Where do I start to treat all this sun damage? Atlanta dermatologist or Plastic Surgeon? Anyone with recommendations? (photo)

I have sun damage on my face & all over. Lots of time in the sun & Tanning beds over the last 20 years. I was a Tan Mom. Addicted & now my skin is ruined. My derm is considered one of the best in Atlanta but he will not address my cosmetic concerns. Seems he is busy with skin cancer & Mohs. I went out on my own and tried dermabrasion & Skin Classic Treatment but not much improvement. I need an ATLANTA derm or PS willing to help with my severe sun damage. Under eyes fat pads are also a problem.

Doctor Answers 8

Treat skin damage

Your best result will be with a plastic surgeon specializing in cosmetic treatments of the skin and well as surgery. I am one of them but certainly not the only one.

He or she can help with your eye bags as well.

Please do not treat yourself. 

Treatment takes time but I have had patients with dreadful skins that with a step-wise approach of skin care, peels and laser got fabulous skins, even after years of tanning. Do not despair. Just find a surgeon who works with the skin. 

Atlanta Plastic Surgeon
4.6 out of 5 stars 43 reviews

Recommendations For The Treatment Of Sun Damaged Skin

This is a difficult problem to manage without a detailed examination but I will give it my best shot. True hyperpigmentation secondary to excessive solar damage is usually located on the temporal and cheek skin. It usually seems more pronounced in summer months because of a tanning of these effected areas. My method of choice is to first drastically reduce the pigment with 2 to 3 IPL (BBL) light treatments. Without using the intense light treatment first and relying strictly on the use of a topical lightening cream would take an extremely long time to notice a result. My recommendation would be as follows:

  1. Intense pulsed light (IPL, BBL) laser treatment. Will much more effectively reach the deeper skin layers and more effectively lighten the pigmented areas.
  2. After the above is done, then go to a topical skin bleaching cream (4%Hydroquinone) for maintenance and to help avoid a recurrence of the hyperpigmentation.
  3. Use sun-block because excessive solar exposure will worsen the problem and make the efforts in step 1 and 2 much less effective.
  4. For long term control (after 4 months) you can go to a 2% hydroquinone for long term maintenance.

Joseph Rucker, MD, FACS
Eau Claire Plastic Surgeon
4.7 out of 5 stars 20 reviews

Treatment of Sun Damage

Without a full examination, it is hard to determine exactly what you need. However, it appears that she have significant pigmentary abnormalities on your face as your main problem. Almost certainly, you will also have some dullness and thinning of the dermis (the support layer of the skin). I have been treating problems like this for over 25 years, and have found only one thing that really does improve the skin and rejuvenate it. That thing is the Obagi Nu-Derm skin care system. The system removes the dead cells, returning the luster to the skin, corrects the pigmentary abnormalities, thickens the dermis to prevent crinkles and wrinkles and protects the skin from further sun damage. There are many dermatologists and plastic surgeons in Atlanta using the Obagi system. Go to Obagi.com to find one near you. To improve your chances of really rejuvenating your skin, make sure the physician actually sees you. Being slightly North of Atlanta, I have found that many of the aestheticians there starting patient's on Obagi do not start them on the entire system or arrange for adequate follow-up. The latter is important since the Obagi system is a medical treatment for sun damage. That, however, is how it works so much better than other options which contain no FDA approved drugs. Though there are lasers etc. approved for treating sun damage, none of them treat the entire spectrum of damage like the Obagi system.

Robert T. Buchanan, MD
Highlands Plastic Surgeon
5.0 out of 5 stars 6 reviews

Treating sun damaged skin


Chronic sun damage affects the structure of the skin, including rapid breakdown of collagen and development of brown sun spots, or solar lentigo. Volumizing and tightening the skin can be performed with laser and radiofrequency devices and to a lesser degree with topical creams. 

I advocate maintenance and prevention for healthy skin care.  I assess and listen to patients about their skin concerns and we find a regimen that works with their lifestyle-whether aggressive or progressive, and keep open discussion about tailoring any new changes, whether under eye dark circles, loss of volume in the face, double chin, hair growth, etc. 

Some derms are pure medical derm.  Some aren't .  I was trained across cosmetic, pediatric, surgical and medical dermatology. It makes a difference to help patients with all concerns.

Nikki D. Hill, MD, FAAD
Tucker Dermatologic Surgeon

Treatment of Sun Damage - where to start

Aestheticians and Medical Aestheticians need to work hand-in-hand to develop a successful skin care program. Each offers different levels of services. Identification of those conditions requiring advanced services or medical products are key to the success of this program.
Clients with the following conditions should be referred to a medical aesthetician:
  1. Hyperpigmentation and irregular pigmentation, age spots
  2. Acne and its complications – e.g. scarring, hyperpigmentation, and large pores
  3. Rosacea
  4. Rhytides (Wrinkles) treatment
  5. Patients with medical conditions such as Diabetes, Exzema, history of cold sore, shingles, psoriasis, rosacea, or steroid use
  6. Scar Management
  7. Previous chemical peel or laser treatment
  8. Severe sun damage (actinic changes of the skin)
  9. Plateau of results by conventional spa services requiring more aggressive medical based protocols
  10. Patients with a history of Skin Cancer or pre-cancers ( e.g. Actinic Keratosis, pigmented sores, or scaling lesions)
The following constitutes some of the treatment tools restricted to Medical Aestheticians:All products consisting of skin care lotions, ointments, liquids, substances, creams, powders, preparations, tonics, antiseptics, and other skin care items and products which the manufacturers or distributors will make available only to a physician or to persons who are working under the guidance of a physician as to their proper use. For example these include all products within the Obagi and / or Biomedic lines, as well as retinoids (e.g. RetinA), antiviral agents, 4% or greater hydroquinones, TCA, etc.
Medical procedures and use of medical equipment which must take place by physician protocol and/or oversight:
  1. Depth of Treatment as solo procedure with a non medical machine based on a more thorough treatment determined by number of passes or time per area; any procedure which requires recovery time because of redness (erythema).
  2. Medical Grade Machine, e.g., limited distribution to medical professionals, options for increased power settings, or medication delivery systems.
  3. Treatment of Patients with Medical Problems Acne, Roseacea, scars, stretch marks, non-uniform pigmentation (dyschromias), history of skin cancer, herpes, diabetes, hepatitis, HIV, previous laser or chemical peel prescription, etc.
  4. Non-medical grade microdermabrasion coupled with other treatments, e.g., glycolic, TCA, lactic acid or Jessner Peel, 4% hydroquinone, Oxymist, Dermaplaning, Micro Peel, Cryotherapy, etc.
  5. Chemical exfoliation (peels) within the scope of a cosmetologist’s license and affecting non-living tissue only, including Blue Peel, TCA peels and medical grade glycolic peels.
  6. Dermaplaning living tissue only per protocol.
  7. Laser treatments such Permanent Laser Hair reduction, IPL (photofacial) laser, vascular lasers (for broken capillaries or veins and red spots), color and scar improvement, and lasers for facial resurfacing.
  8. All injectibles such as Jeuvederm, Restylane, Sculptra, Radiesse, Voluma, Botox, lipoinjection (fat transfer). Surgical procedures.

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 157 reviews

Sun damage and hyperpigmentation with Retinoid Repair Cream

Before you dive in and get aggressive treatments that are very costly, get your skin prepared with a retinoic based cream like Retinoid Repair Cram (see link below) and a regimen to help the hyperpigmentation with Melarase products (AM and PM). The retinoid creams are excellent in rejuvenating the skin and increasing skin turnover and along with the products that reduce pigmentation, you can then spend money to get IPL treatments, laser resurfacing or an Obagi Peel. Be patient, it is a process and it will take time. See the link I provided below where you can purchase the 'Tri Pack Package' 

Hratch Karamanoukian, MD, FACS
Buffalo Phlebologist
4.8 out of 5 stars 41 reviews

IPL or photo facial treatments for pigment and sun damaged to the face

Fortunately you do not have severe skin wrinkles over your face.  The IPL or photo facial treatment is the best for removing pigment caused by sun damage.  The new non-ablative fractional erbium laser is in the 1540, 1450, and 1565 nm range can also remove pigment and build new collagen in your skin.

Photo skin rejuvenation for sun damage and aging

Thank you for your question and the photos.

For definitive recommendations, you will need a full consultation in person. One option to consider is Broad Band Light therapy. It is good at reversing the signs of aging and sun damage, rejuvenating skin to a more youthful appearance.

See two or more board certified physicians for a complete evaluation before proceeding with treatments.

I hope this helps.

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 183 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.