(Standing Appointment)

The Two Laser Treatments That Finally Cleared My Hyperpigmentation

Minimal downtime and (nearly) pain-free.

Originally Published: 
Courtesy of Diana Tsui
diana tsui wearing cat eye liner and a platinum blonde bob

Standing Appointment is our review series that investigates the best new and notable cosmetic treatments in the aesthetics space and determines whether or not they are worth trying for yourself. This week, one writer tries Fraxel and Vbeam lasers for hyperpigmentation.

I like to think I’m pretty good about my skin care routine. Every morning I make it a point to use vitamin C and sunscreen followed by a prescription strength tretinoin at night, plus I always remove my makeup before bed — no matter how late it may be. But the combination of living in Los Angeles for a year, where the sun was much stronger, coupled with terrible breakouts from the stress of the pandemic wreaked havoc on my skin. My normally clear complexion was riddled with dark marks across my chin and cheeks. Despite all my efforts, I had acne-induced hyperpigmentation and I needed some professional help, specifically Fraxel and Vbeam laser treatments.

Acne-induced hyperpigmentation is common — as your skin naturally heals from inflammation it’ll produce melanin, which can darken the skin. Nearly everyone gets some level of discoloration but for those who have medium to deep skin tones, namely those who identify as being of Black, Latinx, Asian, Middle Eastern, Pacific Islander, and Indigenous descent, it can be more pronounced and visible. Being Chinese American, that means I almost always get a dark mark once a blemish pops up. To make things worse, as tempting as it may be to pick at a zit, it only makes things worse as repeated trauma to your skin adds to the inflammation thereby triggering melanocytes to produce even more pigment. Conversely, even if you’re the type to keep your hands to yourself, a pimple can leave a reminder behind. So either way, as frustrating as it may be, hyperpigmentation can be inevitable.

There are plenty of topical solutions for a clearer, bright complexion with sunscreen being your first line of defense as UV radiation can trigger your melanocytes to produce more melanin. Products that contain vitamin C, azelaic acid, glycolic acid, retinols, or kojic acid are also powerful in reducing the appearance of dark spots while your dermatologist can also prescribe retinoids as well as hydroquinone. In my case I was using all of the following, as dictated by my board-certified dermatologist Dr. Shereene Idriss, founder of Idriss Dermatology, including her PillowtalkDerm Major Fade Solution System. After six months my skin was looking brighter, but there were stubborn spots that remained noticeable, so Dr. Idriss recommended I try a combination of Fraxel and VBeam to address my concerns.

What Is Fraxel?

Fraxel is an FDA-approved non-invasive skin treatment consisting of two lasers. One targets pigmentation and sun damage while the other is for wrinkles, texture, and acne scarring. It’s meant to help restore a more youthful complexion with minimal downtime and you can get it done at your dermatologist’s office.

What Is Vbeam?

Vbeam is an FDA-approved pulsed dye laser that’s used to reduce redness. By using a yellow light that’s administered in pulses, it targets dilated blood vessels which can create pinkish and red spots. If you have rosacea, this treatment is also helpful in reducing its appearance. Like Fraxel, this is a service you’ll find at your dermatologist’s office.

Why Did I Need Fraxel & Vbeam Treatments?

While I did have acne-induced hyperpigmentation across my cheeks and chin, some of my most stubborn spots turned out to be due to a completely different reason. “When people see some sort of color, they immediately think it’s hyperpigmentation but the color can either be brown due to post-inflammatory hyperpigmentation discoloration or it can be red, due to post-inflammatory erythema,” Dr Idriss says. The latter is another common condition that can occur after a breakout due to inflamed blood vessels in the surrounding area. It’s common to confuse one for another and the easiest way to tell the two apart is to examine the area and press on it — if you push down and the blot disappears, then it’s not hyperpigmentation. “When I looked at your face, there was definitely a component of redness in addition to the brown so I wanted to use the Vbeam to calm some of it. Then I’d use Fraxel to address that discoloration specifically,” she explains.

Combining Vbeam and Fraxel is not always necessary for hyperpigmentation but in my case, Dr. Idriss thought it was most effective since I had both dark spots, which Fraxel targets, and redness that masqueraded as dark spots, which Vbeam helps with. “You can also use other treatments like the Q-Switch Alex Laser for specific dark spots,” she says. Your doctor can look at your skin and decide which combination works best for optimal results.

My skin before using topicals or getting laser treatments. Courtesy of Diana Tsui
My skin after six months of topicals, pre laser treatments. diana tsui after using topical products for hyperpigmention

How Does Fraxel Work?

On the day of your treatment, you’ll need to arrive at your dermatologist’s office anywhere from 30 minutes to an hour before and receive a topical numbing cream. Once that kicks in, you’re given shields to protect your eyes as your dermatologist works the laser across your face. It’s painful but tolerable — certain areas like around my nose and upper cheeks stung much more than my forehead and jawline.

“Fraxel has a wavelength at 1927 that's specific for pigmentation and it creates microscopic zones of injury underneath the surface of your skin, stimulating new growth,” explains Dr. Idriss adding, “Since your hyperpigmentation was more diffuse, this was an effective way to treat your entire face.” Immediately after the treatment my face felt red and hot, like a severe sunburn. I popped a SkinCeuticals Biocellulose Restorative Mask mask into the fridge and that, along with ice rollers, offered cooling relief immediately after. By the next day the area started to scab, although I was able to hide it with makeup. Within five days my face healed and looked bright and glowing.

My skin pre-Fraxel. Courtesy of Diana Tsui
My skin healing post-Fraxel. Courtesy of Diana Tsui

How Does Vbeam Work?

Unlike Fraxel, you won’t need to be numbed before a Vbeam treatment as it’s much less painful. Vbeam uses pulsed laser energy at a wavelength of 595 nanometers which can penetrate through your skin and targets oxyhemoglobin in your blood. “It collapses blood vessels, shrinking them in the process. You don’t get an instant reduction in redness post-treatment, but the intensity and the duration of which you flush will decrease over time,” says Dr. Idriss. For some, this means anywhere between three to five sessions to see results but since I only had a small amount of redness, one session was enough to see some results within two weeks. The spots around my jawline had lightened up and as an added bonus, the area around my nose was also calmer, requiring less concealer.

How Many Fraxel & Vbeam Treatments Does It Take To See Results?

Most people require anywhere from two to four sessions of Fraxel and VBeam, depending on their redness and discoloration. Dr. Idriss recommends waiting six weeks between Fraxel sessions and three to four weeks for Vbeam. “I never promise one treatment to anyone because when people expect one, they're expecting a miracle,” she says. However, in my case I did only need one session of Fraxel followed up by one VBeam session a month later. The reason? I already had a strict skin care routine that served as a strong foundation prior to my treatments. “I liken laser treatment to teeth cleaning. You can go in and get cleaned once a year but if you're not brushing regularly, what's the point? And so putting you on a skin care routine that is targeted to evening out your skin tone makes the laser treatment work much more efficiently and effectively,” she says.

For most, they’ll see Fraxel results within a week or two, but within five days my skin had healed and looked much clearer and brighter. As for Vbeam, you’ll need to wait closer to two to four weeks to see a reduction in redness. From start to end, my hyperpigmentation journey took eight months starting with topicals and ending with a Vbeam treatment.

How Long Does Fraxel & VBeam Last?

If you’re stringent about applying sunscreen as well as topicals, then once a year treatments are enough to maintain a bright complexion. That being said, there are optimal months during the year to get these lasers done. “It’s better to save this for late fall to early spring since you will be sensitive to the sun and you don’t want to expose your new skin to damaging radiation,” says Dr. Idriss.

My skin after Fraxel and Vbeam treatments.

Courtesy of Diana Tsui
Courtesy of Diana Tsui

How Much Does Fraxel & VBeam Cost?

Costs depending on where you live and your doctor but expect to pay around $1,200 per Fraxel treatment while Vbeam will run anywhere from $400 to $800. These sessions can add up, but like Dr. Idriss says, it can be as little as once a year for maintenance, depending on how strict you are with skincare and sun protection. While lasers are safe, you do want to go to a board-certified practitioner for optimal results. Plus, when done incorrectly you can potentially make hyperpigmentation worse, so it’s also better to do some research beforehand.

Who’s The Ideal Candidate For These Lasers?

While anyone who experiences hyperpigmentation and redness can benefit from this treatment, if you’re medium to dark skin toned, you’ll want to discuss any potential side effects with your doctor. “In more melanated skin you have to be on the conservative side when using these very strong devices so that you don't cause their skin to hyperact,” Dr. Idriss said. That being said, it’s a very effective way to get a bright and glowing complexion.

How I’m Feeling Now

It’s been a month since my Vbeam and Fraxel treatments and skin is noticeably brighter and even-toned. While there’s still redness around my jawline as the stubborn spots fade, I’m able to wear little to no makeup if I want to. As summer starts I plan on being strict with my sunscreen and minimizing exposure but I don’t foresee needing another touch up until this time next year.

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