Why have laser treatments for my sun spots been ineffective? (photo)
I’m 27, female, and have been diagnosed with solar lentigos and nascent melasma on my cheeks. I have had poor experiences with lasers so far. I tried IPL, and got burnt with no effects on the pigmentation. I tried LASEMD laser twice, but broke out in small bumps. Several sessions of dual yellow had no effect either, until the doctor tried a different setting. The spots faded, however my lentigo became eczematised (photo). I am now very wary of lasers, would you agree that I should lay off these? If so, what else can I do?
I can understand that it can be quite tedious to undergo so many IPL and laser treatments for your pigmentations.
Quite often, depending on your type and severity of pigmentations, just by using topical lightening cream and sun protection measures alone, can already help to improve the pigmentations. So you may not even need to do laser treatments.
For now, I would recommend you to take a rest from laser treatments first, let your doctor reassess your treatment options for you.
For more information on the treatments of solar lentigo and melasma, you can read more about them in my "Ultimate Guide to Pigmentation Treatment in Singapore".
Hope this helps!
Dr. David Ng CH
There are a few reasons why the 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 best results with lasers, a pply 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 in these Lasers.
Based on what I see on your photo, my suggestion for you is to lay off treatments like Lasers / Peels for at least 1-2 months as your lentigo is shown slightly inflammed / red.
Thereafter, you might want to consider Lasers and Peels for Pigmentation removal. However, please seek advise from a trusted doctor before starting.
Good classes of Lasers for pigmentation removal is the Picosecond Laser or the Q-switched (nano-second) Nd: YAG laser.
You might also want to consider gentle chemical peels for pigmentation like Jessner's peel.
Please consult a doctor who is experienced in treating pigmentation for a thorough consult. Hope that this helps!
Dr. Justin Boey
I fully agree with Dr David's advice to take a break from laser treatments for the time being. I also agree with his approach of emphasizing on the diagnosis and holistic approach to skin treatments.
IPL is a valuable light treatment and the LASEMD and Dual Yellow are both wonderful lasers for treating solar lentigo and melasma. I highly doubt that adding a picosecond laser would have made a large difference in treating your pigmentation. In fact, there are some studies to show that the long pulse visible light lasers treat lentigenes and melasma better than the pico or nanosecond lasers.
A few truths about Picosecond lasers that get drowned out in the ongoing hype:
1. People like to refer to Qswitch lasers as old nanosecond lasers. They are not! Q-switching is just a technique to obtain short and energetic laser pulses! Many famous Picosecond lasers use Q-switching to generate this: Discovery, Picoway, Fotona Starwalker to name a few.
2. Picosecond lasers in the hands of an inexperienced doctor are still less useful than a old nanosecond laser in the hands of an experienced one!
3. Picosecond lasers claim to be much safer because of generating less heat than the old nanosecond lasers. But adopting proper skin cooling measures with an old nanosecond laser will probably give you more margin of safety than using a picosecond laser without skin cooling! A proper skin cooling machine can bring skin temperature down to below room temperature easily, whereas a picosecond laser used without skin cooling will definitely elevate skin temperatures despite generating less heat.
Have a good laser break and as Dr David mentioned, let your doctor reassess the options for you. Discussing with your current doctor that has been taking care of you all these months could prove to be more fruitful than you think. Based on the fact that he/she has this wide array of options shows that he/she is serious about the work. Most doctors don't have that much investment and options!
Wish you the best.