Which Laser Treatment Is Best for Your Hyperpigmentation?
Plus, in-office and over-the-counter options to keep dark spots at bay.
Although it feels like a far-flung fantasy at the moment, the time will come when we can venture outside into the sunshine yet again. For us that means two things: lots of happy dancing and celebrations, and wearing plenty of sunscreen. Sure, there might be a few other things on our minds, but that last one is major. Why? Because SPF keeps your skin protected from sun damage, which often manifests as dark spots. UVA and UVB rays can also trigger dormant melasma to rear its unwanted head. Given all this extra time we’ve had to inspect our faces from the comfort of our bathrooms, we’ve been thinking about these spots and ways to address them.
If you’re at a loss for why your complexion is suddenly riddled with various forms of hyperpigmentation, know that you are not alone. Dark spots are one of the most common reasons to visit a dermatologist and can arise from things like the aforementioned sun damage and melasma, as well as post-inflammatory hyperpigmentation, hormonal changes, certain medications, environmental exposure, trauma, and genetics. Luckily, there are more options than ever to treat all of the various forms of dark spots so that your complexion can return to an even and glowy state. To learn more, we spoke with board-certified dermatologist and founder of Entiére Dermatology, Dr. Melissa Kanchanapoomi Levin about the types of hyperpigmentation she sees at her NYC practice, as well as the best method of treatment—like lasers and topicals—to banish those dark spots for good. Remember, as with any skin condition, it’s crucial to visit your physician so they can properly diagnose you.
What are the various kinds of hyperpigmentation that you typically treat?
“Pigmentation is an incredibly complex and wide-ranging skin condition and can be due to multiple causes, such as chronic and/or accumulated sun damage, environmental exposures, medications, hormones, inflammation, trauma, genetics, benign growths to malignancy or skin cancer. Once you visit your dermatologist and a diagnosis is established, then you both can formulate a plan on how to safely and effectively treat the brown spots. The most common hyperpigmentation I treat are sunspots (also called lentigines), post-inflammatory hyperpigmentation (marks from pimples, bug bites, or prior inflammation), and melasma.”
Are lasers usually the most effective option to permanently eliminate these dark spots?
“In general, treating all hyperpigmentation the same is absolutely the wrong approach, as the different causes and conditions should be treated differently. No matter how diligent you are with sunscreen, sunspots can continue to develop over the years, and while we are able to treat brown spots with chemical peels and lasers, maintenance is key.
“Lasers are not always the most effective at eliminating hyperpigmentation, but there are certain conditions where lasers are incredibly effective. Light- and laser-based therapies include broad-band light (BBL), Q-switched lasers, Nd:Yag lasers, picosecond lasers, and fractionated resurfacing lasers. It also depends on whether you are treating one individual spot or a larger field of brown spots. It’s really about the right doctor and the right treatment.”
What are the lasers doing to the pigment to get rid of it?
“Different lasers target either melanin or water in order to penetrate the skin and to heat up the target and destroy them. [This] results in the dark spot getting darker, flaking, and falling off after the treatment. With treatments like Halo and LaseMD, controlled micro injuries to the skin results in collagen remodeling and removal of pigment in the upper layers of the skin. If you look closely at your skin after a fractionated laser treatment, such as Halo or LaseMD, it looks like small pixels, which are called micro-thermal zones. These areas are stimulating collagen production and the removal of pigment, which resurfaces and evens [your overall] pigment. Multiple treatments as well as maintenance are necessary.
“For skin that has a combination of brown pigmentation with redness, broad-band light (BBL) is effective in using the heat energy from various wavelengths of light to correct uneven pigmentation and minimize capillaries, dilated blood vessels, and background redness.”
How do these laser treatments differ for darker and lighter skin tones?
“Brown spots are complicated, but [treating] brown spots in darker skin tones is even more complicated. Darker skin types have a higher amount of melanin in the background of their skin, which ‘gets in the way’ of the actual brown spot the laser surgeon wants to treat. Therefore, it’s important to see a board-certified dermatologist who is comfortable treating darker skin types to recommend different treatment options for darker skin types. Usually treatments are more conservative and gentle to minimize the risk of complications, and require more sessions.”
What is the most difficult type of hyperpigmentation to treat?
“Melasma is one of the most frustrating conditions for both patients and dermatologists. It is a chronic pigmentary condition caused by a number of factors such as genetics, sun exposure, and hormones from birth control or pregnancy, but melasma tends to recur easily, whether it’s from the sun, heat, and/or hormonal changes. Treatment options must include vigilant sun and heat protection with sunscreen, sun avoidance, antioxidants, as well as over-the-counter brightening topicals—including hydroquinone, vitamin C, kojic acid, niacinamide, azelaic acid, and retinoids—as well as oral medications, namely Tranexamic acid, and a series (not one!) of in-office procedures such as chemical peels and light laser treatments, like a Thulium 1927nm non-ablative fractionated resurfacing laser.”
What do you recommend for preventing hyperpigmentation in its various forms over the counter?
“Daily and regular re-application of sunscreen is a must; vitamin A derivatives, such as retinol, or better yet, prescription retinoids, to increase skin cell turnover as well as improving pigmentation; [and] regular but modest exfoliation with glycolic acid or other acids, such as trichloroacetic acid (TCA). Antioxidants such as vitamin C and vitamin E help neutralize free radicals from causing oxidative damage to the skin, as well as blocking enzymatic processes that make more pigment, or melanin, in the skin.
“As for ingredients, hydroquinone has been the gold standard for lightening dark spots for the past 50 years, but will not remove the spots. Hydroquinone is one of the most powerful inhibitors of a key enzyme called tyrosinase, which is important in the production of pigment, or melanin. Kojic acid, which is derived from fermented rice and mushrooms, minimizes the production of pigment as well. Other ingredients that improve pigment include azelaic acid, arbutin, and niacinamide.”
What have been the most exciting new innovations in the realm of lasers for hyperpigmentation in the last 12 months?
“Laser-assisted drug delivery with fractionated laser resurfacing is the most exciting. We are now in the time that we understand that the thulium 1927nm wavelength is an ideal laser wavelength that increases the permeability of cosmeceuticals into the skin. We now understand that stubborn pigmentary conditions like melasma are not only due to hyper-reactive melanocytes or pigment-making cells, but also the underlying blood vessels or vascular tone, which is why heat, visible light, and ultraviolet (UV) radiation all trigger and increase melanin production. We are now taking a medication (that has been well-studied) called tranexamic acid and delivering it into the skin with the assistance of a laser, [which helps eliminate the dark spots].”
[Editor’s Note: As ever, we are not doctors or medical know-it-alls. And everybody is different, so make sure to check with a doctor about all of your options.]
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