Treatment for Stubborn Sun Damage on Neck?

Question

I had sun damage (brown spots) on my neck and forearms treated 2 years ago with IPL (4 treatments).  My arms responded great, but my neck only lightened a little bit.  Any other treatments recommended?  Would a TCA peel or Fraxel be worth trying to improve the discoloration on my neck?  Any suggestions would be appreciated.

David Hansen, MD · Answer

You probably need a series of 4-5 light TCA peels such as 10-20% TCA done every 2-4 weeks, alternating with a series of 3-4 IPL treatments together at a cost of roughly $350 each one.

Ron Shelton, MD · Answer

Chemical peels on the arms of the medium strength, which is the level needed to improve coloration, might scar the arms so they should be avoided. Superficial peels might be done to allow topical lightening creams to be more effective. Fraxel is a very good alternative. Several Fraxel Re:store treatments can safely (there are risks with any procedure and please discuss this with your physician) treat the forearms, but no one can guarantee a result of lightening the color. In fact, there is always a small risk of laser –induced post inflammatory hyperpigmentation, in other words, darkening may occur from your pigment response to the trauma of the procedure. Sunscreen is very important to minimize the pigmentation response.

William Groff, DO · Answer

Hi Jenny-- Its hard to say without seeing your neck, but you may have Poikiloderma of Civatte, which is basically caused by repeated sun exposure . This responds well to a series of Fraxel restore treatments, or to one Fraxel repair. I often combine the use of the Vbeam Perfecta and or the Alex Trivantage laser with the Fraxel laser to get the best results when treating this condition. The Vbeam is particularly helpful if there is a vascular component. Take care, Dr. Groff

Michael A. Persky, MD · Answer

Hi Jenny,
It depends on your skin color and skin type.  Fraxel laser has been very effective at treating brown spots on the neck.  In San Diego, Dr. William Groff, Dr. Richard Fitzpatrick, and Dr. Steven Cohen are physicians whom you can consult with to determine what might be best for your neck.
Good luck and be well.
Dr. P

Amir M. Karam, MD · Answer

Treatment of sundamaged and photoaged neck skin is always a challenge.  My preferred approach is with a series of light to medium strength chemical peels coupled with topical treatments.  The neck skin is not the same as facial skin and needs to be treated with care. Scarring and other problems are more common in the neck, so conservatism is best in this area.  We have had good success using this combined treatment program. 
Best, 
Dr. Karam

Otto Joseph Placik, MD · Answer

I would recommend long term maintenance with Retin-A but a series of chemical peels may be beneficial in this particular instance to help improve the decolte area.

Nissan Pilest, MD · Answer

Fraxel is probably a good choice and more controllable than peels (though chemical peels are a less expensive option). With laser a physician can set the depth and coverage pattern in a way not possible with chemical peels. The Fraxel Restore procedure is performed in a series and you will see improvement following each session.
With fractional laser you don't experience a "full peel" but a dot matrix of treated and untreated skin. This hastens healing and you have no discernible sheet-like peeling.
The skin on the neck does not heal as quickly as that on the face, so care must be taken to have treatments at controlled levels no matter what treatment solution you ultimately choose.

Treatment for Stubborn Sun Damage on Neck?

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