Dr Justin Boey has performed more than 5,000 laser treatments till date to help his patients banish pigmentation issues once and for all.
In his DoctorxDentist Session held on 22 July 2018, Dr Boey answered questions from readers on:
- Melasma treatment
- Ineffective laser treatment for pigmentation
- Getting rid of pigment marks due to acne
Melasma is a challenging condition to treat.
This is because there are multiple causes of melasma including sun exposure, hormonal causes (pregnancy, contraceptive pills) and genetics.
It is good that you are doing your best in wearing sunscreen and using the necessary sun protection.
You are correct that melasma is very difficult to get rid off. In fact, melasma can be "improved and well-controlled" rather than "totally removed".
Lasers are effective but they are not the first line treatment for melasma.
Post acne pigment marks are a common occurrence, especially for back acne.
There are 2 main forms: post inflammatory hyper-pigmentation- PIH (brown marks) or erythema (red marks).
Unfortunately, exfoliation alone is unlikely to help very much. Apart from "over-the-counter" exfoliation products, you might want to try medical-grade chemical peels like Glycolic or Jessner's peels. These superficial peels can help to lighten pigmentation over several treatment sessions.
The type of pigment marks that you have will determine which treatments you need.
For removal of brown marks (post-inflammatory hyperpigmentation), Intense Pulse Light (IPL) is one of the effective types of treatment. Other effective treatment options for back acne PIH include topical whitening creams, chemical peels and pigment lasers (Picosecond Lasers, Q-switched (nano-second) Nd:YAG lasers, etc). Sun protection is equally important to ensure good results from your treatments.
For removal of post acne erythema (red marks), IPL can be effective too.
There are a few reasons why laser treatments might have been less effective for you. But I believe that the best way forward is to have a comprehensive talk with your doctor to re-evaluate the condition.
Let me share some common reasons.
1. Post Laser Skin Care
Sun protection and lightening creams are essential before and after laser treatment.
This is to prevent post-inflammatory hyperpigmentation (darkening of skin).
To get the best results with lasers, apply sunscreen at least 1-2 times daily.
2. Sub-optimal Laser Settings
This is a reason why patients experience "less than desired" results.
Inappropriately low settings may lead to sub-optimal results. Excessively high settings possible cause burns, which is what you experienced.
These can take years to resolve. In certain cases, it is potentially irreversible.
3. Choice of Laser
I completely understand that you are wary of lasers now because of your poor experiences.
Lasers do give good results when used correctly and when correctly combined with other synergistic treatments like creams and sun protection.
Patients tend to be fixated on the type or brand of Laser. But what is the doctor's skill and experiences with these lasers?
I'm so sorry to hear that. This must be troubling you quite a lot. Let me briefly discuss how to prevent and treat facial pigmentation.
It's good that you are very meticulous with sun protection. This is one of the most important steps in preventing new pigmentation spots from appearing.
Prevention - Sun protection is key
In addition to what you are already doing for sun protection, I advise:
1) Regular application of high-quality SPF sunscreen every 4-6 hours if you are exposed to the sun.
2) Also, do remember to apply sunscreen at commonly neglected regions like around your eyes and neck.
3) Consider oral sunblock such as Heliocare, which provides another layer of sun protection in addition to topical sunblock.
Dr Justin Boey’s practice of aesthetic medicine centres around the busy modern individual. He is experienced in Facial Aesthetics (lasers and injections) and hair loss treatments. Learn more about him here.