What is Facial Pigmentation?
Facial pigmentation is considered to be one of the most challenging conditions for Dermatologists to treat. Unlike other conditions that can often be treated with a single procedure, all types of unwanted pigmentation on the face require a combination of at-home topical regimes, on-going preventative treatments and occasional in-office procedures. The cause of unwanted pigmentation on the face can be associated with age, sun exposure, genetics, hormones and even some medications. Identifying the underlying causes and working to avoid them is essential in order for any treatment to be effective.
Melasma is the most common pigmentation condition that results in symmetrical, large, blotchy, light to dark brown patches found primarily on the forehead, cheeks and upper lip. Dark-skinned races and women tend to be affected the most. This type of pigmentation is also associated with hormones. It was previously called the “mask of pregnancy” as it was triggered by the hormonal changes of pregnancy. Nevertheless, woman who are not pregnant or have never been pregnant can be effected. However, there is a strong association with hormonal methods such as birth control pills or an IUD that releases hormones. Therefore, before considering other treatment options, changing the birth control method to a non-hormone method is strongly recommend.
Melanocytes are the pigment producing cells in the body. With any type of sun exposure, they produce melamin pigment that can darken the skin. In our youth, the sun creates a golden, desirable colour to the skin. However, with age, the sun often creates a blotchy, uneven and undesirable appearance to the skin. Daily sun protection is the single most important part of an effective treatment regime for unwanted pigmentation. Without exposure to the sun, melanocytes do not make excess pigment. Contrary to popular belief, the majority of our sun damage is not from occasionally sunny vacations or intermittent sun exposure, but rather from the daily sun exposure we receive from our activities of daily living, such as going to and from our car, working outside and even driving in the car. UVB rays are the stronger rays that peak during mid-day and can cause sunburns. However, UVA rays remain relatively consistent throughout the day and even throughout the winter, and can penetrate through car windows. It is this type of daily damage that primarily contributes to the development of skin cancers and unwanted pigment changes. Researchers have now even identified HEV (high-energy visible light) rays that are associated with artificial indoor lights and computer screens. This is why it is ESSENTIAL to wear daily, sun protection… even when it is cold and cloudy outside or when you are working indoors.
Topical Fading Products
After daily sunscreen use, an effective topical regime has been shown to be the 2nd most important step in treating unwanted pigment. By targeting and suppressing overactive melanocytes, we can prevent the further development of unwanted pigment.
Hydroquinone is the most effective product for treating stubborn pigmentation, and works by blocking the overproduction of melanin at a cellular level. By using a full regime that combines hydroquinone with additional products such retinol to increase cellular turnover, glycolic acid to exfoliate superficial layers of damage skin and daily power defence to speed up the DNA repair and protect against the damaging UVA, UVB and HEV rays, we are targeting the pigmentation from multiple angles and can gradually reverse the damage. Hydroquinone cannot not be used while pregnant or breast-feeding and should not be continued for longer than 3 months without taking a break.
A Non-hydroquinone regime is effective for treating sensitive skin and in maintaining desired results long-term. Brightalive is a revolutionary skin brightener that uses technologically advanced, multi-action complexes to break down existing pigment and prevent the new formation of hyperpigmentation without the use of retinol and hydroquinone. In combination with natural Vitamin C and glycolic acid, it can be used long-term for both treatment and prevention.
It is important to remember that we are actively treating a condition and attempting to repair damage. Therefore, some redness and irritation is to be expected during the process. Remember, if you have no reaction, you have no repair! Gradual improvement will occur over a 3-month period of time. By pre-treating your skin prior to initiating any in-office procedures, much of the pigmentation will have been targeted, and the laser can effectively treat the stubborn and remaining pigment.
Facial Pigmentation Treatments
Independent in-office procedures are not overly effective in treating disorders of pigmentation. However, by combining in office procedures with strict daily sun protection and an effective topical regime, we are able to obtain good improvement. However, it is important to understand that unwanted facial pigmentation will be an ongoing problem that will likely require long-term maintenance treatments. Although lasers have revolutionized the treatment of many dermatological conditions, the energy that is generated from these devices can often exacerbate pigmentation, so it is important to consider this concept when choosing the best treatment approach.
Fractional Laser Resurfacing
Similar to aerating your lawn, fractional laser resurfacing refers to the process of creating individual vertical channels of injury into the skin, leaving the majority of the skin intact to repair itself with healthier skin. By using laser energy that penetrates into the deep dermal layers of the skin, excess pigment is broken up making it easier for the body to remove, while simultaneously stimulating collagen production. The SP Dynamis Fotona Erbium Laser minimizes the heat generated through this process to minimize the risk of developing more pigmentation. Once the pigment has been effectively broken up with the laser, then chemical peels or other non-energy devices can be used to continue fading the skin. Some pain is associated with this procedure and you will have some significant redness and swelling for 24-48 hours, followed by mild to moderate peeling for 3-5 days. It is not recommended that you have this procedure more frequently than every 9-12 months and it might not be a good option for darker skinned individuals.
Chemical peels can effectively remove superficial pigment without adding heat to the skin. There are three types of chemical peels that can be used and we can recommend the best one depending on your specific condition.
Glycolic Acid Chemical Peel – This is a gentle, superficial peel that targets the damaged layers on the surface and does not penetrate into healthy tissue. Similar to the process of a Zamboni on an ice rink, a thin layer of a fruit acid is applied to the skin and left in place for 2-3 minutes, and then washed off leaving smoother, healthier skin. Mild tingling occurs when the chemical is applied, but no visible peeling actually occurs. A series of 3 treatments spaced 3-4 weeks apart is recommended
Dermalinfusion Silk Peel – Similar to the process of a steam cleaner, this peel uses a diamond encrusted tip to administer the fading solution followed by a vacuum suction to remove the excess solution and damaged tissue. Through this combination of chemical and mechanical exfoliation, it effectively removes the superficial layers of dead skin cells and damaged tissue. A series of 3 treatments spaced 3-4 weeks apart is most effective when treating pigmentation.
Jessner Plus Peel – The Jessner peel is a 3-component mixture of lactic acid, salicylic acid and resorcinol. This is medium depth peel that removes the superficial layers of skin along with a small amount of healthy skin below. The lactic acid has the unique ability to bind, retain and evenly distribute and penetrate moisture into the deep layers of the skin. Salicyclic acid has an antiseptic and anti-inflammatory effect which increases the process of replacing dead and damaged skin cells. Resorcinol intensifies the actions of the other products and through its antibacterial processes, assists in lightening the skin. For those patient who struggle with acne in addition to pigmentation, this peel would be most beneficial. As this is a medium depth chemical peel, some mild to moderate peeling may occur 2-3 days following the application. A series of 3 treatments spaced 4-6 weeks apart is recommended.
Intensed Pulse Light (IPL) Treatment
M22 Intensed Pulse Light (IPL) treatments are usually NOT optimal for those dealing with extensive hyperpigmentation such as melasma or post-inflammatory hyperpigmentation. However, if the pigmentation is associated more with generalized aging and freckling, it can helpful in evening out pigmentation. However, caution should always be taken when considering laser treatments that generate heat as they can exacerbate this condition.