.
I have a burn, now what?
The recommended treatment for burns, will depend on the degree of the burn. In most cases a burn from an aesthetic laser is a first degree burn. Second degree burns can also occur from laser treatments and third degree burns are not likely. If you suspect that you have been burned severely and find the pain intolerable or if the burn covers a large portion of the body, you may want to go to the emergency room. In most cases, it is not necessary to make a trip to the emergency room, however in rare cases you may need some medical attention. Be sure to let the laser technician know as soon as possible. They should be aware so they can review the treatment settings used and asses if there is an issue with the equipment. They should have you return to the clinic as soon as posable, so that they can give you post treatment instructions. You may also be scheduled to see the doctor or a nurse if necessary. It is the patients responsibility to communicate with the provider, return to the clinic for post treatment visits, and follow post treatment instructions.
Actual first aid treatment will depend on the type of burn.
- Cool the skin as quickly as possible (within the first few hours). This is critical!
- While driving home after the treatment, aim the air conditioner toward the treated area if possible.
- When you get home soak a washcloth in a bowl of ice water, ring out the excess water and apply the cold wash cloth to the treated area. Switch out the cold cloths every couple minuets. When you feel the wash cloth become warm, it is the time to switch it out.
- Do not apply ice directly to the skin, and do not leave cold packs on the skin for an extended period of time. On for ten minuets, off for ten minuets.
- Do not apply an occlusive ointments such as aquaphor or vasaline, unless instructed by your laser technician or doctor, as it can trap in the heat. After the skin has had time to cool, and the skin begins to heal you may then be instructed to use an ointment to protect the skin.
– Do not open or pop blisters. Opening the blisters will make the area more vulnerable to infection
- It may be recommended to loosely wrap the area in gauze
- You can apply a topical hydrocortisone cream and/or antibiotic cream to the burn.
- Watch the skin for sighns of infection
After the burns have healed:
Once the burns have healed, the concern becomes how to treat and prevent scars. The most important thing you can do is protect the area from further injury, this includes avoiding sun exposure. Be sure to use a Physical SPF 35 or higher with Zinc Oxide. You can also prevent and treat hyper pigmentation ( dark skin discoloration) by using a 4% Hydroquinone cream and Tretinoin (Retin-A). Topical Serums that contain Vitamin – C , and products with growth factors (TNS Recovery Complex) can aid in collagen production, improve skin healing and reduce inflammation. If the burn marks are old you may need something like a medium depth chemical peel, to treat the scars.
The Obagi Nu-derm system is your best bet for treating scars or hyperpigmentation from burns, it incorporates the use of prescription strength Hydroquinone and Tretinoin. This is a prescription strength skin care line, available at many dermatology and plastic surgery offices. The treatment protocol is patient specific and a skin care professional will determine the best way for you to use these products. If you have had a recent burn it may be suggested that you skip the use of some products such as the Exfoderm. I usually recommend using a 1/2 gram of the Clear AM and PM, and mixing a 1/2 gram of the Blender with a 1/2 gram of Tretinoin. The strength of Tretinoin and frequency is something that needs to be determined after a personal consultation. Non-facial areas such as the neck, chest, hands and arms are treated differently than facial areas, this is another reason you need to be seen for a follow-up.
Skin Medica’s TNS Recovery Complex has a potent growth factor blend that strengthens the skin’s natural ability to regenerate itself. Although this product is not specifically indicated in treating burns, in my experience it seems to aid in healing. I was in a car accident and the air bag left me with several abrasions and burns. The areas that I treated with TNS seemed to heal much quicker. I use this product any time I am trying to improve skin healing, and it never disappoints.
The top ingredient in TNS Recovery Complex is Human Fibroblast Conditioned Media (TNS®) → A physiologically balanced, naturally secreted and stabilized combination of multiple human growth factors, cytokines and natural proteins responsible for the production of collagen and other extracellular matrix proteins.
Obagi-C Rx contains a patented combination of 4% hydroquinone and 10% Vitamin C. It reaches the dermal layers of skin to address discolorations and has powerful antioxidant therapy. The vitamin-C will also help reduce inflammation.
Is Clinical Pro Heal is a vitamin serum with a 15% Vitamin C, Vitamin E and Vitamin A. It also has 0.5% kojic acid that evens skin pigmentation. It has soothing and healing properties and reduces inflammation. Pro Heal is recommended for treating sunburns, rosacea and insect bites.
Is Clinical Hydro-Cool Serum contains Hyaluronic Acid ,Vitamin B5, Kojic Acid and Menthol. It is a hydrating serum that calms cools and soothes irritated skin. You can use this product alone or add it to another product.
Why you may have got burned
There are several variables that can lead to laser and IPL burns. One of the most common reasons, is that the skin is tan at the time of treatment. It’s important to understand that IPL and all lasers are absorbed by a specific chromophor. In many cases the targeted chromophor is color. We want the energy to be absorbed by the color in hemoglobin to target blood vessels and the color in melanin when targeting unwanted hair or skin discolorations such as freckles. When your skin is tan at the time of treatment, the energy is not just absorbed by the intended target, it is also absorbed by the surrounding tissue as well. Tan or dark skin will hold on to more heat, resulting in a burn. This is also a concern for skin of color. People with darker skin tones need to be careful to go to a skin professional that understands how to treat their skin type. This is not to say that if you have dark skin you are not a candidate for laser, however there are some lasers that are more appropriate for dark skin. It may also be recommended to precondition skin in advance.
I don’t find machine malfunction to be a common reason that laser burns occur, however it does happen. In my opinion some of the most severe burns are a result of a problem with the equipment. I believe that this can be hard to prove, because the laser manufactures are not likely to admit any fault.
In some cases the technician performing the treatment may be at fault. Technician error is a growing cause of laser burns, simply because the industry is growing. There are a large volume of new laser technicians entering the industry. Some of these new technicians will be knowledgable and talented, unfortunately a greater number will not. A “good” laser technician needs to have a good understanding of laser technology and skin. This comes with experience and continued education. Not all lasers work exactly the same, so a laser technician needs training for each laser they work with. The more experiance a technician has with lasers in general as well as a specific laser will reduce the posability that thier clients will be burned. In addition to understanding the technology being used, the technician should understand how skin will react and determine if someone is a good candidate for treatment. They should also determine if someone needs to precondition their skin before treatment and what is a good post treatment protocol. Keep in mind that even the best laser technician can encounter an unexpected complication, and burns are an inherit risk of laser and IPL treatments.
I can not stress enough the importance of going to a qualified, experianced laser technician with a good repution.
You Play A Role
Nobody wants to hear that they have some responsibility, but in many cases it is the ugly truth. I don’t think anyone deserves to have a burn or complication and I am sincerely sorry when it happens. However, everyone should except the role they play in their treatment. For example, you should not be tan when you have a laser treatment. It is the patients responsibility to inform the laser technician if they have had ANY sun exposure or even spray tan to the treated area. Patients are also expected to inform the laser technician of any medication or skin care products they are using. You also need to communicate with the laser technician during and after the treatment, and let them know what you are feeling. Be sure to follow all pre and post treatment instructions, such as avoiding heat and sun exposure. If you don’t follow the pre and post treatment instructions, you run the risk of a complication.You play an active part in your own treatment, and that begins with choosing a qualified and experienced laser technician. If you chose to go to a specific med-spa based on price or location, you should understand the risk involved.
Burns and other complications are an inherit risk of aesthetic and laser treatments, you should understand and except all risks before you consent to treatment. You should also understand that additional products or treatment may be needed at an additional cost to you. It is important that you communicate with your laser technician and return to the clinic for follow-up visits.
Melasma (chloasma) is hyperpigmentation or dark, irregular patches commonly found on the upper cheeks, nose, upper lip, and forehead. The patches can develop gradually over time or during pregnancy. Melasma can also develop when taking oral contraceptives or hormone replacement therapy medications. Melasma is thought to be stimulated by hormones, however exactly which hormones are involved has yet to be determined. The most important factor in the development of melasma is sun exposure,and without the strict avoidance of sun exposure, treatments for melasma are likely to be unsuccessful. Melasma can be permanent or disappear and reappear with each pregnancy.
Hyperpigmentation is the term used to describe any type of abnormal dark area of the skin, this includes melasma, freckles and sun spots. When we treat hyperpigmentation in the skin, it is important to understand that the melanocyte is not functioning properly, so it overproduces melanosomes and the excess melanin can not be evenly distributed among the keratinocytys. As the cells rise to the surface of the skin they cause over pigmented or dark spots. When the skin is exfoliated with AHA’s, chemical peels or microdermabrasion, the hyperpigmentation will appear lighter because some of the top layers of skin have been removed and the pigment is less dense (temporarily). The pigment is still there, it is just appears lighter and the melanocyte is still not functioning properlly, so in a few weeks as the top skin layers are replaced the pigment will appear dark again. Tanning will also further stimulate the melanocyte causing darker pigmentation to develop and Melasma will become worse. Hydroquinone works to suppress the melanocyte and is an excellent way to treat the pregnancy mask. For best results Hydroquinone can be used in conjunction with exfoliating treatments. I understand this description may be a little difficult to understand, so if I have lost you, you can come in for a consultation and I will use visual aids to better explain the cause and treatment for hyperpigmentation.
Melasma: My Personal Story
I have Melasma myself, on my upper cheeks and forehead. I first developed Melasma patches on my upper cheeks in my late twenties and later after giving birth to my second child I developed another large patch in the center of my forehead. I have successfully treated my Melasma, but I need to continue to maintain my skin so that it doesn’t come back. As a Medical Esthetician, I obviously have access to the best skin care products and treatments available. I can share both my professional and personal experience with treating Melasma. Using hydroquinone, and broad spectrum sunblock is absolutely necessary for treating and controlling Melasma. Even after successful correction of Melasma, the hyperpigmentation can reappear especially after sun exposure.
My Personal Skin Regimen
My personal skin regimen includes using the Obagi Nu-Derm system, with a 1/2 gram of Clear (4% hydroquinone) AM and PM. Initially I used a 1/2 gram of a .1% tretinoin ( Retin-A) every night, however I am now on a maintenance protocol and only use tretinoin occasionally. I also use a topical vitamin C and a broad spectrum sunblock containing Zinc oxide. I top it off with Jane Iredale mineral makeup SPF 20.
Professional Skin Treatments
I have had an Obagi Blue Peel, and Fraxel treatments. I personally felt I had better results with the Blue Peel. Fractional laser resurfacing and Blue Peels are ideal when treating deep or resistant Melasma.
Although I have corrected my Melasma, I still need to continue to maintain my skin to keep the Melasma under control. In addition to the topical products I previously mentioned, I try to have a light chemical peel every 4-6 weeks. The chemical peel I have found that gives me the best results treating pigmentation, is a custom chemical peel.
Obagi Nu-Derm System
This is correction after using the Obagi Nu-Derm System. This is a prescription strength skin system and is only available at medical skin clinics. Treatment protocols vary depending on skin type and condition.
Obagi Blue Peel
This is an example of deeply pigmented Melasma.
After treatment with Obagi Nu- Derm & Obagi Blue Peel
It is important to precondition with the Obagi Nu-Derm System and Retin-A before having a Blue Peel. I recommend preconditioning for a minimum of 6 weeks or longer depending on how aggressively Tretinoin is used. Patients that are better preconditioned get a better result. It is also necessary to continue to use the creams after peel to prevent Hyperpigmentation & to maintain healthy skin.
Custom Chemical Peel for Melasma
The Custom Chemical Peel I use is a light peel that can be repeated as often as every 4-6 weeks, compared to the Obagi Blue Peel which is a deeper peel necessary for treating deeper pigmentation. I have decided to not include details of my protocol for this custom peel. It is proprietary information that I don’t wish to share with others in the industry. If you would like to learn more, you can schedule a private consultation. I can tell you that with this peel, I will usually get light peeling for 2-3 days. The peeling is minimal and I would not consider there to be any “down-time”, you can still go about your regular routine. You just don’t want to schedule a peel less than a week before any major event like a wedding. I make it a point to work with my clients and their social calendar, so that they look their best for any events.
Get Professional Treatment For Melasma
If you have Melasma call to schedule a free consultation at
Paradise Valley Skin Klinic.
After Obagi Most Women Go Naked
The Obagi Nu-Derm® system is the world’s #1 professional skincare program, used by more than 11,000 physicians throughout the world. It is the most effective treatment for skin health restoration, correcting complex problems such as acne, melasma (brown spots), fine lines, wrinkles, and scars.
The Obagi Nu-Derm System contains prescription-strength formulations that can only be sold through a licensed physician, such as a dermatologist or plastic surgeon.
*Take a moment to watch the Obagi video at the end of this post.
The goal of the Obagi Nu-Derm system is to create soft, radiant- looking skin, increase skin tolerance and restore normal skin functions. The problem is, it only works if you use it. It works even better when you use it correctly. Dr Zein Obagi created the Obagi Nu-Derm as a skin health restoration system, and the products are designed to be used together. Each of the products are good individually, but if you don’t use the full system, you will not see the amazing results that Obagi is famous for.
- Increase smoothness
- Reduce pore size
- Improve elasticity
- Normalize oil production
- Increase skins own ability to hold moisture
- Increase skin tolerance to all external factors
- Generate a balanced, even skin tone
- Reduce hyperpigmentation ( freckles, age spots, melasma, Post inflammatory hyperpigmentation )
I have worked professionally with the Obagi products for over 10 years, and have had “literally” thousands of clients on the Nu -Derm system. The results shown in the before and after photo’s are typical and common. If you use the Obagi system correctly you will experience skin transformation. Using a specific dose and frequency that’s recommended specifically by your skin care professional for your skin condition, the prescription-strength system exfoliates old skin leaving healthy, new skin that looks and acts younger and healthier. The products in the Nu-Derm System are clinically proven, prescription-strength, ingredients that work to improve your skin cell function, compared to retail products that contain more cosmetic-based ingredients.
Obagi System: Steps 1-6
All of the products are labeled AM, PM or both AM/PM and numbered 1-6 in the order you would use them. The lines between the letters in the word OBAGI are designed as a tool to measure product. For example from the O-A = 1/2 gram ( thick like toothpaste).
Step #1 Cleanser AM/PM
Foaming Gel – For Normal/Oily Skin or Gentle Cleanser – For Normal/Dry Skin
Proper cleansing is necessary
Step #2 Toner AM/PM
Adjusts the pH of the skin for increased penetration of the system ingredients.
Exfoderm® Forte – For Normal/Oily Skin
An alpha hydroxy acid (6% glycolic acid, 4% lactic acid) that removes old skin cells while promoting new skin cells for a lighter, brighter, firmer complexion for skin that needs deeper exfoliation.
Step #5 Bleander & Tretinoin PM (mixed as prescribed)
This step restores damage to the deeper layers of the skin. It restores skin elasticity by enhancing the production of collagen and elastin.
A topical prescription treatment that contains 4% hydroquinone to target hyperpigmented (discolored) areas of the skin and increase the penetration of the active ingredients of the system.
Tretinoin Cream 0.025%, .05% , or.1% (as prescribed)
A topical prescription, use as directed. *Do not wax skin that is treated with tretinoin.
Step #6 Healthy Skin Protection SPF 35 AM
A sunscreen with 9% micronized zinc oxide and 7.5% octinoxate that helps to protect newly transformed, younger looking skin and prevents further sun damage. This is a physical/chemical sunscreen with UVA/UVB protection.
If you just want to FEEL good you should get a spa treatment. If you want to LOOK good, then follow the recommended Obagi Nu Derm protocol. Generally, with a more aggressive protocol you will have more reaction, however you will also have more stimulation, see correction faster and build up tolerance more quickly. That doesn’t mean everyone should start out aggressively, individual system protocol is determined by skin type.
Reaction Phase: Out with the Old
Inital correction and stimulation phase
This is the time in which the damaged top layer of skin is replaced by a new layer of healthier cells. It takes about six weeks for ” newborn” cell to reach the surface of the skin and exfoliate.
You WILL experience one or more of the following symptoms:
- Dryness – Itching
- Burning – Redness
- Sensitive skin
- Exfoliation ( flaking and peeling)
These reactions are a sign the skin restoration is in process. The Nu- Derm system is accelerating the skin cell turnover to alter the rough top layer of the skin.
Tolerance Phase: In with the New
Correction and stimulation continues
Your skin has built tolerance , skin improvement is viable. The skin increases the production of collagen and elastin, to diminish wrinkles and reduce pore size.
Correction Phase: Healthy Glow
Finally, your skin enters the last stage and you are ready for a maintenance protocol. Skin tolerance is now complete.
“Begin with the end in mind.” – The 7 Habits of Highly Effective People
Peeling is more severe in the center of the face and around mucus membranes (eyes, nose and mouth). You can try focusing product use on the forehead and cheeks and blending them in toward the center of the face. Most people notice that the peeling reaction peeks late afternoon-early evening. It is okay to cleanse your face later in the day ( at least 4 or 5 hours later) and reapply sunscreen and makeup. Cleansing the skin can help slough off some of the loose peeling skin. If you have an social event and need to stop reactions, discontinue step 5, four days before event. Obagi Action and Tolereen are “control” products that can be used as needed to relieve surface tightness, itching and dryness. Control products should only be used temporarily, as they slow the skin restoration process. Be sure to discuss options for controlling your reactions with your skin care professional.
Obagi Nu-Derm Action
A moisturizing cream to be used as needed to soothe areas of dry, flaky skin.
Obagi Nu-Derm Tolereen
Contains 0.5% hydrocortisone for the temporary relief of itching and burning associated with minor skin irritations.
Find Obagi neer you. www.obagi.com
Cosmetic Laser Warning!
What you need to know before choosing to do a cosmetic procedure.
On one complaint website, there were 1,437 complaints regarding laser treatments and over 600 for one specific laser center. If you decide to go to a discount laser center because you are looking for a low cost, you are taking a gamble. Some clinics hire inexperienced, even unqualified technicians to do treatment and rarely have a Doctor on site. A clinic may have a “medical director” on staff whom acts as a medical director for several locations. A med spa with a medical director on staff does not mean it is the medical practice of that person and the medical director may never actually be in the clinic. I have even heard of cases where the “medical directer” was in another state. Med Spas often set sales quota’s for employees, so technicians are pressured to rush treatments. I call this type of practice ” turn em’ & burn em’ “. I don’t blame the technicians, it’s just a poor way to do business. These types of laser centers usually have a very high employee turn over rate and many unhappy customers.
Increasing popularity for Laser, IPL and RF treatments has lead to an increase of treatment complications. A poorly done laser treatment can lead to burns, hyperpigmentation, hypopigmentation, ocular injury, scars and a simple lack of results. Most complications are preventable and all are manageable. The increase in complications is primarily due to lack of training, experience, and medical supervision. It is important to know that it is not just the technology, it is also the technique that determines the result of a treatment. Cosmetic and laser treatments can be complicated and are best done by an experienced technician. Laser and IPL treatments all come with some inherent risk, which you should understand and except before you consent to treatment. Burns and other side effects can result even when treatment is performed by the best and most experienced laser technicians.
With all the new products and technology available today it is easy to be confused, when choosing a treatment. Laser, IPL, LED, Infrared, Radiofrequency and fractional resurfacing are all energy based technologies and each have different indications. A knowledgeable esthetician / laser technician can educate you on energy based treatments in addition to other treatment options. In some cases a chemical peel, Botox, or a cosmetic filler may be a better option than laser. A consultation with an experienced esthetician can help you to make an educated decision on treatment.
It’s easier to stay out of trouble than to get out of trouble.
Patients play an active role in their treatment.
Tanning is a contraindication to most laser and IPL treatments, it is the patients responsibility to use proper protection from UV rays and inform technician of any possible sun exposure. Follow all pre and post treatment instructions, including keeping skin cool. Patients that are noncompliant may be responsible for treatment complications. Anyone with dark skin is at increased risk for complications, and should look for an experienced technician that specialize in treating dark skin.
When choosing to do a cosmetic procedure always look for someone who is experienced with proper training and a successful reputation. Do not base decisions regarding laser treatments, solely on price. A poorly done treatment will cost you more in the long run. Laser clinics should not operate the same as a tanning salon or health club. Laser treatments are serious and should be treated as such.
Are they telling you what you want to hear?
Regardless of the technology, laser hair removal usually requires a minimum of 12 treatments on the face and 8 treatments on non-facial areas. In most cases periodic treatments are needed to maintain results. Laser technicians that tell you that you will only need 5 treatments are not necessarily lying to you intentionally, this is often what they are told by the companies that manufacture lasers. Same applies to claims of safely treating tan skin or effectively treating light hair, although it may be possible don’t count on it.
Questions to ask:
Are you a licensed esthetician and certified laser technician in this state?
Is there a Doctor on location?
How long have you been doing laser treatments?
How long have you been in this clinic?
Have you treated my skin type before?
If you have been burned
Most complications are manageable, and can often be completely resolved. Treatment protocol will depend on severity of burn. In some cases the “burns” are not as severe as they look. If it is just superficial redness with speckles of dark, you may even get a nice result. Unfortunately some burns may need medical attention and can lead to scarring. If you have been burned, return to the laser clinic immediately for follow up care. Proper treatment of the skin post treatment can make all the difference.
The marks in the above photo appear to be from an IPL treatment, however I would not say this is anything to be alarmed about. The marks may look bad, however with appropriate home care she may even have a nice result.
Laser and IPL Burns
These are photo’s found on the internet that show various examples of burns from laser and IPL.