Best Treatment for Brown Sun Spots?

Question

I have many brown sun spots on my cheekbones and surrounding area. What would be the best course of treatment for this problem?

Raffy Karamanoukian, MD, FACS · Answer

Hyperpigmentation can ruin your skin and can be caused by either PIH (post-inflammatory hyperpigmentation), melasma, age or sun spots, and chronic inflammation.  Starting treatment is easy with topical creams; followed by laser and light therapy. I would use a combination skincare protocol that includes topical Melarase creams first, followed by a combination of light fractional laser, depigmenting lasers and IPL, vascular pulsed dye laser, and Covalent peels. 
Recommended Creams: Melarase Brightening Kit
MelaClenz
Melarase AM
Melarase PM
Melapads
Replenish Retinoid Cream
Best, 
Dr. Karamanoukian
Realself100 Surgeon

Tracy Mountford, MBBS · Answer

Sun damage is a major contributing factor to age spots.  Avoiding exposure with regular use of sunscreen is so important at any time of year, to protect the skin from sun damage. Depending on your age and the severity of your sun damage, there are a number of treatments that can help. These include IPL (Intense Pulsed Light) which can reduce age spots and improve the appearance of sun damage. It works by targeting brown pigment and red vessels, and also has the benefit of stimulating collagen production.
Chemical peels are also a safe way to improve your skin. An acid is applied to the top layer to stimulate new collagen production and fade pigmentation. Peels are especially good if you also suffer from fine wrinkles or acne damage. To maintain the improvement in skin quality, prescription cosmeceuticals are also recommended. They contain higher concentrations of active ingredients such as Vitamins A and C, which work with the clinical treatments to minimise brown spots.  Hope this helps.

William Kwan, MD, FAAD · Answer

Sunspots on the face are one of the most common issues that I see with patients who come to my office.  I generally recommend a topical bleaching agent, either with or without hydroquinone. Obagi Nu-Derm is a good choice and can often dispel most of the brown spots. Any discoloration that doesn’t respond to the topical bleaching is then treated with either a Picosecond 522nm laser or a long pulsed alexandrite laser. One of these options will usually eliminate the remaining spots within 1-3 treatments.

Dennis Gross, MD · Answer

Treating Different Types of Sun DamageDark Spots – If you are a patient who is interested in getting rid of dark spots on the face, chest, arms, hands or legs the Gentle Max Pro Alexandrite resurfacing treatment will quickly and easily eliminate them, leaving the skin clear and youthful. The number of treatments will depend on your skin—and how many brown spots you have. Expect that you might need one to several treatments over the course of several weeks to get rid of the dark spots entirely. Following the treatment, any spots treated by this laser will become darker in color, scab and gently flake off. Total downtime can vary from two to five days. This laser is brilliant! It’s quick, there is no scarring and very little downtime.Discoloration, Melasma and Redness – To treat the whole face, especially freckles I recommend the IPL (Intense Pulse Light or Photo Rejuvenation) treatment. Focusing on achieving a beautiful even skin tone all over, this treatment will remove any superficial discoloration. There is no downtime with this treatment; you will walk out of the office with noticeable improvement in brown hyperpigmented areas, as well as a reduction in overall redness. A series of treatments may be recommended.Anti-aging, Rejuvenation and Dark Spots – A few times a year I highly recommend doing a Retinol Peel. These are our deeper peels, which also go by names like the Vitamin A Peel or Retinoic Acid Peel. This peel treatment delivers a stronger concentration of acids than your professional in-office no downtime peel. It is followed by a high dose of retinol meant to maximize ingredient penetration and absorption of the anti-aging actives. A Vitamin A Peel is suitable for all skin types and will gently remove dead skin cells and promote a healthier looking skin. Your skin will be glowing, softer and with a smoother more even skin tone. Downtime is 5 to 7 days and involves facial peeling as well as staying out of the sun. Afterwards it is recommended to use gentle products (such as a moisturizer and face wash) with simple non-irritating ingredients.Keep in mind, regardless of these amazing treatments, you should never go in the sun unprotected. Dark spots will return if you do not wear sunscreen or increase your level of SPF. Sun damage can happen all year-round. Dark spots, redness and freckles are all ways your skin is talking to you, and telling you that it has had too much UVA/UVB exposure.

Aaron Stone, MD · Answer

As we age the pigment cells of the skin migrate from a widely dispersed pattern into clumps separated by areas of less pigmentation. This is hastened by sun exposure and appears to the eye as age or brown spots. The best treatment is laser with a 1064nm wavelength as that has the best absorption for that color. When multiple brown spots appear on the face most doctors prefer chemical peel or laser resurfacing to even out the pigmentation over a broad area rather than treat each spot indvidually.

Randolph Capone, MD, FACS (in memoriam) · Answer

UV light (from the sun's rays and tanning booths) causes DNA damage and collagen/elastin degradation associated with the aging process.  This can cause the appearance of brown hyperpigmentation spots, increased skin cell adherence, fine wrinkles, and the general loss of skin luster.  It also causes skin cancers which can be deadly.
Brown hyperpigmentation represents irregular melanin deposition in sun-exposed areas of the face, arms, hands, and decolletage.  One of the best treatments is Intense Pulsed Light (IPL).  IPL photofacials are performed at 3 week intervals to erase the brown spots and smoothe the appearance of the complexion.  Usually 3-4 sessions are required with essentiall ZERO downtime!  
To ensure your complexion stays even, we also recommend starting a strict medical skin care program (eg Obagi) with limitation of sun exposure / broad spectrum SPF in addition to the IPL treatments. 
For completeness, you should know that medium-depth chemical peels can also do a very nice job of erasing brown spots and can help erase fine lines simultaneously, but are typically associated with anywhere from 2-4 days of downtime.  So the added benefit of eliminating wrinkles comes with the cost of a few days of downtime. 
In any event, discuss all these issues thoroughly with your plastic surgeon or dermatologist and get going on a course of therapy!  And stay out of the sun, or at least buy a good hat.

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