From sun spots and freckles to acne scars and melasma, hyperpigmentation, in any of its forms, can be as unstoppable as its most common instigator, the sun. And while using a strong sunscreen can of course help fend off possible damage, even the most cautious of skin experts and professionals often still find themselves the victims of hyperpigmentation. Unlike the haunting memory of once using baby oil and reflectors to actually invite a tan though, the unwelcome traces of hyperpigmentation don’t have to be permanent. With lasers, peels, and products galore, see which methods five leading skin experts use to treat hyperpigmentation on themselves and their patients.
Dr. Diane Berson, Dermatologist
“I definitely have suffered from hyperpigmentation,” says board-certified New York dermatologist Dr. Diane Berson. “For me, it’s classic photo damage, like freckles, because I’m fair-skinned and have light features.”
Like many people who came of age between the 1960s and the 1990s, Dr. Berson spent a lot of time in the sun, growing up, often without any protection. Upon starting her career in medicine, however, she discovered a number of ways to help erase the dark remnants of her teenage years and has been using them to turn back time ever since.
“My first go-to is a topical retinoid,” the dermatologist explains, which not only exfoliates the outer layer of her skin but actually targets discoloration explicitly. For this, Dr. Berson looks to prescription Tazorac cream but is also a fan of gentler cosmeceutical alternatives, like Emepelle Night Cream, SkinBetter AlphaRet, and Senté’s Bio Complete Serum. In addition to using a retinoid at night, she uses an antioxidant, like SkinCeuticals C E Ferulic, and a lightening cream underneath her sunscreen every morning.
“As for products that specifically correct hyperpigmentation, I have three favorites—Lytera by SkinMedica, SkinBetter Even, and SkinCeuticals Discoloration Defense,” she says. And while a retinoid, an antioxidant, and a lightener can work wonders, Dr. Berson can’t stress enough the importance of wearing sunscreen even when you don’t think you need it. “I always tell my patients, just like you’re told to put your seatbelt on even if you’re driving only a few blocks, you should wear sunscreen even if you’re just walking down the street.”
The Upper East Side dermatologist also swears by the magic of a good laser. “My favorite treatment, by far, is the Fraxel,” she notes, referencing the 1927 laser strength, in particular. She also relies on lighter laser treatments, like Clear + Brilliant, and a host of chemical peels, such as SkinMedica Vitalize Peel or Beta Lift Salicylic Peel by Theraplex, to help maintain pigment-free skin. “If I use all those products every day and do the treatments regularly, I won’t ever have any hyperpigmentation.”
Dr. Pearl Grimes, Dermatologist
Dr. Pearl Grimes, a Los Angeles dermatologist and the director of The Vitiligo and Pigmentation Institute of Southern California, has seen it all, as far as hyperpigmentation goes, so she likes to break it down into three main categories. “There’s melasma, which is caused mostly by hormones, pregnancy, and genetic predisposition,” she says. “Then there’s post-inflammatory pigmentation, which is most commonly from acne, and there’s hyperpigmentation related to aging and the sun—and for me, it’s that third one that’s probably the easiest to treat.”
Like Dr. Berson, Dr. Grimes believes that “retinoids play a major part in treating hyperpigmentation”; but her true focus, for her patients and herself, rests in lightening creams. “We’re in a really interesting period right now,” she explains. “Hydroquinone [skin-bleaching cream] has been around for about 60 years—and it’s not unsafe, but it is banned in some countries.” Having said that, the dermatologist still uses the prescription lightener, but she also recognizes the benefits of other treatments.
“I’m a huge advocate of chemical peels,” Dr. Grimes says. “But when I treat pigmentation, I’m a bigger fan of the superficial peels rather than the deeper peels.” This means doing an alpha-hydroxy-acid (AHA), glycolic-acid, or salicylic-acid peel every two to four weeks. She thinks low-wattage lasers, like Clear + Brilliant and IPL (intense pulsed light) photofacials, are great for hyperpigmentation on lighter skin but is wary of their use on darker hues. “With dark skin, you often have to be even more aggressive with treatment,” she notes. “Everything mentioned I use on dark skin except Clear + Brilliant and IPL.”
Jeannel Astarita, Esthetician
“When I was growing up, we mixed Iodine and baby oil,” says Jeannel Astarita, the founder and CEO of Just Ageless medspa at New York’s 11 Howard hotel. “We would say, ‘I need to burn like seven times to get my base tan for the season’ because we didn’t know any better.” Of course, with the blistering sunburns that she’d often get as a child came years of bad hyperpigmentation. “I’ve actually had both hyper- and hypopigmentation on my face and body from never using any sunscreen when I was younger,” she says, “but lasers, chemical peels, and good products have cleaned up nearly all my sun damage.”
Related: Chemical Peels: Beyond the Basics
Astarita, like Dr. Berson, is a firm believer in the Fraxel laser. “To get the best results, you really need to do Fraxel,” she says, noting that, in her experience, gentler uses of it more frequently deliver better results than does one heavy treatment every few years. The esthetician also loves lighter lasers—like Cutera’s new excelV+, IPL, and the Laser Genesis, which targets red pigment rather than brown and can be done even in the summer, unlike other lasers. She even uses these lasers to target hyperpigmentation on her body, particularly on her chest and arms. “It can take 20 years off someone,” says Astarita, “but you need to allow for more recovery time with the body.”
On a day-to-day basis, the Just Ageless founder uses Superheal O-Live Gel, a blend of vitamins A, C, and E and olive leaf extract, and Phyto-C’s Selenium in C antioxidant serum, the only cosmetic formula that’s supported by the National Cancer Institute. Although her face is sensitive to harsh ingredients, Astarita is sure to mix a retinoid into her skincare lineup at least two nights a week, opting for SkinBetter’s AlphaRet Intensive Overnight Cream (which she uses on her arms, chest, and at the tops of her knees). But most important, the esthetician has learned her lesson since her youthful days and has made sunscreen a crucial part of her daily routine. “I love Isdin’s SPF 50+ because it’s mineral-based and contains anti-aging ingredients, like hyaluronic acid.”
Dr. Leslie Irvine, Plastic Surgeon
“I, luckily, don’t have horrible hyperpigmentation,” says Santa Barbara facial plastic surgeon Dr. Leslie Irvine, “but I have definitely had my fair share of sun-based discoloration.” She is also an advocate of doing a Fraxel once a year but finds that using a lighter Vbeam laser or doing an IPL on a more regular, near-monthly basis can work wonders for sun spots.
Related: Laser Treatments: Beyond the Basics
“It’s also incredibly important to use a retinoid or retinoic acid,” she says—but while many of her patients use prescription retinoids, Dr. Irvine prefers the less concentrated alternatives. “I have found that using over-the-counter retinols is a lot better and a lot more tolerable while still delivering basically the same results,” she explains. The plastic surgeon also uses an azelaic-acid gel to combat her light rosacea and, of course, sunscreen every day.
Dr. Joshua Zeichner, Dermatologist
Dr. Joshua Zeichner, a New York City dermatologist and the director of cosmetic and clinical research in dermatology at Mount Sinai Hospital, is an expert on treating acne, which means he is also acutely aware of how to best treat the scars that frequently take its place. “While active acne is a major issue for patients, when pimples resolve, they often leave behind long-lasting dark spots,” he says. “These spots remain longer than the original pimples and can be even more bothersome.” For these, Dr. Zeichner relies on topical retinoids, which both “treat pimples and then lighten the dark spots by increasing cell turnover.”
The other major iteration of hyperpigmentation that the derm sees regularly is melasma—typically around the cheeks, temples, forehead, and mouth. “It is thought to have a hormonal component, as it almost exclusively is seen in women,” he explains, “and pregnancy and birth control pills are thought to play a role.”
To treat these stubborn spots, Dr. Zeichner has to pull out the big guns. “We treat it using prescription topical combination therapy, with hydroquinone, to block pigment production, low-concentration cortisone, to calm inflammation, and tretinoin, to enhance cell turnover,” he says, noting there are a number of ingredients that can deliver calm and brightening results. “Look for niacinamide, vitamin C, kojic acid, licorice-root extract, or soy,” advises Zeichner, as all these actives help block production of abnormal pigmentation.
“Hyperpigmentation has a significant impact on self-esteem and, unfortunately, is difficult to get rid of,” the doctor says, but he has found that treating it with responsible and effective products can make all the difference.
