What's the most effective way to get rid of facial sun spots? I tried the Max G laser twice, but spots came back (Photo)

I'm 46 yrs old with very stubborn facial sun spots mostly in the cheek area with none on my forehead. In the winter time, my dermatologist used the Max G Laser twice but the spots gradually came back in different areas around 6 weeks later. I was not out in the sun at all except to get into my car, and I used a broad spectrum sunblock daily (Elta MD UV Daily Broad Spectrum SPF 40 Moisturizing Facial Sunscreen with Hyaluronic Acid, Transparent Zinc Oxide and UVA/UVB Protection).

Doctor Answers 10

Sun spots and treatments

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Sun spots can be treated extremely well with the Fraxel Laser.  Special care must be used for weeks after the laser to ensure that the spots don't return.  You can even get a considerable amount of sun through the car.  Please consult a board certified dermatologist with expertise in these lasers.

This is melasma

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Melasma has the tendency to recur. This condition is due to genes, sun and hormones. Treatments are aimed at treating the pigment, but also slowing down pigment production. Specialists will have their own variation of managing melasma however here are some of my methods-

1. Start with strict sun protection twice a day. 

2. Add bleaching creams such as HQ

3. Titrate some vitamin A and AHA peels

4. Very gentle Q switch lasers

I have included a link regarding a summary of current melasma management. 

All the best

Dr Davin Lim 
Laser and aesthetic dermatologist
Brisbane, Australia

Melasma Responds Well To Bleaching; "Sunspots" To Certain Peeling Agents

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
I am not much of a fan of many kinds of lasers, having found their results to be disappointing, as in your particular case. Treatments also tend to expensive and multiple treatments are typically required. 

Although there is no substitute for a in-the-flesh examination of the skin, from the photos it appears that there are two problems: melasma (i.e. the background confluent brownish discoloration) and individual "sun spots" or "liver spots" (solar lentigines). The former may be treated by home-use prescription bleaching agents, combined with the use of certain peeling agents, e.g. Jessner's solution, low-strength TCA, or high concentration glycolic acid. Home use products may contain lightening agents, such as  hydroquinone, azalaic acid, abutin and kojic acid.

The liver spots may respond well to either light electrodessication or TCA 25% applied directly to the spots.

It should go without saying that a consultation with a board certified aesthetic physician with experience and expertise in treating skin pigmentary problems is strongly recommended to ensure the right treatment or combination of therapies will be tailored to your particular needs. 

Nelson Lee Novick, MD
New York Dermatologic Surgeon
4.9 out of 5 stars 33 reviews

Brown spots

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
A photo has its limits. But from your photos I suspect you may have melasma. This is different from regular sun spots. Melasma brown spots tend to cluster in patches whereas sun spots are usually more discrete. Melasma is worsened by heat and sun, estrogen, and other triggers. Do you take any hormonal therapy? You may benefit from a triple cream like TriLuma which is FDA approved for melasma, in combination with several chemical peels in the office. Finally something like Skinceuticals CE Ferrulic can be applied in the AM before your moisturizer, to help decrease pigmentation. 

There are good laser treatments but, especially if you have melasma, it needs to be done properly. Usually the regimen above works best. Be well. 

Estee Williams, MD
New York Dermatologist
5.0 out of 5 stars 23 reviews

Bleach and vi peeel

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
The use of a pretreatment with a combination bleaching product with hydroquinone, ionic acid, tretinoin, and a steroid will lighten the area.This can be followed by the vi peel ,a medium depth peel which can lighten dark areas on any color of skin. There is redness for one week.

Morris Westfried, MD
Long Island Dermatologic Surgeon
5.0 out of 5 stars 5 reviews

Melasma to Face

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
There is a couple different treatments you can do for this problem. The Sciton Profile BBL treatment works well in targeting melanin in the skin which causes the brown pigmentation. Another great option is the Permea laser by Clear and Brilliant. They are both quick and easy procedures, I recommend doing either in a series of 3or4 4-6 weeks apart.

As always, wearing SPF45 or higher on a daily basis is very important.

#sunspots. #brownspots. #agespots

How to treat sunspots.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Your skin is extremely sensitive to the ultraviolet rays from the sun. I usually treat patients with tretinoin cream mixed with hydroquinone and then sunblocks. This should eliminate the spots almost completely within a month of treatment. Then you need to remain on some maintenance and strong sunblocks to prevent recurrence. 

Facial Pigmentation

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Hello. From the photos, it seems like you have both Melasma and sunspots known as solar lentigines. Certainly, if you were seen by a dermatologist, they would do a Wood's lamp evaluation, to determine the depth of your melasma. If it is superficial, the treatments are often more effective. The actual number of lentigines could also be determined. Solar protection is of the utmost importance. You should wear an SPF sunblock of 30-45 every morning and reapply it regularly. Wear a broad brimmed hat, and remember, UVA rays will penetrate your car windows. Please see your dermatologist for specific lightening creams, some will contain Hydroquinone, Vitamin C and tretinoin (Vitamin A).Remember, Melasma is a chronic,recurrent skin disease, so protecting your skin from the sun will be a life long process.

Gail Nield, MD, FRCPC
Toronto Dermatologist

What's the most effective way to get rid of facial sun spots? I tried the Max G laser twice, but spots came back

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Thank you for your question. This is Melasma which is different from basic sun damage. It requires topical treatment as well as a combination of different lasers and or peels to keep it at bay. Consult with a Board Certified Plastic Surgeons office for a treatment plan that is best for you.

Treatments for skin lightening of melasma

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
I would begin with topical skin lighteners such as Melarase AM and Melarase PM followed by IPL Limelight and Q switch laser. 

Dr. Karamanoukian
Los Angeles

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 95 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.