Does Hyperpigmentation happen to everyone after IPL?

I have been reading about how the IPL laser treatment sometimes leaves people with hyperpigmentation or spots on their skin. Does this happen to everyone? Is this related to some type of unique trait that certain people have? I would prefer if this did not happen to me when I get my procedure done. Are certain doctors better at avoiding it?


F, 54, Pennsylvania

Tags:woman age 45-54 laser hyperpigmentation

Intense pulsed light (IPL) treatment involves using broad spectrum light waves to reverse the signs of aging, create smoother skin tone, and stimulate collagen production. Post-treatment, you’ll probably notice that the hyperpigmented areas are darker than usual. Don’t worry — this is normal.

The blotches typically flake off within about two weeks. You may also find your face is slightly more red than usual in the hours following treatment, but this tends to fade within a day. Other side effects may include mild swelling and/or bruising, and the enlargement of some capillaries, but, again, these usually fade within a day or two. Depending on your skin type and the severity of sun damage, you may need multiple treatments to remove some age and sun spots, and achieve the results you want.

Things can get a bit more complicated if you’re treating more complex skin conditions such as melasma, which manifests in blotchy, brown spots or patches. Melasma pigment resides deeper in the skin, making it more difficult to reliably remove via light therapy. Indeed, there is a small risk that the melasma will actually darken after IPL treatment. If you have melasma, it’s critical that you seek an IPL provider who is highly experienced in this type of skin treatment.

You are quite correct in saying that some people are naturally more susceptible to IPL hyperpigmentation. Due to the way the light interacts with the dermis, people with naturally dark skin or significantly tanned skin (this includes people of African, Asian, Greek, and Italian descent, among others) are at higher risk of post-inflammatory hyperpigmentation.

Regardless of your skin type, I highly recommend that you book a consultation with an experienced cosmetic dermatologist to discuss treatment options and minimize the risks associated with IPL.

Dear Viv1000:

In 1975, Thomas Fitzpatrick, MD, Chairman from the Department of Dermatologist from Harvard Medical School developed a human skin color scale to estimate the individual response of a patient's skin to UV light. Initially intended for the quality of “burn” to the skin, it is also now used to determine the amount of pigmentation following injury to the skin. Physical injury as well as thermal and chemical burns, UV and laser all stimulate many inflammatory responses in the skin. One of them is the production of melanin, a brown colored pigment and a very strong anti-oxidant.

Laser is the production of one wavelength light frequency. IPL is the use of a range of wavelengths to be absorbed by the skin to injure brown and red blemishes so the white cells (macrophages) will carry the pigment away. Melanin formation also called PIH or “post-inflammatory pigmentation” can unfortunately be the side-effect of the same treatment to get rid of it. It will occur in patients of Fitzpatrick III to V. Patients of Fitzpatrick I and II generally do not develop PIH and those of Fitzpatrick VI will not respond well to these wavelengths of laser. You should know that IPL can also create a texturing to the skin and will require multiple session to obtain optimal results.

If you are a patient who will develop PIH, I recommend an initial regimen of “pigmentation control” using ZO Skin Health using tretinoin and hydroquinone and provided by a Certified ZO Skin Health Team. This will limit the reactionary side-effect and rejuvenate your skin as well. 

I hope this was helpful. Always consult with a Board Certified Plastic Surgeon and / or Dermatologist for proper evaluation and care.


Dean Kane, MD, FACS