Hyperpigmentation and Brownspots skin are a common concern for patients and can represent a variety of skin conditions. The most common cause of hyperpigmentation include melasma (chloasma), lentigines, cafe-au-lait macules as well as a variety of other causes. Since not all brownspots are the same, therefore not all treatment options are the same.
For practical purposes, our practice likes to divide skin hyperpigmentation and brownspots into either epidermal (superficial) or dermal (deeper). We treat these conditions with a variety of topicals, chemical peels, as well as lasers to help patients improve the appearance.
We use the latest in skin analysis technologies to track improvement for patients. Analysis of the skin allows for accurate assessment in skin improvement more so than what standard photography can.
Brown spots and hyperpigmentation mean so many different things to many patients. Dr. Shah and Chughtai’s goals is to create a plan individualized for each patient utilizing a combination of groundbreaking technology including 4th generation IPL’s, Pico lasers and other technologies with proprietary skincare products to help treat a variety of skincare issues.
Before and After
Brownspots Skin and Hyperpigmentation Conditions:
Melasma is the formation of patches, often hormonal, and often in women. It is the apperance of dark brown patches seen along the midportions of the face (cheeks, forehead, nose) although it can be seen along the temples as well. Often the best treatment options are a combination of modalities including the use of retinols, skin lightners and antioxidants.
- It is critical sun is avoided. Sun can exacerbate and cause reformation of melasma
- Topical treatments can be effective in some patients. Topical treatments include the use of hydroquinone often in combination with a retinol. The hydroquinone promotes skin lightening and takes 6 weeks to be effective, while the retinol can encourage skin turnover. Newer skin lighteners are also available with less side effects. Antioxidants can be helpful in this process as well.
- Chemical peels. Chemical peels can be beneficial in specifically targeting browns in the skin. The Melanage peel system is effective and can be tolerated by a variety of skin types.
- Intense pulsed light- Newer intense pulsed light modalities such as Lumeca can be helpful in specifically targeting brown areas in fewer treatments
- Laser- Both ablative and nonablative treatments can be effective. Resistant browns often respond to q-switched Nd:YAG as well as in some cases q-switched KTP. In some cases, Nd:YAG can be helpful. Ablative technologies including erbium can be helpful in improving browns as well. Sometimes lighter type fractionated C02 treatments can be of assistance.
PICO lasers are often becoming the gold standard in treating resistant melasma. While traditional lasers used in melasma is controversial, pico lasers allow for much safer treatment due to to utilizing a pico second (1 trillionth of a second pulse) vs a nano second (1 billionth of a second). Faster pulse times prevent heat from building up which can irritate melanocytes.
Overall, melasma is a challenge to patients and providers alike. Conservative treatments are the mainstay. However, when conservative treatments are ineffective, patients can progress with other treatments especially in cases where melasma is highly visible.
Lentigines are a variety of areas which are also known as age spots. They are typically flat and brown. As we age brown spots increase, and sun exposure is thought to be a main culprit. Brown spots can be particularly concerning when seen on the face and hands. Lentigines are not all the same. Some lentigines respond well to IPL, while others need deeper penetration. Newer IPL’s such as Lumeca offer improvement in targeting browns while other lasers such as nd:YAG and q-switched nd:YAG and even q-switched KTp or q-switched ruby may be of help. Ablative treatments including erbium and fractionated C02 can be of help in combination or as standalones to treat lentigines.
Which laser for which brown spot?
Dermal effectiveness vs epidermal effectiveness (put pico in both epidermal and dermal)
Some lasers and IPL’s can target various depth of discoloration. Traditional IPL’s are only effective for superficial browns which can create the traditional chocolate chip appearance. Newer IPL’s can penetrate deeper treating some dermal lesions. PICO lasers can treat a variety of depths and can be tailored to a variety of skin types.
PICO vs IPL
PICO lasers represent a newer modality of treating hyperpigmentation. PICO lasers are much faster than traditional lasers and can treat darker skin types safely. This allows for brown spots on type 3-6 skin to be treated with less risk. PICO lasers can be used to tone the skin, treat individual brown spots and create overall improvement in facial appearance. IPL lasers are used for lighter skin tones and can help treat both browns and reds. We tailor a patient’s treatment based on their skin type and goals.
Laser vs. Chemical Peel
Both newer lasers such as Pico lasers and peels can be effective in treating browns. Some newer peels such as melanage and revance can be used to treat browns safely and effectively. Pico lasers are the only laser recommended for melasma as they prevent heat from building up within the skin.
Skin Care Products in Chicago
Traditional methods of treating brown spots were to utilize harsh chemicals such as hydroquinone to attempt to depigment the skin. The biggest risk with these techniques is a permanent change in skin coloration called ochronosis. We use the alternate approach of using natural skin brighteners such as arbutase and other approaches to safely help with your skin. Most patients respond to a combination of laser therapy and skincare products to help prevent return of hyperpigmentation. We advocate for the use of Reef-safe, non-chemical sunscreen.
Frequently Asked Questions about Chemical Peels
It is located in Chicago, IL. at 200 West Superior St., Suite 200. He has a variety of lasers and peels to effectively treat brown spots and hyperpigmentation.
Some skin lesions are improved with 1 treatment. However, deeper skin lesions often require several treatments to be effective.
The 2-pass technique is where a lower energy is used with a laser or IPL laser treatment but the face is treated in 2 passes instead of 1 pass. We do employ different techniques based on a patients skin and skin limitations.
Typically, hyperpigmentation or brownspot treatments are not covered by insurance.
Melasma and lentigines can be both epidermal or dermal. Often times treatment options will be adjusted to accommodate for depth of lesion at Dr. Shah’s office in Chicago, IL.
There are risks with any procedure, including chemical peels. We most often recommend individual assessment to determine the intended goals and start with a lower grade strength to determine how your skin will respond.
Most peels are not expensive in price.
Most patients see immediate textural changes to their skin. Longer lasting changes are seen with increased strength of chemical peel and frequency.
Each patient has an individual recovery period. Many patients with lighter peels can return to work that same day. Medium strength chemical peels may require longer periods of recovery at the extra benefit of more change.
Peels work by removing the superficial layers of the skin. When the skin repairs itself, the skin can feel tighter and rejuvenated due to the removal of superficial layers of skin as well as the introduction of new collagen in the skin.
Most peels in Dr. Shah’s office are administered by an aesthetician. Stronger peels are performed by Dr. Shah.
Dr. Shah is a double board certified facial plastic surgeon who has written over 50 scientific articles including three landmark articles about facial anatomy revolutionizing the way plastic surgery is performed. Dr. Shah specializes in Hyperpigmentation and takes an analytical approach to patient recovery after the procedure. Based in Chicago, IL; Dr. Shah is not only recognized as one of the top plastics surgeon not only in the city of Chicago, but in the world.