LAM FACIAL PLASTICS

Hi Dr Lam,

a)have you ever heard of fraxel causing hypopigmentation (from a single session?
b) have you ever known it to be delayed, as in not showing up for a year then suddenly appearing?
c) if so, why is it delayed?
d) is it likely permanent and if so is there anything that can be done to treat it?
e) finally, if one also developed lots of tiny milia from the fraxel is it at all possible that the milia cluster and its accompanying white color might be mistaken for hypopigmentation (i know that question might be a bit "out there"?

thanks for answering this exhaustive list, your time is really appreciated

hmmm, i have never heard of that. the problem with the term "fraxel" is that it is applied to about a million types of fractionated lasers: Pixel, Fraxel, Active FX, Mixto, etc. so whatever you had was one of these brands. I own the Pixel and have never seen it. I don't own a Fraxel so I do not have enough clinical or scientific experience to give you a good answer (even the word Fraxel is used by different companies). I wish that I could. Delayed hypopigmentation is possible with classic CO2 lasers along, for example, the jawline, that can occur a year later and progressively worsen over 5 years (sorry, not trying to scare you. this is about old-school co2). However, that is with a fully ablative mode, i.e., non-fractionated. The Active FX and Mixto systems rely on CO2 but I have not heard that they cause hypopigmentation in the fractionated mode (but then again they are too new for me to have heard of such a phenomenon.) That last question does not make sense to me. Milia are milia and they do not look like hypopigmentation. If the milia were so clustered together, they would make you look like the elephant man with little bumps all over the place (just kidding about the extreme example, btw).
best,
sml

thanks for the comprehensive answer doctor, i would just like to know then if anything can ever be done to treat hypopigmentation or if it resolves naturally? thanks again

hypopigmentation generally does not entirely resolve but it can. the only thing that i know that can repigment skin is PUVA (pulsed UVA light). I do not offer that therapy. You need to check with a cosmetic dermatologist who does. you can also bleach the surrounding skin to balance it out or just wait patiently to see what happens.
best,
sml