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#45943 - 09/20/07 09:55 AM Laser Burn!
mommy_xo Offline
Member

Registered: 09/20/07
Posts: 6
Hey everyone,

I'm a newbie here. I've been receiving laser hair removal for my underarms (alexandrite), and recently the settings were changed to treat hyperpigmentation. It burned like crazy during the treatment and a few hours after I came home too. The pain went away and the next thing I know, I wake up the next morning with all these dark gray marks in my underarm! They're not uniform in shape - I have about 4 patches about 1.5x1.5 cm and then smaller random marks. Are these superficial burns and will scab off?

I tried asking the settings, but the person didn't specify too much. I know it was 14j on the Apogee...and supposedly 14j was used on my skin prior to these dark gray burns and my skin was completely fine. The person mentioned they were just changing the wavelength setting so it is shorter to treat the hyperpigmentation - this definitely concentrates the energy more causing the laser to be more powerful.

BTW, I'm probably about a skin type IV.

Bottom line is that I'm worried that these dark gray marks will be permanent! I hope they'll resolve in a week, or better yet, have them completely scab off. \:\(

I plan on calling the office to discuss this issue tomorrow or ASAP. Am I overreacting and should I wait a few more days?

Thanks for your help in advance.

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#45944 - 09/20/07 11:00 AM Re: Laser Burn! [Re: mommy_xo]
mommy_xo Offline
Member

Registered: 09/20/07
Posts: 6
I came across this post on the site...I hope it has some truth to it:
http://www.hairtell.com/forum/ubbthreads.php/ubb/showflat/Number/39177/page/1#Post39177

 Originally Posted By: sslhr

Here is the issue. If you go out in the sun and have fair skin or even not so fair skin and let yourself bake, you can get second degree burns. This is a burn down through the entire epidermis into what is called the basal layer and will create blisters. This type of burn rarely, if ever, creates scars. As far as I know, it is impossible to get a third degree (full thickness burn) from the sun.

In a 2nd degree sunburn, the skin looks pretty normal except for serious redness and the blisters. But they are quite uncomfortable and very painful.

Now let's turn to laser hair removal. Other lasers are different. At normal settings, as far as I know, it is impossible to create a full thickness burn. The reason is that what is creating the heat is the absorption of melanin in the skin and the melanin is only found in the epidermis and in the hair follicle. The melanin in the hair follicle can create a microburn around the hair follicle (which is what we are trying to do) but the heat absorbed by the melanin in the epidermis isn't going to cause a burn that is deeper than the epidermis. So what you get is a 2nd degree burn, that rarely, if ever, causes a scar. Now this is not to say that it can't cause a scar if it is improperly cared for (and gets infected or doesn't heal properly), but in and of itself it doesn't.

But there is a second complicating factor that involves these kinds of burns that is not found in sunburns and that is the melanin itself. In sunburns it is not destroyed and therefore the burn looks normal colored. But with lasers, the melanin is what is targeted and what generates the heat. This melanin is destroyed and in the process of being destroyed it creates this black colored reaction.

Think of it this way, if I had a handful of little paint balls and layed them on the floor, they would be noticeable but wouldn't cover that much of the floor. But let's say I smash them, now all of a sudden, paint is every where and things look a lot worse. Yet, I still have the same amount of paint.

This is what happens in the skin with the melanin which is exploded and all over the place. It makes the blisters and reaction look much much worse because everything now looks black. And we equate black with charring and necrosis (gangrene for example). Yet all we are looking at is superficial (within the epidermis) melanin that has been spread out and is now catching the light and bouncing it back in a way that makes the skin look black.

I have met many physicians who when seeing their first example of a laser induced burn with the melanin destruction were horrified and assumed the worse. Yet, weeks later came to realize that the skin was healing quite well and resolving completely. Which by the way, think of all the pictures you have seen about bad reactions. How many of those reaction have you seen pictures several months later? The answer is probably none because the horrifying reaction has gone away and the picture has lost all its drama.

These things do happen to the best of us. Anyone who says they haven't had these kinds of reactions hasn't treated many people and/or been around long. And when it does happen it is important to take care of the person and make sure that they understand what happened, what to expect, and are supported through the process. But litigation? Come on. It has its place but not as a first reaction. Is this the kind of society we want to live in?

And it is important to understand that in the vast majority of cases, these kinds of burns resolve to completely. I don't need photos or triage to know this. People need to know the truth, otherwise, imaginations run wild and that actually harms someone much more. These kinds of reactions can be uncomfortable and painful, but will resolve fairly quickly. And the silver lining is that often the results are actually better faster, though it is not the best way to get there.

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#45945 - 09/20/07 02:57 PM Re: Laser Burn! [Re: mommy_xo]
James W. Walker VII Offline

Top 10 Contributor

Registered: 06/03/02
Posts: 8055
Loc: Buffalo NY, & Traveling the US...
WoW, it is rare that someone makes such skillful use of the search feature before posting.

I hope sslr and LAgirl can discuss this further with you.
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#45952 - 09/20/07 06:35 PM Re: Laser Burn! [Re: James W. Walker VII]
LAgirl Offline

Top 10 Contributor

Registered: 12/22/04
Posts: 9994
Loc: New York, NY
Yes, good job on the search \:\) If it's not scabbing, then it's probably just pigmentation and it will go away though it may take up to a few months.

It sounds like you're too dark for an alexandrite laser, which many people with skin type IV are. Lowering the pulse doesn't "cure" pigmentation. It actually makes it more probable in your case as it's makes the laser more powerful and dangerous to your skin.

You should wait until this heals before having any more treatments. I would definitely show it to your clinic. And I would also switch to a Yag laser more suitable for your skin type.

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#45970 - 09/21/07 07:18 AM Re: Laser Burn! [Re: LAgirl]
mommy_xo Offline
Member

Registered: 09/20/07
Posts: 6
The replies are appreciated!

I went back to the MD's office today to have it checked out by this one nurse who has expertise in treating pigmentation with lasers. Basically, she said that it's not uncommon with this type of treatment for pigmentation, as opposed to laser hair removal where it definitely should not look like that. Supposedly, it'll start to scab within the next week and will eventually slough off (I wasn't sure if what I saw was typical for scabbing).

I do notice changes in its appearance, becoming a little more pink in most of the gray areas. I'm rescheduling another appointment if there are no drastic changes after a couple of weeks. My next appt for laser is in 4 weeks, but we'll see how my underarms are coping.

Surprisingly, the alexandrite actually works well on me for laser hair removal. I've had about a total of 4-5 treatments without any problems (GentleLASE & Apogee). The most recent incident was because I changed my treatment plan for pigmentation and the settings were readjusted: Apogee, 15j, 15mm spot size, 10msec (haha I asked for that information when I came back today).

Prior research was done on the same type of pigmentation problem (same skin tone), but these were the settings used in the study:
alexandrite laser (unspecified)
5msec
16 to 23 j/cm^2
10mm spot size (first 3 treatments)
12.5mm (7 treatments)

...I think for my next treatment I'm going to request for these settings instead.

I've heard that shortening the pulse duration damages the epidermis and then causes the pigmentation to fall off.

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#45977 - 09/21/07 05:33 PM Re: Laser Burn! [Re: mommy_xo]
LAgirl Offline

Top 10 Contributor

Registered: 12/22/04
Posts: 9994
Loc: New York, NY
pigmentation is not normal and should not be happening. don't let them convince you otherwise. and in order to protect your skin from pigmentation, the pulse setting should be raised.

what exactly do you mean by "for this type of treatment as opposed to laser hair removal"? You ARE getting laser hair removal treatments. GentleLASE and Apogee are both alexandrite types of laser hair removal lasers.

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#45978 - 09/21/07 05:47 PM Re: Laser Burn! [Re: LAgirl]
mommy_xo Offline
Member

Registered: 09/20/07
Posts: 6
Ohh no, I'm not getting laser hair removal treatments anymore (hence the opposition). I have had melasma in my underarms from my pregnancy that never went away - they are using a hair removal laser (Apogee, GentleLASE) to treat the hyperpigmentation (melasma).

The hyperpigmentation was there before I received any laser treatments. The dark gray burning spots was my concern after my first treatment specifically toward the melasma (that's why they changed the settings on the laser).

The dark gray spots that turn into scabs are common when treating hyperpigmented areas like solar lentigines, melasma, etc.

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#45979 - 09/21/07 06:31 PM Re: Laser Burn! [Re: mommy_xo]
Choice Offline
Top 10 Contributor

Registered: 07/24/02
Posts: 446
When treating hyperpigmentation (freckles, age spots, melasma, etc.) with a laser, the crusting you describe is absolutely suppose to happen. It's an indication that the pigment absorbed enough energy for the spot to flake away. If the hyperpigmentation is deep, additional treatments will be necessary. I've had this done for some age spots...love it, love it, love it.

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#45980 - 09/21/07 06:44 PM Re: Laser Burn! [Re: Choice]
LAgirl Offline

Top 10 Contributor

Registered: 12/22/04
Posts: 9994
Loc: New York, NY
ahhh. that makes sense! your original post stated that you were getting laser hair removal specifically so it got us confused.

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#45981 - 09/21/07 08:36 PM Re: Laser Burn! [Re: LAgirl]
mommy_xo Offline
Member

Registered: 09/20/07
Posts: 6
Haha yeah..I did state we changed the settings to treat the hyperpigmentation, but I should've been more clear that we completely stopped hair removal. Sorry! \:\)

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