Faced with a wide array of options ranging from microdermabrasion, topicals and chemical peels to all the different types of lasers, many patients feel overwhelmed.
The most commonly used group of lasers for hyperpigmentation is the "q-switched" and "pico" lasers. For these non-ablative or "lunchtime" lasers, the laser light energy is specifically absorbed by the melanin in the pigment spots and is transformed into mechanical (photoacoustic) waves, which disperse the pigment into much smaller particles without breaking the surface skin. The spot lightens over time as the "pulverised" melanin is cleared away naturally by the body.
Other micro-resurfacing lasers (such as Fraxel Dual, Lavieen BB laser and SmartXide fractional CO2 laser) take a different approach with precisely controlled laser skin renewal and regeneration. As sun-damaged or acne-scarred skin gets progressively renewed, the uneven pigmentation, texture and elasticity of skin improve simultaneously. As micro-channels are created in the skin and product delivery is greatly enhanced, pigment lightening agents and growth factors are often applied immediately after to further boost the brightening and skin rejuvenation benefits. Minor downtime (skin redness, roughness, flaking) might be a few days to a week as the skin renews.
Microdermabrasion provides more superficial resurfacing with micro-crystals that physically exfoliate the surface dead skin cells and promote skin turnover. Many patients like it as a clinical facial to improve skin smoothness, help fade dark pimple marks (post-inflammatory hyperpigmentation), while keeping clogged pores and breakouts at bay. In practice, microdermabrasion or gentle chemical peels can be combined with non-ablative pigment lasers (e.g. q-switched laser) for faster clearance.
Selection of the different approaches or modalities depends on the type of hyperpigmentation, the skin type and overall skin condition, as well as the lifestyle preferences of the patient. Newer modalities, such as Sylfirm micro-needle radiofrequency, further strengthen the doctor's armamentarium for difficult-to-treat hyperpigmentation like melasma by addressing the issue from yet another different angle. An experienced doctor armed with multiple treatment options would be able to offer a comprehensive approach.
Whether it is microdermabrasion or laser, I think it is important to remember that these treatments for pigmentation only help to remove the existing uneven pigmentation. For any of them to work properly, daily measures to reduce new pigment production are vital. These include religious sun protection, sun avoidance and skincare formulated to regulate melanin production and transfer.
