Service: Fotona SP Dynamis (Er:YAG 2940 nm / Nd:YAG 1064 nm) & StarWalker MaQX (QS 1064/532 nm ± dye 585/650 nm).

Cause / Mechanism

Pigmentary changes arise when laser energy disrupts epidermal and dermal melanocytes. Excessive fluence, wavelength mismatch, or inadequate post-procedure photoprotection can trigger post-inflammatory hyperpigmentation (PIH). Hypopigmentation occurs when melanocytes are destroyed, more common with Q-switched and ablative lasers. Scarring develops when deep dermal injury occurs. ^{1 2}

Risk Factors

• Patient: Fitzpatrick IV–VI (higher melanin activity), recent tanning, history of melasma or PIH.
• Device: short-pulse, high-fluence treatments; repeated passes.
• Operator: insufficient test spots, lack of parameter titration.
• Environment: unprotected UV exposure post-treatment. ^{2 3}

Signs & Symptoms

• PIH: patchy brown macules/papules within 1–3 weeks post-procedure.
• Hypopigmentation: discrete or confluent white patches, may persist months.
• Scarring: textural change, atrophy, hypertrophic/keloid formation. ^{4 5}

Prevention

• Careful parameter adjustment according to skin type (lower fluence in darker types).
• Strict pre- and post-treatment photoprotection (broad-spectrum SPF 50+). ⁶
• Educate patients on sun avoidance, especially 2–4 weeks post-procedure.
• Consider prophylactic hydroquinone or retinoids in high-risk PIH patients (per dermatology guidance). ⁷

Management Protocol

Post-Inflammatory Hyperpigmentation (PIH):

• Immediate: strict photoprotection and SPF.
• Mild: topical hydroquinone 2–4%, azelaic acid, or retinoids as tolerated. ⁷
• Moderate-severe: dermatology referral for chemical peels or further topical therapies.

Hypopigmentation:

• Observation (some cases repigment spontaneously within 6–12 months).
• Camouflage cosmetics for cosmetic support.
• Dermatology referral if persistent (may consider excimer laser, topical calcineurin inhibitors). ⁴

Scarring:

• Early identification and referral.
• Silicone gel/sheeting for hypertrophic scars.
• Intralesional corticosteroid for resistant hypertrophic/keloid scars.
• Fractional laser resurfacing may assist long-term but not acutely. ⁵

Follow-up & Documentation

• Document onset, severity, and treatment steps.
• Provide written aftercare instructions highlighting photoprotection.
• Schedule regular reviews until resolution or referral.
• Record incident in Laser Log; use outcomes in quality review meetings. ^{1 2}

Sources

1. AS/NZS 4173:2018 Safe use of lasers and intense light sources in health care., viewed 7 October 2025, https://www.standards.org.au ↩︎
2. ARPANSA. Advice for providers: Lasers, IPL and LED for cosmetic purposes., viewed 7 October 2025, https://www.arpansa.gov.au ↩︎
3. Australasian College of Dermatologists. Pigmentation disorders and PIH., viewed 7 October 2025, https://www.dermcoll.edu.au ↩︎
4. DermNet NZ. Postinflammatory hyperpigmentation and hypopigmentation., viewed 7 October 2025, https://dermnetnz.org/topics/postinflammatory-hyperpigmentation ↩︎
5. UNSW Safety. Risks of laser-induced scarring., viewed 7 October 2025, https://safety.unsw.edu.au ↩︎
6. Cancer Council Australia. Sun protection recommendations., viewed 7 October 2025, https://www.cancer.org.au ↩︎
7. Australasian College of Dermatologists. Hydroquinone and retinoid use in pigmentation., viewed 7 October 2025, https://www.dermcoll.edu.au ↩︎