Fitzpatrick III–V · Pigment Risk · Pacific Plaza
CO2 laser is used routinely in Asian skin, but the chance of darkening afterwards is higher than in fair skin. This page explains why that darkening arrives late, which setting matters most, and who should wait, as Dr Sin Yong plans fractional CO2 at Atelier.
Yes, fractional CO2 can be used in Fitzpatrick III to V skin, and it is at Atelier, but post-inflammatory hyperpigmentation (PIH) is more likely than in fair skin. The risk is reduced, not removed, by how densely the laser is applied, by preparation, by avoiding sun while the skin heals and by a follow-up timed to when darkening would show. Whether it suits you is decided at assessment.
Why It Happens
Resurfacing is a deliberate wound, and the pigment cells in darker skin answer inflammation by making more melanin. The timing catches people out: the surface closes and looks clean, then patches darken over the following weeks, most often on the cheeks and other sun-exposed areas.
A widely cited series of deep fractional CO2 treatments, 490 sessions in 374 patients, recorded an adverse event after 13.6% of treatments and hyperpigmentation after 1.2%. That series included few people with darker skin, so the pigment figure may well be higher in Singapore's population.
Settings
Two settings are easily confused. Energy decides how deep each column goes; density decides how many columns are placed, and so how much of the surface is treated. Two studies in Asian patients in 2007 linked higher density with more darkening.
So depth is kept where a scar needs it and coverage is limited elsewhere: point shots into the pits, lighter passes over the texture around them, and pulse settings that limit heat spread. Coverage is built over staged sessions rather than in one heavy pass. No single number fits everyone, because the right settings depend on the scar, the site, your skin type and how you have reacted before.
| Setting | What it controls | A fair question |
|---|---|---|
| Density | How much of the surface is treated | How is coverage limited for my skin type? |
| Energy per column | How deep each column reaches | Which scars need depth, and which do not? |
| Point shots or passes | Treating single pits versus the whole zone | Will the deepest pits be treated separately? |
| Interval | Time for healing between sessions | When will darkening be checked? |
Who Waits
Wait during pregnancy; with active acne; with an infection, cold sore or inflamed eczema in the area; with a fresh tan; after recent isotretinoin; and while taking medicines that make the skin sensitive to light.
Extra care is needed if you smoke, have diabetes that is not well controlled, take medicines that suppress immunity, tend to form keloid or hypertrophic scars, have had radiotherapy to the area, or have active vitiligo, or active melasma across the field to be treated.
At Atelier
Dr SY checks your skin type and any past darkening, maps the scars, and confirms that the acne is controlled and any tan has gone. Daily broad-spectrum sunscreen starts before the first visit, antiviral tablets are arranged if you get cold sores, and a small test area may be treated where your reaction is hard to predict. Where scars are shallow, non-ablative resurfacing may be the gentler choice; see acne scar resurfacing.
The CO2 protocol itself is on Tetra Pro Scar³ acne scar treatment, the appointment on what to expect: CO2 laser, and healing care, including moist healing and sun protection, on CO2 laser aftercare.
Dr Sin Yong holds a Key Opinion Leader appointment with DEKA.
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Atelier Aesthetics · Owned by AYA
9 Scotts Road, Pacific Plaza #12-01A, Singapore 228210 · +65 8023 7170
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