Suggest treatment for post inflammatory hyper-pigmentation under the eyes

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Posted on Wed, 13 Aug 2014 in Skin Hair and Nails
Question: I had a rhinoplasty 7 weeks ago and to my surgeons suprise, had severe swelling and bruising around my eyes down to the cheekbone. The color went from black to deep purple to red. After 2 weeks the swelling and alot of the bruising was improved. After 4 weeks there was a brown stain under both eyes that did nor resolve. My Dr. said it is hemosiderin staining. It looks very bad, like I have a black eye even with heavy corrective makeup.
My Dr. suggested vitamin C and an antihistamine daily, and said it usually resolves within a year, sometimes longer! Is there nothing I can do to get this resolved? I've heard Q-switch laser has been used to remove the iron deposit stains under the skin. What is your opinion of this and do you have any suggestions on how to solve this problem?
Thank you
doctor
Answered by Dr. Sanjay Kumar Kanodia 3 hours later
Brief Answer:
Kindly send pictures of the affected area

Detailed Answer:
Hello,

Welcome and thanks for posting your query to the forum.

I can understand your concern for brown stain under both eyes.

In view to help and guide you best I request you to please upload few good resolution pictures of the affected area so that I can analyze it better. I would like to analyze the grade and extent of pigmentation. Kindly send good resolution pictures focusing the area of concern which can be seen on higher magnification. For uploading the pictures you have a facility on the right side of the page or can send on:

YYYY@YYYY

with "attention:Dr Sanjay Kumar Kanodia"

The pictures will be confidential and will not be available for anyone else to see except me.

Hope to hear soon from your side.

With regards,

Dr Sanjay Kumar Kanodia
MD- Dermatology
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sanjay Kumar Kanodia 8 hours later
I have attached photos of my under eye area. Thank you for your help.
doctor
Answered by Dr. Sanjay Kumar Kanodia 6 hours later
Brief Answer:
Post inflammatory hyper-pigmentation

Detailed Answer:
Hello,

Welcome again and thanks for posting the pictures so that I can now guide you best regarding your condition.

After analyzing all the pictures and correlating with all the facts I can get that the condition is known as "Post inflammatory hyper-pigmentation" or PIH.

To tell you medically about this condition: Our skin is multiple layered structure. There are certain important cells in the skin which continuously produces color to the skin. These are superficially present in the upper skin known as epidermis.

These melanocytes are the cells which regularly produces color/pigment known as melanin in the skin. This is a tendency in ourselves to get higher activity of these mealnocytes after any minor to major injury or irritation of any kind.

Correlating with your history I can get that you had sinus surgery which resulted inn accumulation of blood. This accumulation of blood as well as surgery near the affected areas stimulated the melanocytes of the skin to cause over production of melanin in the skin. This pigmentation is known as "Post inflammatory hyper-pigmentation" or PIH.

Once occurred it remains for quite long time and I reassure you that it treatable and is a natural sequel to all these kind of problems.

There is no need of any lasers for your kind of pigmentation so please do not waste your money in same. On one side lasers would not be beneficial as well as can cause further irritation and accumulation of more pigment.

If I were your treating dermatologist then for your marks I would have prescribed a cream (under dermatological supervision) containing Kojic acid with arbutin, Vitamin C and mulberry extract in it or Azelaic acid cream. These are one of the best and safest creams to be applied.

Apply any of these creams in a very thin layer at night time only so that these should not be visible to naked eye. Apply at night time before sleeping.

I suggest my patients to use the same for 1-2 month of period to see the results.

Apply a sunscreen in day time for 1-2 times on the area. By proper continuous regimen these marks will be alright.


I further suggest yo to take a good diet containing lot of vitamin C in it. Increase your weight a bit so that the accumulation of underlying fat will mask the pigmentation.

I hope these information will help you in getting rid of pigmentation. I will be glad to reply any further queries.

With glowing skin wishes,

regards,

Dr Sanjay Kumar Kanodia
MD- Dermatology
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sanjay Kumar Kanodia 37 minutes later
I sent a follow up question but I don't see it here.
I also sent you a post open photo 8 hours after surgery, and 3 weeks after.
I was prescribed Bleach Ease 6% cream 2 years ago to lighten dark patches on my cheek area..it lightened the problem area, and using a small amount once a day at bedtime has maintained an even toned complexion.
Could I use the same cream for this problem or should I request the type of cream you suggested from my dermatologist. My plastic surgeon was 50/50 on whether my problem was hemosiderin staining or post inflammatory hyperpigmentation ...I'm relieved you think it is hyperpigmentation. I've been afraid that lasers would cause more darkening of the skin.
Let me know your thoughts on the cream.
Thank you!
doctor
Answered by Dr. Sanjay Kumar Kanodia 8 hours later
Brief Answer:
Diet + Kojic acid + Relaxation exercise for eyes

Detailed Answer:
Hello,

Welcome again to the forum and thanks for your follow up.

Let me again reassure you that presently the problem is not because of any hemosiderin deposits. It is simple "Post inflammatory hyper-pigmentation" or PIH.

I have gone though the post surgery pictures and can make out that there had been a lot of accumulation of blood along with major swelling of face with inflammation around eyes.

In all these kind of cases there is always a chance of Post inflammatory hyper-pigmentation due to inflammation and more activity of melanocytes.

As I pointed out one important thing that presently the fat reserve below your eyes is bit lower side. Therefore not only PIH but also low fat contents results in more darkening around and especially under the eyes. Stress and strain around eyes with computer activity and poor sleep can accentuate the condition.

In my opinion you can use Bleach Ease 6% cream as it contains not only Hydroquinone but also Kojic Acid and Bearberry Extract Rich in vitamins C too. Use it at night time in a thinnest possible amount so that it should not be visible to the naked eye. In day time use a sunscreen also along with night cream.

I suggest you to have a good diet to improve your fat reserve...do not get obese!!! Just increase your weight up to 3- 5 Kilograms ( around 7- 10 pounds) so that the fat reserve under your eyes will also increase.

I also suggest you to do "Relaxation exercise for eyes". It will improve the blood circulation around the eyes, reduce the strain and therefore help in movement of pigment and its reduction.

You can go by key words of "Relaxation exercise for eyes" and search. I am quoting one example:

http://www.wikihow.com/Exercise-Your-Eyes

I further suggest you to reduce your work stress and if you working on computers then should give a 5 minutes break after every one hour when you can do the above mentioned exercises.

Diet and sleep plays the most important role so go for best of diet and sleep of atleast 8 hours.

All my good wishes for your early recovery.

I hope these information's will help you. If you have further queries I will be happy to help or if not then can close the query and rate the answer.

For any future guidance regarding skin conditions you can ask me directly at:

bit.ly/drsanjaykanodia

"Wish you good health"

Regards,
Dr Sanjay Kumar Kanodia
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sanjay Kumar Kanodia 2 minutes later
Thank you do much for your help.
doctor
Answered by Dr. Sanjay Kumar Kanodia 5 minutes later
Brief Answer:
"Wish you good glowing skin- today and always"

Detailed Answer:
Dear beautiful lady,

Good morning form Pink City, XXXXXXX

As we say "morning sun brings all the good fortune and positive brighter side- I send you all my good wishes with this rising sun and a positive energy that your things will be better and best.

All my good wishes for your early recovery.


"Wish you good glowing skin- today and always"

Regards,
Dr Sanjay Kumar Kanodia
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
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Dr. Sanjay Kumar Kanodia

Dermatologist

Practicing since :2002

Answered : 4165 Questions

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