Skin pigmentation is a prominent problem that is an inevitable part of the natural aging process – yet is largely manageable.
When talking about pigmentation, you have to talk about melanocytes – pigment-producing cells that are responsible for making melanin in our skin.
The amount of melanin that we have is what determines our skin color and protects our skin from harmful ultraviolet (UV) radiation – and while having more melanin means greater protection from the sun – it can also make us more susceptible to pigmentation problems when we don’t take sufficient steps to preserve our skin.
When too much damage occurs in the skin – this results in the abnormal production and deposition of melanin in the skin – which is what we later see as pigmentation.
Despite genetics playing a huge role in whether or not you are likely to develop pigmentation, environmental factors such as the overexposing your skin to the sun without adequate protection and hormonal imbalances can also give rise to pigmentation. In addition, skin injuries caused by inflammation can also trigger something known as post-inflammatory hyperpigmentation (PIH) to occur.
Especially in Asia where fair and clear skin is deemed to be a highly attractive and coveted trait – understanding the type of pigmentation you have and identifying your treatment options is the key you need to unlock your best skin yet.
Knowing which layer of the skin pigmentation occurs is vital.
There are many different types of pigmentation that all pose distinct characteristics, and the most common ones are namely:
- Solar lentigines (sun spots)
- Birthmarks (café au lait spots, port-wine stains, and naevus of ota)
- Post-Inflammatory Hyperpigmentation (PIH)
When diagnosing and treating each type, it is important to first realize that pigmentations don’t always occur in the same layer of the skin.
Pigmentations can appear anywhere in the 3 layers of the skin, and in several types, occur in both the epidermis (shallow) and dermis (deep) layer. In general, the deeper the pigmentation is in the skin, the harder it is to treat.
Epidermal pigmentations include freckles, solar lentigines, and café au lait spots; dermal pigmentations include naevus of ota, and mixed pigmentation lesions include PIH and melasma.
To determine the severity and depth of your pigmentation – your doctor will most likely conduct a visual test with the help of a Wood’s lamp, before deciding the best steps forward.
Why aren’t topical creams always effective?
Topical creams in general are effective and are often the first-line of therapy for mild to moderate pigmentations. They work by either exfoliating or inhibiting melanin formation in the skin; however, requires a long-term commitment in order to continue seeing effects and preventing relapse.
Hydroquinone remains as the gold standard for the treatment of facial hyperpigmentation – today, a triple combination cream containing hydroquinone, a skin lightening agent such as tretinoin, and a mild corticosteroid is frequently used due to its effectiveness and synergistic effects as compared to just using one or two treatments alone.
Other topical treatments include azelaic acid, topical retinoids, and even topical agents such as kojic acid and vitamin C – which all brings relatively good results in treating epidermal pigmentations.
With that being said, topical treatments aren’t helpful if you wish to get rid of deeper, dermal pigmentations in a short period of time – this is where stronger treatments such as chemical peels, dermabrasions, and laser treatments can be valuable.
While laser treatments are often considered to be second or third-line therapy options, they are a safe, versatile, and effective solution for those who aren’t seeing results with first-line therapies and are experiencing stubborn pigmentation that doesn’t seem to go away.
What laser treatments are there for removing pigmentation?
Melanin has a broad absorption spectrum (630 – 1100nm), and lasers work by precisely targeting melanin pigments in the skin. When the right laser wavelengths are used, it is able to specifically target the melanin to heat and break it up into smaller pigments that is later absorbed and removed by the body naturally.
Just like how pigmentations aren’t created equal, so are lasers. They all utilize different mechanisms of action and come with their own list of side effects and results that are ideal for a range of skin types.
The most common lasers that have been studied in treating facial pigmentation are the Q-switch, pulsed dye laser (PDL), intense pulsed light (IPL), as well as the fractional CO2 laser.
In general, longer wavelengths such as 1064nm is more effective in reaching deep within the skin to treat dermal or mixed epidermal-dermal pigmentations. Since blood vessels and non-pigment producing cells called keratinocytes also play a role in pigmentation – this is the reason why vascular lasers can also help to treat red or purplish spots.
Despite the fractional CO2 laser being effective in treating stubborn pigmentation, it often comes with a higher risk of post-treatment hyperpigmentation and longer recovery times. Although Q-switch lasers can result in the removal of 70% – 100% of a single dark spot, overly frequent sessions can also lead to complications like mottled hypopigmentation (white spots) that are potentially irreversible.
In order to prevent this, doctors have to use lower fluences for treatment – which can make it overall less effective, with more sessions required in order to see improvements.
However, picosecond lasers are an excellent solution that we offer at The Clifford Clinic that can help patients achieve faster and better clearance than traditional lasers, without additional risks and side effects.
A photoacoustic laser that generates intense laser energy at one-trillionth of a second to safely penetrate deep into the skin to break down melanin into smaller particles – pico lasers don’t use thermal energy, meaning to say that it is completely safe to use on all skin tones and types! Coming in multiple handpieces, doctors are able to fully customize your treatment to treat pigmentation at multiple layers within the skin.
In fact, the HEXA MLA (Microlens Array Technology) is an advanced extension of the pico laser that we offer here at our clinic. Combining different light intensities and concentrating them on the target area – both the pico and HEXA MLA laser provide higher peak power and ultra-short pulse durations to boost your results in just one session!
It can also be used to treat acne scars and enlarged pores – compared to subcision acne scars treatment, no incisions are required at all!
In general, 2 – 6 sessions of laser treatments conducted every 1 – 4 weeks are required to start seeing results.
Most importantly, the proper selection of laser wavelength, spot size, fluence, and pulse duration is key to seeing optimal results.
Treating stubborn pigmentation @ The Clifford Clinic
Since majority of patients face multiple pigmentation types at a single time – a holistic, combination approach is what we like to use at The Clifford Clinic.
Depending on your skin tone, the type and intensity of your pigmentation, as well as your lifestyle habits – our doctors will recommend a combination of treatment options that include topical treatments, chemical peels, and laser treatments to give you the best results!
At the end of the day, stubborn pigmentations are a difficult condition to treat, although not impossible. Unless you make the necessary changes to your daily habits and skincare routine – such as applying a broad spectrum sunscreen of at least SPF 30 daily – pigmentations can easily relapse and resurface on the skin.
At The Clifford Clinic, we offer a range of medical-grade and highly-reliable lasers, including the Q-switch, Vbeam, Fraxel Dual, Picocare 450, and HEXA MLA lasers to help you regain bright and beautiful skin. In fact, many of these lasers can also be utilized as an effective acne laser treatment!
Our doctors have decades of experience treating pigmentation cases, and use only the most powerful, state-of-the-art machines to deliver the best pigmentation laser treatment – The Clifford Clinic is a one-stop centre for all your dermatological, body, and hair needs – contact us to book your appointment today!