Dr John MD's dermatologist overview of causes and treatments for IPL damage, IPL laser damage and burn

IPL Damage: by John Wu, M.D.

What is IPL damage and laser burn?

Although laser, IPL, and other intense light treatment procedures have changed aesthetic medicine, these procedures have also produced a large number of people who have post inflammatory hyperpigmentation (new dark pigment spots) as a resulting complication.

Not everyone is suitable for laser or IPL procedures in its usual conventional form. If you have sensitive skin, or if your ancestry is Asian (East Asian, Southeast Asian, or South Asian), Latino, Persian, African-American, or sensitive skin Caucasian, then you must be very careful, or otherwise you may get IPL damage and be burned with dark spots that disappear with great difficulty.

How to recognize IPL damage, IPL laser damage?

How do you tell if your dark spots may be a result of IPL or laser? If your dark spots have an angular shape or if your dark spots line up in rows or columns, then the possibility that your spots are dark pigmentation from IPL damage due to laser or IPL is quite high. Quite simply, angular spots or spots in rows or columns do not exist in nature, they are man made.

Many people do not know that in about 1/4 to 1/3 of Asian, Latino, Middle Eastern, or African-American patients treated with laser or intense light treatments, these patients end up with the opposite of what they are trying to treat: new dark brown spots in a line pattern or rectangular pattern or checker pattern (see the case studies pictures). The reason why these new dark spots appear in such a pattern is because the part of the machine that comes in contact with the skin is rectangularly shaped, so that when it causes deep burns it will form lines or rectangles. And the reason why these spots are spaced almost exactly the same distance apart is because the bursts of light are applied in rows. Those with brown/yellow discoloration or uneven skin tone due to fluctuating hormone levels are especially prone to IPL damage or IPL laser damage from laser and IPL intense light treatments.

How to best treat and repair IPL damage, IPL laser damage?

The new dark pigmented spots from laser or IPL damage is NOT your typical brown spot from just an over-secretion of your own melanin pigment. Instead it is an over secretion of melanin PLUS burn damage in the top layer of your dermis. What happens is that red blood cells (which contains dark iron) within the fine capillaries of the top layer of the dermis also absorb the light energy from laser and IPL intense light treatments. In 1/4 to 1/3 of ethnically susceptible patients, the iron containing red blood cells get cooked, causing damage to the dermis similar to what you see when your skin is burned by something scorching hot. Sometimes this phenomenon appears within 3-4 weeks of the laser/IPL treatment. Sometimes it occurs several months later because in these people the initial IPL damage IPL laser damage from the treatment is not enough by itself, but through the cumulated exposure to UV radiation, the total damage builds up to the point where you see it in the form of new dark pigmented spots in a line, rectangular, or checkered pattern several months later.

The worst thing you can do is to do more IPL or laser light treatments to try to burn these new spots out. You cannot repair or treat damaged tissue by using a damage causing procedure. It would be like trying to fix a broken chair by kicking it harder. What would happen is that the new pigmented damage spots will become even darker, sometimes turning deep purple. But it often amazes me that having another round of IPL or laser is many treating physicians' answer to the initial laser or IPL damage despite the fact that the first round of IPL or laser is what actually worsened the dark pigmentation in the first place!

Some physicians would prescribe hydroquinone for IPL damage or IPL laser damage cases. This does not work to treat the problem, because the main problem is not over secretion of pigment (although there is an element of this), the main problem is damaged tissue, which hydroquinone does not repair. Besides, hydroquinone has the opposite effect in many Asians, Latinos, Middle Eastern, or Mediterranean and East European patients by causing a deep gray or blue discoloration on top. The medical term for this is called exogenous ochronosis (I will show an example of this in another post.)

Some physicians also prescribe corticosteroid creams (also known as medicated anti-inflammation creams prescribed for skin inflammation). This does not work to treat the problem either because corticosteroid creams treat excessive reddened inflammation, but the problem here is not excessive reddened inflammation, it is deep tissue burn and damage. Actually, using corticosteroid creams will retard the repair process, because prolonged corticosteroid cream usage will shrink the skin tissue and inhibit all types of cells. Prolonged use will also cause wrinkles, sagging skin, and a red web of bursted or dilated capillaries.

The only effective way to treat this type of dark pigment IPL damage spots from laser/IPL is to repair the tissue damage in the top and middle layers of skin. You must stimulate your own repair cells to remove and repair the damaged tissue and create new healthy skin tissue. This takes at least 2 months of intensive repair, but it actually works. In my experience of treating thousands of patients with laser/IPL damage (especially Asian patients), this is the ONLY way.

You can check out my case studies of those with IPL damage who have improved significantly.  There are before and after pictures, along with their own videos.  

How to prevent future IPL damage, IPL laser damage?

Well, basically if you are Asian, Latino, Persian, dark hair Caucasian, or Caucasian with sensitive skin, you better be really careful before undergoing these procedures. You must understand that you are rolling dice with your face, as about 1/4 to 1/3 of the patients will get new dark pigmented damage spots. If you are African American, you probably have type 5 or type 6 skin, in which case I strongly recommend that you do not undergo a laser or intense light procedure, as you may also get keloids (thick scars that rise above the skin surface).

If you must undergo laser or intensive light treatments, try to follow the tips below:
    • Make sure your physician is an expert who has treated thousands of patients with type 4-6 skin and can actually recognize IPL damage or IPL laser damage.
    • Make sure that any laser or IPL intense light machine is primarily designed based upon type 4-6 skin (especially for Asians, Latinos, other type 4-6 ethnicities). Please note that most of all machines sold are not designed based on type 4-6 skin.
    • Make sure that the physician use the same IPL or laser machine and do a small test patch of skin and wait at least 1 month to see if that patch will have new dark spots. If the tested patch does not get new dark spots, please note that it is no guarantee that other parts of your face will not turn dark, as different parts of the face have different receptivity to intense light energy.
    • Make sure that your physician has a comprehensive method to reduce your chances of post procedure hyperpigmentation (IPL damage), including an effective non-hydroquinone non-steroid repair cream after the procedure that helps heal and repair your skin afterwards. This is probably the single most important thing that you can do after the procedure.
    • Make sure you use a sun protection cream containing ONLY pure physical sunblock which reflects UV light comprehensively against UVA and UVB. 20% fine grade zinc oxide is best. Avoid chemical sunscreen ingredients as many of those are unstable with effects that are not long lasting, and although they may help prevent sunburn they do not do a good job at preventing pigmentation or wrinkles. Some chemical sunscreen ingredients are very harsh and may actually cause dark pigmentation in the applied areas for those with sensitive skin or those who have undergone laser/IPL treatments.

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