Solar lentigo - Best way to tackle my freckles/dark spots? (photos)

Question

Hi all, I have very large dark spots (my derm referred to them as solar lentigo) on my face they look like freckles and are mainly concentrated on one side of my face. I am of south Asian heritage and a 4 on the Fitzpatrick scale I’m booked in for a cosmelan peel but from research and looking at before & afters I’m not sure if this will get rid of my freckles. I’m also worried about rebound pigmentation. Is cosmelan good or better treatments out there?

Raffy Karamanoukian, MD, FACS · Answer

Our office has many different treatments for scars depending on the depth of atrophy or hypertrophy. Scars require a combination approach using our HI DEF protocol which uses a combination of lasers, topical scar modulation, and RF treatments to pixelate scars, improve contour, reduce hyperpigmentation, and improve the visibility of the scars so that they are no longer visible in ambient light. Everyone has a unique pattern of scarring and we employ our HIDEF technique to improve texture, color, contour, and topography. We often use a combination of treatments that begin with a careful examination to examine the micro texturing of the acne scars. Atrophic scars and indented  scars can benefit from injectable fillers such as Radiesse, Sculptra, and Restylane with or without subcision to remove tethered scars and atrophic depression. Hyper-redness in scars can be improved with V beam laser, Excel V, BBL, IPL, and Venus RF to improve  the redness and reduce the visibility of deep scars. Fractional Thulium laser and clear & brilliant can also reduce the inflammation and redness of the scar when combined with topical therapy. Fractional lasers such as Fraxel, erbium, and CO2 laser can be combined with radio frequency and also fractional RF to improve textual issues and microtopography. Subcision and TCA cross are also used for deep ice pick scars and narrow valley scars in order to improve the micro texture.  Above all, our combination approach with our clinical nurses and board-certified plastic surgeons can improve the quality of your skin by using at home Melarase creams combined with PRP treatments in our office to improve your skin quality and tone. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your scarring.
 
Finally, hyperpigmentation of scars can be improved with at-home Melarase AM, Melarase PM, and Melapads to help reduce active PIH and melanin deposition.

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Robert T. Buchanan, MD (retired) · Answer

The problem with using a peel for solar lentigo os that the peel only removes the outer layer of the epidermis. This does remove a large portion of the cells containing the abnormal pigment, but does nothing about the cause or the pigment at the bottom of the epidermis. Thus, the pigment is just tightened, not eliminated. The only way to completely remove the pigment is with a treatment of the pigment cells that are causing the problem. The best is Obagi's Nu-Derm System. You can also treat all the pigment with an IPL that targets the pigment throughout the epidermis. If you are just wanting to improve the problem then repeated peels every 6-8 weeks can work. The other thing you need to do is use a good zinc oxide sunblock DAILY to reduce recurrence.

Solar lentigo - Best way to tackle my freckles/dark spots? (photos)

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Solar lentigo - Best way to tackle my freckles/dark spots? (photos)

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