Pigmentation Anyone?

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Dear Dr Naomi,
I am turning a certain age in 3 months. Now, while I don’t want to go on and on about how horrified I am to suddenly reach said age, I do want to be cute again. In a nutshell: my skin has changed – my girlish freckles have now turned to blotches, and I have some unsightly pigmentation on my upper lip. Plus, there is a new acquition of broken capillaries and redness on the cheek (I don’t believe I ordered these either). Gone are the carefree days of looking fresh as a daisy wearing a smidgen of creme blush and lippie. Sigh. (See photo – I was 24). Youth is so wasted on the young isn’t it?  I want that skin back – the skin that I failed to appreciate then. What can you do?
Desperate and grasping at straws,
Aleesa

1. Freckles and blotches:
First of all, you should have a yearly skin check to make sure there are no 
cancers or pre-cancers. If the skin check is all clear then the freckles/blotches can be treated cosmetically.

A bleaching cream like Hydroquinone or Kojic Acid will even out pigmentation. Vitamin C is a great topical for this also.

Moving in to the more invasive (effective) treatments, there is IPL or pigment laser. Make sure you use a medical grade machine, as all IPLs are not equal. With IPLs, if the therapist tells you you will need 5 treatments, the machine is probably not good enough.

Fractional laser is another option, but with  IPL directed at pigmentation or pigment laser, you are targeting the actual problem and will get brilliant results from the first treatment. This is not the case when Fractional Laser treats freckles, because Fractional Laser only treats a small percentage of the surface area of the skin with each treatment.
In fair skinned patients, pigmentation issues (eg freckles/ solar lentigos) are really easy to treat, as we can turn the machines up and get an amazing result. With darker skinned patients, we can’t do this as it risks post inflammatory pigmentation (PIH).
Please see my blog post re  Top Ten Freckle Removal FAQs:   http://www.drnaomi.com.au/blog/index.php/freckle-removal-top-10-faqs/

2. Pigmentation on Upper Lip.
This may be Melasma. Sometimes it can be post-inflammatory pigmentation (PIH) from
laser hair removal or waxing the upper-lip. This can also be the result of hormones (eg. the pill) and the sun. So sunscreen and sun avoidance are paramount. The gold standard of treatment is a prescription mix of Tretinoin and Hydroquinone. Other bleaching agents may also be used eg. Kojic Acid. Sometimes a steroid is added to the mix to reduce the inflammation. This can be used with needling (Derma-Roller) for home care. Regular peels should also be used, also Sonophoresis with suitable vitamins and  LED. Many laser devices have been trialled to treat Melasma, including IPL/ fractional laser/Q switch laser, with varying levels of success and always the potential of causing worse pigmentation in these susceptible individuals. Other topicals can be used including Vitamin C and many more.

3. Capillaries and Redness on the Cheek
Capillaries can be treated with IPL and laser, which target the vessels. To the typical patient with capillaries, I recommend 3 treatments, 3 weeks apart. This will usually provide an improvement of 80%. Facial capillaries are a problem that will re-occur, so I suggest treatment every 1-2 years depending on the case.
If any lasers/IPL are to be used on those with darker skin tones like yours, Aleesa, then I would recommend pre-bleaching with Tretionoin/Hydroquinone or a Kojic acid mix for 8 weeks prior to the treatment to reduce the incidence of PIH. Also, steroids should be used in the post treatment period for the same reason.

Once we have treated all of the above flaws, then the canvas will be clear and we just need to maintain the skin as well as possible, with great home-care including needling and sunscreen. Also regular microdermabrasion/peels, needling, Sonophoresis and LED treatments will keep you glowing. Regular IPLs (2 yearly) and fractional laser (2 yearly) will keep the skin in good condition.

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