What are pigment lasers?

Pigment lasers, such as the Revlite laser and Picosure laser, are used to treat pigmentation of the skin and also for tattoo removal and some other conditions. They cause selective damage to pigment within the skin. The treatment is generally safe, however caution is required since there are risks of causing excessively increased or decreased pigmentation particularly in those with pigmented skin types.

Alternatives to pigment lasers depend upon the condition being treated and can include doing nothing, topical treatments, tablet treatments, cryotherapy and chemical peels.

All treatments carry risks and it is important that you carefully weigh the benefit of pigment laser treatments against these potential risks when deciding whether it is the right treatment for you.

Contraindications

Certain conditions significantly increase the risks of treatment. It is important to inform Dr Lynch if any of the following apply :-

• Tanning / sun exposure: Tanning increases the risks of laser treatment. Inform Dr Lynch if you have been in the sun, have had a tan, or a sunburn, within the last 4 weeks. You should not have pigment laser treatment if you have a sun tan.
• Tattoos or permanent makeup e.g. eyebrows, lip liner: These are likely to be damaged by the laser and this can result in inflammation, blistering scarring and change in color which can be unsightly. It is essential that you inform Dr Lynch if you have tattoos or semi-permanent makeup e.g. lip liner, eyebrows, eye liner etc.
• Hypertrophic or keloidal scarring (lumpy scars): If you have previously experienced hypertrophic or keloid scars you can be at risk of developing scars from minor injuries such as laser treatment.
• Recurrent coldsores: Coldsores can be triggered by laser treatments. If you frequently experience herpes virus infection (coldsores) near to the site of treatment then you may need antiviral prophylaxis to decrease this risk.
• Pregnancy: It is not recommended to have laser treatment during pregnancy due to an increased risk of complications.
• Important events: Due to the risks of unsightly changes in appearance of the skin it is not advisable to have treatment shortly before important events such as weddings or important business meetings etc.
• Vitiligo or other inflammatory skin disease such as psorisasis or lichen planus: If you suffer from an inflammatory skin disease, laser treatment can cause this to be triggered at the site of treatment . It is essential to inform Dr Lynch so that the risks and benefits of treatment can be discussed.

Risks

• Pigmentary Change (common): There will often be a temporary increase in pigmentation. Usually this will resolve within a few weeks, however there is a risk of permanent changes in pigmentation with the treated area becoming hyperpigmented (darker) or hypopigmented (lighter) than the normal skin color. There may also be patchy loss of pigmentation. Risks are higher in those with pigmented skin types.
• Redness and inflammation (common): The treated area will often be red and inflammed. In most cases this will persist for around a week, although rarely redness can last longer and very rarely can be permanent.
• Pain (common): There will be some discomfort during the procedure and afterwards. Very rarely pain may persist for a longer period or fail to resolve.
• Bruising, bleeding, blistering, crusting (common): In most cases the skin will remain intact, however there can be bruising, blistering or crusting.
• Infection (uncommon): There is a risk of herpes virus reactivation (coldsores). There is also a risk of bacterial infection, particularly if the skin is broken due to blistering or crusting.
• Scarring (uncommon): Scarring is not common with pigment lasers but can occur. This may be raised or lumpy (including hypertrophic or keloid scar), depressed, different in color from the adjacent skin (redder/lighter/darker), or different in texture (for example more shiny) in comparison with the adjacent skin. * Nodule or cyst formation (very uncommon)
• Failure to Achieve Desired Results, worsening of appearance: It is possible that this procedure does not lead to the degree of improvement that you desire. Very rarely you may feel that the overall appearance has been worsened by laser treatment.
• Recurrence of the condition: The treated condition, for example hyperpigmentation can recur.

Additional risks

Test patch

For pigment lasers, a test patch is always required to assess how your skin responds to the laser at a particular setting. It is necessary to allow at least a week after the test patch to assess for any late complications such as bruising or pigmentary change. A test patch reduces but does not eliminate the risk of complications.

Aftercare

Immediately after the treatment the skin will often appear whitish grey. It is essential to minimize sunlight exposure and to use a sunblock cream for several months after treatment. There may then be a temporary increase in pigmentation which usually resolves within 1-2 weeks. Occasionally there will be bruising, blistering or crusting. If the skin is broken apply vaseline from a new tub several times daily to provide a barrier and prevent scabbing.