Not sure if this is PIH or cryo burns?

I’ve had laser done on my whole arms four weeks ago and my thighs and bikini area 3 weeks ago. It was the 7th session for my arms (my 1st with an Alexandrite, previous ones were Diode) and the first for my bikini area. Since last week, I’ve noticed a few dark spots on my bikini area and hipbone. It didn’t bother me much, I thought they would probably fade after a few weeks. And I thought maybe some spots were due to ingrown hair.

Yesterday, I noticed that I have a few of this similar spots on my upper arms too, but only on a small portion of my left upper arm. They are not that dark (I can still wear sleeveless tops), but they’re there. My thighs have a row of these spots too, although they are much lighter. My skin is a bit darker in the groin/hip area and that’s where the noticeable spots are.

I didn’t think that this could possibly be Post Inflammatory Hyperpigmentation, but it seems like it is? I just googled and apparently PIH appears weeks after the procedure. Just when I thought I was safe. And wow, most of the stuff online say this thing can actually last for years?

The strange thing for me is that I didn’t really experience itchiness or discomfort. The spots were just suddenly there. And not even immediately after the procedure.

The machine used on me was Candela Gentlelase. Settings were 14J,18MM for the whole arms and 16J/18MM for the thighs and bikini (although when I really couldn’t handle it any more, I asked for the settings to be lowered to 14J. But that was only for like the last 10 clicks). I really pushed for these settings because I want the treatment to be as effective as possible. I’ve never had any reaction on the arms on my previous Diode treatments. I’m a Skin Type III (light-skinned Asian).

Does this mean I should discontinue my Alexandrite treatments? Or treat with lower joules (which will be like discontinuing treatments as well, right)? But I treated such a large surface area and these burns showed up only on small parts. I don’t know if I should discontinue. However, if I continue, the rest of my arms and thighs can possibly be covered with these spots on my succeeding sessions. Should I risk it?

Also, I read about cryo burns just now. This is a whole new knowledge for me. This is a particularly interesting study. Prior to my treatment, I really read up on Alexandrite and Gentlelase settings, but I didn’t bother with the DCD setting. It never occurred to me that hyperpigmentation can be caused by that thing which was put there to protect your skin. Aside from the built-in cryo spray, the clinic I went to also had a zimmer cooling thing that was blowing cool air all throughout my treatment. It was such a relief to have, but now I’m wondering if that caused these burns? But it really just felt like targeted air-conditioning, it’s hard to imagine it doing any damage.

For those who have experienced cryo burns, can this be resolved by simply lowering the DCD setting as the study suggests?

Thanks Romeo and JSIMR for replying. I’m posting in a seperate thread to make it easier for you to track my progress. Anyway here’s a picture of the left upper arm:
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I know upper arms are more prone to induced growth, but by the time I read about that, I’ve already done the treatment. So I guess I’ll see and will be more careful about it.

Also, I had a full 8 sessions of Diode done on my lower legs in the past. The first one was terrible, it was unbelievably itchy and red and you can see the shape of the laser. My skin was pigmented for about two months, and then it went away. For this, I had no redness, no itchiness, nothing for weeks. The ones on my upper arms showed up maybe just this week, four weeks after my treatment.

Another picture of my arm:
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And those spots in my bikini area:
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I think I’ve experienced a mild burn from Diode before and this is nothing like that. The ones on my bikini line just look like a bunch of mosquito bites, except that I’m sure they’re not. And they appeared simultaneously a week and a half or so after the procedure.

The ones on the arms look like a bunch of fading mosquito bites.

Do these look like cryo burns?

I don’t see much in the photos except for the last two, and those only show a couple minor pigmentation issues. To be honest, I wouldn’t worry about it too much personally. They will go away. I suspect these areas may have been exposed to the sun.

Either way, I also suspect the hair is nowhere near coarse enough for any more laser treatments on this area.

What bothers me is why the clinic is using both Cryo as well as Zimmer. Sometimes, in order to save money, some clinics use the Zimmer and then turn down the Cryo settings. This, in turn, may cause pigmentation issues.

I don’t understand. Is it a bad thing that these two cooling techniques are being used? What should I tell them to do? The marks have lightened up a teensy weensy bit and I’m due for my next session next week (the pics were taken 3 and 4 weeks after a laser session so the hair is not that obvious. Hair has since grown again.) I want to make sure I don’t get marks again. Should I ask them to turn up the cryo settings and turn down the zimmer? Do you have any suggestions for the ideal DCD settings?

I think they use cryo spray just because it comes with Candela. Maybe they use the Zimmer too to make sure no one gets burned/the patients are comfortable during the procedure. 98% of clinics here use diode, because it makes more sense in an Asian country. It’s actually quite risky on my hospital’s part to have the Alexandrite, I’m assuming that’s why they go the extra mile with both the cryo and zimmer. They’re considered to be quite a fancy hospital and it would really hurt their reputation if someone complains of burns. The upside of that, is their Alex prices are 1/2 of diode laser treatments. This is the only reason why I can afford them.

The Cryo costs money because each canister can only shoot X amount of times.
The Zimmer is just cold air so it doesn’t take anything more than electricity to power it.

You shouldn’t be getting any more treatments on any area that has side effects until those side effects clear up.

I also don’t see any coarse hair in those photos, so I’m not sure it’s worthwhile to spend money on treatments anyway.