HELP - I'm 45 with minimal wrinkles but have the dreaded sun spots. They are not bad but being a blonde with fair skin and not exactly wearing a ton of make-up, they are bothersome. I'm also a runner and really enjoy spending my time outdoors. Hate hats, wear sun block & glasses - not a sun worshiper but I definitely don't hide from it. Heres my question - I'm so afraid of spending 'x' amount of money to have the Fraxel only to be disappointed - making the spots worse by doing the things I enjoy!?! Any advice?
How to Treat Sun Damaged Skin and Still Enjoy the Sun
Doctor Answers 8
Use IPL for sun spots
Certainly you can't have it both ways and be in the sun and then erase the effects and then repeat. It just doesn't work that way. Start to wear hats, continue with the sun screens and use IPL to treat the spots. If you are 45 and don't break this cycle, you really won't like what your skin looks like at 55.
Treating sun spots in a sun lover
You need to be honest with yourself about how willing you are to protect your skin from the sun. Don't waste your time and money treating your sun damage if you are not going to start protecting yourself from the sun. You don't have to stay home and hide and stop doing the things you love, but you do need to adapt your behaviors in order to minimize the damage to your skin. Wear SPF 30 or higher sunscreen, one with avobenzone and zinc oxide or titanium dioxide and wear a hat. Try to do your outdoor activities when the sun isn't at it's peak, which is usually between 10 and 2.
If you decide that you want to treat your sun damage and you are going to start practicing good sun-protection, you have a variety of options. You can start with a retinoid cream at night that will help build collagen and fade the discolorations. You can boost the effectiveness of the retinoid cream by adding a hydroquinone, like with TriLuma cream. You should also use an antioxidant serum in the morning. Another option would be intense pulsed light. IPL will treat the brown spots very well, and it sounds like that is your main concern. Fraxel is another option, which treats fine lines and pigment. However, if you are only treating the brown spots then IPL may be the way to go.
Practice 'Safe Sun'
This question is really a very tough one. The bottom line, though, is that sun exposure causes lines, wrinkles, spots of discoloration as well as skin cancer. Nonetheless, if you wear sun block and/or a wide brimmed (4 inch) tightly woven (not straw) hat, you may still enjoy the sun. In our experience in sunny Florida, we find that the key difference between patients who have a great result and fair result, is that our patients who enjoy great results practice safe sun (ie wear sunblock and a hat), whereas those who go right back into the sun do not fare as well.
Topical Retinoid prior to Fractionated Laser Resurfacing for Sun Damaged Skin
Don't do Fraxel if you can't protect your skin from sundamage
If you can't protect your skin, or choose not to, then you should not have an expensive laser treatment. I would have you try to do your outdoor activities very early or late. Use an inorganic and organic sunscreen ( a U.V. "A" and "B" sunscreen, one that contains a photostable UV A blocker such as Helioplex, as well as a titanium dioxide / zinc oxide mineral-based sunblock which would be applied over the sunscreen). If you use a high number block, and get treated in a less sun-intense season, you could be considered a candidate. But if you don't follow this advice then you would be wasting your money on Fraxel for sunspots as they can come right back after unprotected sun exposure.
First we need to be realistic. If you are continually exposed to the sun, you will continue to experience further sun damage. The best advice I have: maximize your sun protection when outdoors. Hate hats? Learn to love them. Use sun bock (SPF 30 or greater), and reapply frequently.
Treatments for sun damage; Given your frequent exposure to the sun, I would recommend procedures with less down time and which are less expensive. Intense Pulse Light is the best solution, but will require at least a day or two out of the sun before and after treatment.
Try Triluma first
I think it is very important to get exercise and be active, even if it means a little sun damage. It is not worth spending a lot of money on procedures, however, if you continue to get the sun damage. It sounds like you are being as careful as you can be using sunscreen and hats, but are you using an antioxidant? Are you taking oral anti-oxidants? Is your SPF at least 50? These ideas will help a lot. I'd also try Triluma for 6 months to see how much improvement you get, then talk to your dermatologist about Fraxel Dual, IPL, light peels, Pearl laser, SilkPeel when you can avoid the sun for 4 weeks or more if you do not respond to Triluma.
How to Treat Sun Damaged Skin and Still Enjoy the Sunny Outdoors
Both IPL and Fraxel will help with your sun damaged skin. Wearing an effective physical sun block is essential to preventing further sun damage. If you do choose to have your sun damaged skin treated, you should have it done during the winter time when you are less exposed to the sun. Certainly avoid sun exposure in the immediate post treatment period to avoid post inflammatory hyperpigmentation. Many top skin care products have pigment lighteners that help with sun damage.
Having your "cake" and eating it too is always difficult. Good luck and be well.