What would be the best treatment for my skin discoloration? (Photo)

Question

I have read through a few different procedures and have tried to find what this is. I have always had a thick white line around my mouth, it’s very visible even with makeup on. I also have a brown mark next to my mouth which I think is a birth mark but would also love to be rid of it as well. I was not 100% if a procedure such as anything as these would be helpful in my case or not.

Anna Chacon, MD, FAAD · Answer

Thank you for your detailed question and photo. Based on the description and image, it appears that you have two distinct concerns:

Hypopigmented (white) band around the mouth, likely perioral leukoderma, which may be congenital or due to a pigmentary disorder.

Hyperpigmented brown spot, possibly a café-au-lait macule or a congenital lentigo (commonly referred to as a birthmark).

1. White Line Around the Mouth (Hypopigmentation):
This type of pigmentation loss is typically difficult to camouflage, even with makeup, and unfortunately, hypopigmentation does not respond well to traditional lightening treatments.
Potential treatments may include:

Excimer laser: Can sometimes stimulate pigment in localized vitiligo-like lesions.

Tacrolimus ointment: In select cases, this has helped repigment mild leukoderma.

Micropigmentation (cosmetic tattooing): Can be considered when no medical treatments are effective.

Careful sun protection to avoid further contrast between the surrounding skin and hypopigmented area.

2. Brown Spot (Hyperpigmentation):
If this is a benign birthmark or lentigo, there are several treatment options to lighten or remove it, depending on its depth and size. These include:

Q-switched laser treatments (such as Nd:YAG or Alexandrite lasers): Target melanin and can gradually lighten pigmented lesions.

Pulsed dye laser or Intense Pulsed Light (IPL): Helpful for superficial pigmentation.

Topical skin lightening agents: Hydroquinone, kojic acid, or azelaic acid can help fade surface pigmentation over time.

Final Thoughts:
The hypopigmented area around the mouth will be more resistant to treatment than the brown lesion, but both concerns are treatable with appropriate modalities. It is important to confirm the exact diagnosis through clinical evaluation and possibly a Wood’s lamp exam or biopsy before proceeding with laser treatments.

Be sure to use broad-spectrum sunscreen daily, as UV exposure can exacerbate pigmentation contrast and delay progress.

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

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin in Winnetka and Chicago. This is a great question. For addressing the thick white line around your mouth and the brown mark, both Pico laser treatments and CO2 resurfacing lasers could be effective options. Pico lasers are known for their ability to target pigmentation issues with minimal downtime, making them a good choice for reducing discoloration and improving skin texture. They work by delivering short bursts of energy that break down pigment without damaging surrounding skin, which can help with both the brown mark and the white line's appearance. On the other hand, CO2 resurfacing lasers are excellent for more significant textural changes and can effectively treat deeper skin concerns, including scars and pigmentation. This treatment promotes collagen production and can improve overall skin tone and texture. I love both of these lasers and highly recommend. I hope this helps and best of luck!

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