Facial Hyperpigmentation

Facial hyperpigmentation is one of the most common skin conditions that affects millions of individuals around the world. It often manifests itself as spots or patches of skin that are darker than your natural skin tone. Hyperpigmentation can occur on the skin for several reasons and most often presents on the sun exposed areas of the face and body. Facial hyperpigmentation can affect all individuals, regardless of age or skin tone. Although this skin condition is cosmetic, it can seriously impact one’s self-esteem. Thankfully, there are many treatment options available such as chemical peels, Cosmelan, Mesopeels, skin resurfacing lasers, and topical skin care products. If you are suffering from hyperpigmentation, post-inflammatory hyperpigmentation, melasma, sun spots, or dark spots, board-certified cosmetic dermatologist Dr. Michele Green in NYC is here to help.

Hyperpigmentation is a broad term which describes many skin conditions which leaves your skin discolored from a myriad of factors. There are three main types of hyperpigmentation: age spots, melasma, and post-inflammatory hyperpigmentation. Depending on the type of hyperpigmentation you have, there are different causes and treatment options available. Some of the most common factors that contribute to hyperpigmentation include sun damage, acne scars, and hormonal changes. Some patients can also develop hyperpigmentation as a side effect from other treatments, such as Fraxel laser, Intense Pulsed Light (IPL), or Picosure lasers. Therefore, it is imperative to consult with an expert in facial hyperpigmentation, like Dr. Michele Green in New York, to determine the best treatment options to decrease and remove your hyperpigmentation.

Dr. Green has over 25 years of experience in treating facial hyperpigmentation. In her private, Upper East Side dermatology office, Dr. Green has treated thousands of individuals who suffer from hyperpigmentation in all skin tones and skin types. By combining noninvasive in-office cosmetic procedures with the best specially formulated skin care, from her MGSKINLABs line, Dr. Green is able to offer her patients a customized treatment plan which address their body and facial hyperpigmentation. She takes pride in understanding the individual needs and goals of each of her patients to help them look and feel like the best version of themselves. It is no wonder that she is consistently voted as one of the best dermatologists in NYC by the New York Times, New York Magazine, and Castle Connelly. When it comes to treating your facial hyperpigmentation, Dr. Green will help you achieve clearer and more radiant skin.

What causes facial hyperpigmentation?

Hyperpigmentation is a general term that is used by medical professionals to characterize patches of skin that are darker in color than the rest of the skin due to the overproduction of melanin. Dark spots can develop for a wide variety of reasons, though the most common contributing factor to facial hyperpigmentation is overexposure to the sun. Fluctuations in hormone levels, a genetic predisposition to melasma, the healing process of acne lesions, and skin damage caused by laser treatment, can also all lead to the development of facial hyperpigmentation. Facial hyperpigmentation can occur in individuals of any skin tone and type, and depending on the underlying cause of the hyperpigmentation may appear at any age.

Facial Melasma

Melasma is a skin condition that is commonly characterized by brown or blue-gray patches. There are several factors that contribute to melasma but the two main causes are sun exposure and hormones. Melasma, or chloasma, is often call the “mask of pregnancy” because it commonly occurs in pregnant women due to hormonal fluctuations. Ninety percent of patients who suffer from melasma are women, due to both a genetic and hormonal component. Other factors that make individuals more prone to melasma include thyroid disease and having a darker skin tone. Studies have shown that there is a connection between thyroid disease and melasma. There is also an increased presence of melanocytic and lentiginous nevi in patients with melasma. Additionally, melasma is more likely to develop in patients with darker skin types, especially in patients with type IV or darker skin tone. In fact, fifty percent of patients who suffer from melasma also report a positive family history of hyperpigmentation disorders.

There are various treatments currently for improving facial melasma that range from over-the counter creams, prescription skincare products with hydroquinone, chemical peels, Clear+ Brilliant laser treatment, and Cosmelan peels. In many cases, lasers are not the ideal treatment for melasma since they can cause post-inflammatory hyperpigmentation and worsen existing hyperpigmentation and melasma, ultimately making it more difficult to treat. When other treatment options have failed, Cosmelan peels can often the best course of treatment. The Cosmelan peel consists of 51 active ingredients that work to depigment the skin, for use in patients of all skin tones. Cosmelan works to remove the accumulation of melanin and inhibit the formation of new pigment.

If you know you have a propensity for melasma or facial pigmentation, preventing new sun damage is key to achieving and maintaining clear skin. It is imperative that you use sunscreen with an SPF of 50 and higher every day and reapply at least every two hours when outside. Dr. Green recommends layering on two different sunscreens to ensure total sun protection. She recommends using a chemical based sunscreen, such as one that contains avobenzone, and a physical based sunscreen, such as one that contains zinc oxide or titanium dioxide. Using sunscreen as well as practicing sun avoidance and wearing protective clothing, hats, and sunglasses, whenever possible is paramount to preventing melasma and facial hyperpigmentation.

When to consult a dermatologist for facial hyperpigmentation?

Many individuals notice hyperpigmentation but choose to ignore it but this can be dangerous since skin cancer in its earliest stages can look just like a sunspot. That’s why it is so important to see a board-certified dermatologist, like Dr. Michele Green in NYC, early on. Dr. Green can help distinguish whether or not the spot is benign or a skin cancer. When you consult a Dr. Green during the early stages of hyperpigmentation, the hyperpigmentation is less likely to be deeply entrenched in your skin, which can make removing it easier. In addition, Dr. Green can recommend the best skincare products that both treat your hyperpigmentation and prevent it from worsening.

Dr. Green can help determine the cause of your hyperpigmentation and the best cosmetic treatment. Some patients develop hyperpigmentation as a result of medications they are taking, such as birth control pills, and discontinuing these medications can help the hyperpigmentation fade. During your consultation with Dr. Green, will suggest various treatment options, such as chemical peels, skin resurfacing lasers, Cosmelan peels, mesopeels, and topical skin lightening agents. She will help determine the best cosmetic treatment for you, your skin tone, and life style, to bring you beautiful, clear skin.

Before and after Cosmelan Treatment

Sun exposure and facial hyperpigmentation

Melanin in the skin is the principal determinant of skin tone and is also responsible for the appearance of patchy areas of darker skin. Damaging UV rays from sun exposure can cause an increase in melanin production, leading to hyperpigmentation of the skin, which can be extremely difficult to remove. Patients who develop facial hyperpigmentation as a result of sun exposure may manifest dark spots in a few different ways. Some patients with sun damage may experience overall skin discoloration whereas others can develop distinct age spots or sunspots. In the realm of cosmetic dermatology, sunspots may also be referred to as liver spots or lentigines. Certain medications, like the antibiotic Doxycycline and Minocycline, can increase photosensitivity and put one at higher risk for forming dark patches, sunspots or macules on the skin.

The best treatment method for treating facial hyperpigmentation caused by sun exposure is largely dependent on your specific skin tone. Patients with fair skin may be best treated with chemical peels or laser treatments. Patients with darker skin tones may be best treated with hydroquinone, mesopeels, or Cosmelan chemical peels. During your consultation with Dr. Green, she will evaluate your facial hyperpigmentation and make her expert cosmetic recommendations based on your skin tone and the type of dark spots you have.

Hormonal changes and facial hyperpigmentation 

Facial hyperpigmentation due to hormonal changes is far more likely to occur in women than in men due to hormonal fluctuations as ma result of pregnancy, oral contraceptives, or menopause. Fluctuations in estrogen and progesterone have been shown to trigger the overproduction of melanin in women. Melasma, also known as chloasma, is the most common type of facial hyperpigmentation experienced by women undergoing hormonal fluctuations during pregnancy. The ‘mask of pregnancy’ refers to the appearance of melasma that forms on the upper lip, the forehead, the cheeks, and the nose, often resembling a mask. Oral contraceptives (the birth control pill) and some hormone replacement therapies can also exacerbate the appearance of hyperpigmentation or lead to melasma by increasing levels of the hormones estrogen and progesterone.

Female 35-44, Cosmelan, 2 & 1/2 months post treatment

Genetic predisposition causing hyperpigmentation

Individuals with darker skin tones are more prone to hyperpigmentation since they have more melanin, the component of skin that is responsible for producing your skin tone. Skin tone is affected by genes and there are certain genes that are involved with controlling the overall amount of melanin that is produced by melanocytes. There are also genes that play a role in determining the total number of melanocytes any individual has. As we age and the skin starts to change over time, the genetic makeup of an individual may make one more or less likely to become hyperpigmented. There is a strong hereditary component to certain forms of hyperpigmentation, such as melasma. Approximately 50% of individuals suffering from melasma report a positive family history of the condition and many identical twins have been reported to develop melasma.

Acne lesions and other inflammatory skin conditions that cause facial hyperpigmentation

Post-Inflammatory hyperpigmentation (PIH) refers to the dark spots that may be left behind after an acne lesion, or other inflammatory skin condition such as eczema or psoriasis. Wounds from abrasions or scars from an injury can also heal with discoloration. The color of the dark spots associated with post-inflammatory hyperpigmentation can vary from brown, black, red, pink, or purple patches of skin depending on skin tone. During the natural healing process of the skin, there is potential that skin cells involved with healing the area are also contributing to the overproduction of melanin, leading to the development of hyperpigmented areas of skin. Although this type of hyperpigmentation may fade over time, it’s more effective and efficient to have treatment with a board-certified dermatologist, like Dr. Green in New York. She can help guide you with the best skin care, sun protection, and skin lightening products.

Hyperpigmentation secondary to medications

Certain prescription and over-the-counter medications may increase the risk of developing facial hyperpigmentation. Antipsychotics, anticonvulsants, antimalarial medicines, and NSAIDS are among some of the different groups of medications which can impact the skin tone. Different medications may lead to hyperpigmentation through varying mechanisms. Some medications cause melanin to accumulate in the skin, causing hyperpigmentation. To determine whether the facial hyperpigmentation is related to medications, a thorough investigation of your medical history will take place during your consultation with Dr. Green.

Laser damage causing secondary hyperpigmentation 

If a laser treatment is used on a skin tone that is not well suited for that specific type of laser, it can result in skin discoloration and hyperpigmentation. In addition, If the energy (or heat) used is too high for a particular skin tone or skin type, the result can be an excess of hyperpigmentation as well. Dr. Michele Green has treated and corrected hundreds of patients with resulting hyperpigmentation from the Fraxel, Picosure, and IPL laser. Special care must be taken when treating hyperpigmentation, especially in patients with darker skin tones, to avoid a worsening of the underlying condition.

Similarly, melasma is an underlying condition which can often worsen from laser treatments, such as IPL, Picosure®, or Fraxel® laser. These laser treatments can potentially exacerbate the patches of hyperpigmentation associated with melasma and make them more difficult to remove. For this reason, Dr. Green always develops treatment plans for melasma that rely on chemical peels, Cosmelan® peels, Mesopeels®, and topical skin lightening treatments. Dr. Green uses a combination of products which are hydroquinone-based and some which are hydroquinone-free.

Treated with Cosmelan – 6 weeks

How to treat facial hyperpigmentation 

There are a number of treatment options available for the varying types of facial hyperpigmentation. During a consultation with board-certified dermatologist Dr. Michele Green, the appropriate treatment for you will be determined based on your medical history, past cosmetic treatments, skin type, and the types of dark spots you’re experiencing.

Topical treatments for facial hyperpigmentation

There are a number of topical treatments available that can help with facial hyperpigmentation such as hydroquinones, retinoids, retinol, azelaic acid, tranexamic acid, and kojic acid. Hydroquinone is particularly effective in treating varying types of hyperpigmentation and is only available as a prescription from a dermatologist, like Dr. Michele Green a physician. Hydroquinone is a common ingredient in skin bleaching creams which helps lighten areas of hyperpigmentation and melasma. It can be compounded with Retin-A or other active ingredients of varying strengths from 4 to 10 percent for maximum effect in reducing difficult facial pigmentation.

Retinoids and retinol are also utilized by Dr. Green in treating facial hyperpigmentation. Retinol can either be found in various over-the-counter skincare products and retinoids are prescribed by a dermatologist, like Dr. Green. Retin -A is a commonly prescribed tretinoin to treat facial pigmentation. Retin-A is a derivative of vitamin A that increases the rate of skin cell turnover. Through this process, retinoids exfoliate discolored and hyperpigmented skin cells and replaces them with healthy, new skin cells at the surface of the skin. Other helpful topical ingredients include azelaic and kojic acid, which are both tyrosinase inhibitors. Tyrosinase is an enzyme that is responsible for melanin production so usage of these ingredients can decrease hyperpigmentation by interfering with melanin production. One of the most popular topical products is Dr. Green’s Vita-C- Serum. Vitamin C serum acts to promote skin cell renewal while decreasing the appearance of dark spots.

Cosmelan Peel

The Cosmelan peel is a professional-grade mask that Dr. Green often uses to treat melasma. The mask is applied to the skin by Dr. Green in her Upper East Side, Manhattan office and worn for a number of hours (which is determined by your skin tone and the degree of hyperpigmentation). The Cosmelan peel works through several mechanisms to effectively diminish the overall appearance of melasma. Cosmelan reduces the production of melanin (responsible for skin pigment) inside the melanocytes (skin cells that are responsible for making melanin) by inhibiting the tyrosinase enzyme. It also blocks the transfer of melanin from the melanocyte to the keratinocyte, preventing the migration of pigment to the epidermal layer of skin. The result is a reduction in visible melasma and a complexion that is more even in skin tone.

Chemical peel – 2 months before and after

AlexTrivantage Laser

Candela’s AlexTrivantage laser is used in Dr. Green’s office for reducing the appearance of undesired age spots, sun spots, freckles, and birthmarks. The laser is able to safely target the excess pigmentation in the skin while leaving the surrounding tissue unharmed, making it a powerful tool in the treatment of facial hyperpigmentation. The AlexTrivantage laser is a Q-switched Alexandrite laser, with the proven 755 nm wavelength, as well as the 532nm and 1064nm wavelength for darker skin tones. The AlexTrivantage laser is ideally suited for removing sun spots or freckles.

Fraxel Laser treatment 

The Fraxel laser is the “Magic Eraser” and the gold standard treatment for improving skin tone and texture. Fraxel is a fractionated skin resurfacing treatment that is often recommended for patients who suffer from extensive sun damage and facial hyperpigmentation. It has the ability to effectively diminish the appearance of dark sun spots in an entire area of the face, neck, chest, arms, or legs, with little downtime. The Fraxel laser creates controlled, microscopic wounds in the skin through application of highly concentrated laser pulses. As the skin repairs these wounds, new collagen is produced, new skin cells grow, and the damage from the sun begins to heal, revealing a brighter, more radiant complexion that is even in tone. Fraxel, however, should not be used in the treatment of melasma and is best suited for patients with lighter skin tones, particularly skin types I-III.

Intense Pulsed Light 

Intense Pulsed Light (IPL) is another treatment to remove facial hyperpigmentation and dark spots, and improve the overall appearance of your skin. IPL treatment is different from other lasers in that it possesses many different wavelengths of light, whereas most lasers typically release a single wavelength. IPL is able to address a wider variety of skin concerns due to the varying wavelengths of light released. Depending on the wavelength, IPL can treat hyperpigmented skin cells, hair follicles (for hair removal), or facial rosacea (broken blood vessels) and increase new collagen formation for skin tightening. When it comes to treating hyperpigmentation, the pigment cells in the dermis of the skin absorb the light energy released by IPL and are destroyed, while surrounding cells are unharmed.

Clear + Brilliant® Laser

The Clear + Brilliant Laser is a gentle laser treatment, which utilizes fractional laser technology, to treat facial hyperpigmentation, fine lines, reduce pore size, and improve the overall appearance of skin tone and texture. The Permea handpiece is specifically designed to remove facial pigmentation in 4 to 6 treatments. Clear + Brilliant is commonly referred to as a “mini-Fraxel” laser, and will rejuvenate and address the early sings of sun damage and photo-aging in all skin tones.

Chemical peels for facial hyperpigmentation

Chemical peels are a very popular treatment that Dr. Michele Green recommends often  to her patients who are looking to reduce facial hyperpigmentation and dark spots on their face and body. Trichloroacetic acid peels (TCA peels) are used to chemically exfoliate the skin. The chemical peel increases the rate of skin cell turnover, which encourages the dead and discolored skin cells to be more quickly replaced with new, healthy, evenly-colored skin cells. Dr. Green often combines different chemical peels with her unique line of MGSKINLABs products to exfoliate, enhance, and remove unwanted pigmentation.

Microdermabrasion

Microdermabrasion is a cosmetic procedure which targets the epidermis, the top layer of your skin. During the procedure, a special applicator gently exfoliates the top layer of skin. This minimizes the appearance of skin discoloration and dark spots while improving the appearance of fine lines, texture, and tone, through the induction of collagen synthesis. Alternatively, aluminum oxide or sodium bicarbonate crystals can be used through microdermabrasion to gently renew the top layer of your skin. There is no recovery time associated with either type of microdermabrasion. Careful sun avoidance and the proper sunscreens are always recommended when treating hyperpigmentation.

HydraFacials

The HydraFacial is a three-step medical grade facial that helps to improve the overall look and feel of the skin. The HydraFacial focuses on deeply cleansing, gently exfoliating, and intensely nourishing the skin. The gentle, unique vortex fusion technology of the Hydrafacial allows for powerful extraction of impurities from the pores while simultaneously infusing beneficial antioxidants into the skin. The result is a radiant and healthy glow in just one thirty minute treatment with no downtime involved. By customizing your HydraFacial treatment with a Britenol booster, you can further improve the complexion by evening and brightening your skin tone. The Britenol booster is formulated with Vitamin C, bearberry extract, and alpha-arbutin to effectively provide the skin with radiance while minimizing the appearance of hyperpigmented spots.

VBeam Laser Treatment 

The VBeam laser works by releasing a burst of light at a wavelength of 595 nanometers to target the red pigment in blood vessels. The energy is converted into heat in the skin and absorbed by the atoms which are responsible for color. As a result, the VBeam laser does not interact with other parts of the skin and successfully treats the redness that forms in patients suffering from post-inflammatory hyperpigmentation. Typically, 4 to 6 laser treatments will help remove the inflammation from melasma, and other disorders of hyperpigmentation.

VBeam 4 sessions, 2 months before and after

Mesopeels for body and facial hyperpigmentation

Mesopeels are a specially formulated type of chemical peel with the capacity to address varying types of hyperpigmentation, fade pigment, and decrease the activity of melanocytes. Mesopeels are designed to diminish the overall appearance of skin discoloration  and dark spots in a gentle but efficient manner. Dr. Green typically uses the mesopeel to treat patients who are concerned with facial hyperpigmentation in the delicate eye area, where traditional chemical peels may be too irritating.

Other delicate areas of the body which may be hyperpigmented and more sensitive to a traditional chemical peel, such as the axillae, groin, inner thighs, and buttocks, can be treated with mesopeels too. Mesopeels induce the  production of new collagen and elastin, as a result of chemo-exfoliation, for brighter and healthier looking skin. One of the key advantages to Mesopeels is that there is absolutely no recovery time with this special type of chemical peel.

Treating facial hyperpigmentation with patients in skin of color

In general, laser treatments such as the Fraxel laser, Picosure, and IPL often worsen melasma and hyperpigmentation . These lasers often make it more difficult to effectively remove and treat melasma in the future. If you are of Asian, Mediterranean, Hispanic, or African descent, it would be best to avoid these lasers when you have melasma. For patients of color, the best treatments include chemical peels, mesopeels, Cosmelan peels, and topical treatments. These products work on all skin tones and can effectively treat melasma, sunspots, dark spots, and other pigmentation disorders without worsening your underlying skin condition. It is especially important to seek out a board-certified dermatologist, like Dr. Green, who has years of experience in treating patients of all skin tones.

How much does treatment for facial hyperpigmentation cost?

The total cost for treating facial hyperpigmentation will vary depending on a number of factors. The severity of the hyperpigmentation, the chosen method of treatment (skin lightening products, chemical peels, laser treatments, or a unique combination of treatments) will all need to be factored in when determining the cost of your treatment. Additionally, the experience of your treating physician and your geographical location can affect the total cost of your treatment. A board certified dermatologist, like Dr. Michele Green, who is an expert in treatment melasma and hyperpigmentation will be more expensive than a nurse at a medspa.

It is inherently important to select a board certified cosmetic dermatologist, like Dr. Michele Green in New York, with both the experience and expertise to help you achieve the best cosmetic results. The incorrect treatment of facial hyperpigmentation can exacerbate the issue, making your hyperpigmentation even more difficult to remove. Treating melasma with the Fraxel laser, IPL, or Picosure, may ultimately make it more difficult to remove this facial hyperpigmentation or melasma. Dr. Green is a board-certified cosmetic dermatologist with over 25 years of experience in treating melasma and disorders of pigmentation with the best skin care, chemical peels, and laser treatments. During a consultation with Dr. Green, the most suitable cosmetic treatment for your specific type of facial hyperpigmentation and skin tone will be determined, and the total cost discussed.

How to best treat facial hyperpigmentation from Melasma

Melasma should be approached in a different manner than other varieties of facial hyperpigmentation. Too often, patients have laser treatments to remove melasma and the result is a worsening of the overall appearance of the melasma and hyperpigmentation. Melasma is a type of pigmentation which is more difficult to treat, as the hyperpigmentation becomes more entrenched in the deeper layers of the skin. Dr. Michele Green specializes in treating patients whose melasma and pigmentation were worsened by ablative and non-ablative laser treatments. Dr. Green prefers to treat melasma with Mesopeels, chemical peels, VBeam laser treatment, and Cosmelan peels, preventing exacerbation of the existing hyperpigmentation. Cosmelan was initially developed to treat melasma, however, Dr. Green has expanded its use to also treat acne scars, post-inflammatory hyperpigmentation (PIH) from lasers, sun spots, sun damage, and discoloration on the face, neck, chest, back, and other areas of the body.

How to treat hyperpigmentation during pregnancy

During pregnancy, hormone levels, specifically the female hormones estrogen and progesterone, are in flux. Increased levels of these sex hormones have been found to be tied to the overproduction of melanin, increasing the chances that a woman may develop melasma or ‘the mask of pregnancy,’ especially when combined with sun exposure. While one is pregnant, cosmetic treatments designed to treat melasma and facial hyperpigmentation, such as the Cosmelan peel and trichloroacetic acid chemical peels, can not be used. Additionally, the majority of topical skin lightening products (such as hydroquinone) are not to be used when pregnant. Therefore, the best way to manage any facial hyperpigmentation or melasma that you have during pregnancy is to use the proper sunscreen and avoid sun exposure. This can help prevent the worsening of any hyperpigmentation during your pregnancy. Once you are no longer pregnant, you can discuss with Dr. Green the best combination of in-office cosmetic treatments and at-home skin care products to treat your hyperpigmentation/melasma.

How to treat post-inflammatory hyperpigmentation

Post-inflammatory hyperpigmentation (PIH) can result as a side effect from inflammatory acne, rash, or other cutaneous injury. If the hyperpigmentation is related to post-inflammatory hyperpigmentation and the dark spots are brown, black, red, or violaceous in color, Dr. Green often suggests a combination of treatments for best cosmetic results. In-office trichloroacetic acid (TCA) peels help to increase the rate of skin cell turnover, sloughing off the discolored skin cells and revealing new, healthy skin cells and creating an overall improvement in both tone and texture. Often, Dr. Green will recommend that patients supplement the in-office chemical peel treatments with powerful, yet gentle topical skincare products including antioxidants such as MGSKINLABs Vita-C serum, retinol such as in her unique Antioxidant Infusion, and skin lightening creams which are both hydroquinone based and hydroquinone-free. Patients who prefer not to have any peeling, may prefer the Clear+Brilliant laser, to remove the pigmentation or Mesopeels. In your consultation with Dr. Green, you will discover which combination of treatments and products is best suited to minimizing the appearance of your post-inflammatory hyperpigmentation.

Post-inflammatory hyperpigmentation may cause areas of skin to become hyperpigmented as brown, black, or purple spots, but it can also cause erythema. Red or erythematous patches of facial discoloration can be effectively treated with the VBeam laser. Dr. Green uses the VBeam laser on patients who are suffering from facial rosacea, acne marks, broken capillaries, sun damage, port wine stains, stretch marks, and post-inflammatory hyperpigmentation. The VBeam laser operates on a wavelength which only targets the skin cells which are red or erythematous, leaving the surrounding tissue untouched. The VBeam is extremely safe and effective and has no recovery time.

How to get rid of stubborn upper lip hyperpigmentation

Hyperpigmentation of the upper lip typically results as a symptom of melasma. Dr. Green loves the results that the Cosmelan peels provide her patients who are struggling with melasma, and often suggests Cosmelan treatment to anyone who is dealing with stubborn hyperpigmentation on the upper lip area. Having a Cosmelan peel followed by maintenance products provides outstanding results with essentially no downtime. In addition, skin lightening products, with and without hydroquinones and light chemical peels, can hasten the removal of stubborn upper lip hyperpigmentation.

Cosmelan – 8 months before and after

Total body skin lightening- is it safe?

No! Total body skin lightening is a popularly sought after procedure in many countries around the world. While there are many methods for diminishing the appearance of dark spots and hyperpigmentation on the face and body, total body skin lightening can be risky and require a lifelong commitment to maintain results. The in-office procedures and at-home products used to achieve full body skin lightening can be dangerous to patients and are not advised by Dr. Green. However, if there is an area of the body which is darker than the rest, an “even” skin color can be achieved through the correct skin care and chemical peels.

One particular treatment that seems to be consistently popular for total body skin lightening, despite numerous potential and dangerous side effects, is the use of intravenous glutathione. Glutathione is an antioxidant which is naturally found in the human body and is said to help lighten the skin. Glutathione is recognized as a skin lightening agent because it deactivates tyrosinase (the enzyme responsible for stimulating melanin production in the skin). It is thought that intravenous glutathione treatments enhance the inhibition of melanin production and can be used to lighten the entire body. In her office, Dr. Green does not offer glutathione injections for skin lightening as it has not been clinically proven as an effective and safe treatment.

Glutathione injections for skin lightening are growing in popularity around the globe, but have not been approved by the FDA for cosmetic use in the United States. There can be severe side effects associated with total body skin lightening via glutathione injections, including various skin disorders, thyroid function problems, kidney malfunctions, and possible cancers. Dr. Green does not recommend total body skin lightening with glutathione injections.

Can Vitamin C help treat hyperpigmentation?

Vitamin C is often touted as the powerhouse of skincare. As a strong antioxidant ingredient, vitamin C is able to help combat the negative effects of harmful free radicals that contribute to premature skin aging. Vitamin C also helps to treat the appearance of hyperpigmentation by inhibiting melanin production in the skin and working to brighten overall skin complexion. Vitamin C also plays a role in the synthesis of collagen in the skin. Collagen is a protein in the skin which gives it a firm foundation and contributes to a youthful, supple appearance. By promoting skin cell regeneration and inducing the production of collagen, vitamin C improves the texture and tone of skin. By incorporating a vitamin C serum into your regular skincare routine, you can effectively diminish the appearance of redness, hyperpigmentation and dark spots to reveal a more radiant, youthful, even-toned complexion.

Dr. Green often incorporates her high potency Vita-C serum to the skin care regimen for her patients suffering from facial hyperpigmentation. Applying this high concentration vitamin C serum to the skin, both morning and night, will improve skin tone, texture, and overall radiance. The Vita-C serum is a great supplement to in-office procedures which are targeted at diminishing the appearance of facial hyperpigmentation and can also work well with other skincare ingredients like hyaluronic acid, niacinamide, and retinol.

What other skincare essentials should I incorporate into my routine to treat hyperpigmentation?

Retinoids are a class of topical creams which are derived from vitamin A, such as tretinoin. Retinoids are available at lower concentrations over-the-counter but can also be prescribed at higher strengths by a medical professional. They help to further diminish any facial hyperpigmentation by increasing the rate of skin cell turnover. The dead skin cells at the surface layer of the skin are more quickly sloughed off and healthy, new, even-toned skin cells are encouraged to come to the surface more rapidly. Patients with sensitive skin types should always consult with Dr. Green prior to incorporating a retinoid product (even if it is an over-the-counter purchase) into their skin care regimen, as retinoids can potentially cause skin irritation.

Beta Hydroxy Acids (BHAs) and Alpha Hydroxy Acids (AHAs) are ingredients that act as chemical exfoliants, helping to rid the skin of dead and hyperpigmented skin cells and contributing to the formation of new, even-colored skin cells. Salicylic Acid, Kojic Acid, and glycolic acid are some of the more common AHA and BHA skincare ingredients found in different cleansers, serums, moisturizers and more which can help remedy the appearance of facial hyperpigmentation. When using any chemical exfoliants, it is always important to remember that sunscreens are a daily necessity.

Sun protection is a lifelong priority if you have facial hyperpigmentation. Sun exposure has the potential to exacerbate the appearance of your hyperpigmentation. Melanocytes, the skin cells responsible for melanin production and skin pigment, can be retriggered by sun exposure. This means that excess melanin is likely to be reproduced and the excess pigmentation returned if triggered by the sun, even if the skin has been treated for hyperpigmentation in the past. To prevent this, select a sunscreen that offers broad-spectrum coverage, protecting against both UVA and UVB rays. Religiously apply SPF daily and be sure to reapply often when spending time outdoors. For best protection, wear a hat and sunglasses to further prevent your hyperpigmentation from worsening or reappearing.

Hydroquinone is the gold standard ingredient in many skin lightening creams. There are currently no hydroquinone based creams which can be purchased over-the counter. Dr. Michele Green can prescribe hydroquinone-based skin lightening creams, with a concentration of 4 percent and greater.  Dr. Green has created a special at-home pigment protocol for her patients to lighten dark spots and even out the skin. Most patients use this pigment protocol to treat skin problems such as freckles, melasma, age spots, sun damage, discoloration and hyperpigmentation from acne scars. Skin lightening creams can also naturally lighten dark skin. Skin bleaching is a cosmetic treatment to reduce the prominence of skin discolorations and even out the overall skin color to achieve skin brightening.

Are Skin Lightening Creams Safe to use on the face?

Using skin lightening creams to diminish hyperpigmentation and dark spots is safe as long as they are used appropriately and are under the supervision of a qualified dermatologist, like Dr. Michele Green in NYC. It is essential that skin bleaching creams are used correctly and cautiously so as not to over bleach the skin. Incorrect use of skin lightening creams can cause skin irritation and sensitivity as well as leave the skin hypopigmented, hyperpigmented, discolored, or inflamed. If you are considering incorporating a skin lightening cream into your treatment regimen for facial hyperpigmentation, be advised that it is always best to do so under the supervision of a dermatologist. During your consultation with Dr. Michele Green, you will have the opportunity to learn about what skincare products would benefit your unique situation and the proper use for each product.

Can Facial Hyperpigmentation return after it has been treated? 

Melanocytes, the skin cells which are responsible for producing melanin, have memory. Our skin cells absorb UV radiation which causes mutations and long-term damage that remains even after treatment. For that reason, the importance of sun protection for individuals who have suffered or do suffer from facial hyperpigmentation can not be understated. Exposure to the sun after completing treatment for facial hyperpigmentation or melasma can encourage melanocytes to produce melanin, causing the uneven pigment to return. In order to maintain the cosmetic results of your hyperpigmentation treatment, always remember to use a broad-spectrum sunscreen with a minimum SPF of 50, reapply generously, and wear protective clothing to shield your skin from the sun (like a hat and sunglasses).

What is the best sunscreen to minimize sun exposure and facial hyperpigmentation?

When considering the best sunscreens to use to prevent sun damage, pigmentation, and melasma, it is very important to remember two facts. First, it is important to use the correct sunscreen and SPF. Secondly, it is important to remember to re-apply sunscreen. All too often, patients will say that they applied sunscreen once in the morning, and forget to re-apply sunscreen during the day, after sweating, or after swimming. It is vital to remember to re-apply sunblock, even on a cloudy day, to prevent the sun’s damaging UV rays from causing sun spots, melasma, hyperpigmentation, and sun damage.

Secondly, if your skin is prone to pigmentation or melasma, it is best to layer sunscreens for the very best protection. It is vital to apply a chemical sunblock first to your face. After the sunscreen penetrates, a layer of a physical sunblock, containing zinc oxide, should be applied. By layering both of these two different types of sun-blocks, your skin will have the best protection against sun exposure and the least chance of developing sun damage or hyperpigmentation.

Commonly Asked Questions & Answers

Where does hyperpigmentation come from?

There are many factors which contribute to hyperpigmentation including genetics, sun exposure, hormonal fluctuations. The main culprit of hyperpigmentation is sun exposure. As your body tries to protect itself from the sun’s damaging UV rays, the body produces more melanin. Melanin production gets stimulated from the melanocytes within the skin, resulting in hyperpigmentation. Melasma also tends to be genetic and is much more common in women than in men. Over 50 percent of patients reported a positive family history of melasma. One reason that women are more prone to melasma lies in the fact that estrogen and progesterone are linked to melanin production. Elevated levels of these two sex hormones are common during puberty, pregnancy, and menopause and will contribute to a greater likelihood of women developing hyperpigmentation.

Are freckles a form of hyperpigmentation?

Yes, freckles are a form of hyperpigmentation. They are most commonly found on individuals with fair skin or red hair but can occur in other skin tones as well. Individuals with freckles have uneven melanin production across their face which causes tiny areas of discoloration known as freckles. These small dark spots are usually less than 5mm in diameter and typically harmless. Sun exposure can result in an increased amount of freckles and can coalesce to form larger sun spots. It is essential to use a broad-spectrum sunscreen with an SPF 50 or greater to ward against forming sun spots, freckles, or hyperpigmentation.

Why do I have hyperpigmentation on my face?

Hyperpigmentation on the face is most likely a result of sun exposure. When the skin cells on your face are exposed to the sun’s harmful UV rays, the melanocytes increase melanin production. Melanin is the pigment that gives our skin, hair, and eyes their color but overproduction of it in certain areas but not others will result in hyperpigmentation. Hormonal fluctuations can also contribute to hyperpigmentation. It is common for pregnant women to develop melasma, a type of hyperpigmentation that is characterized by brown or blue-gray patches on the skin, typically on the face.

When will hyperpigmentation fade?

The answer varies from patient to patient, depending largely on what triggered the onset of the hyperpigmentation. For patients who experience hyperpigmentation in the form of melasma during pregnancy or as a result of taking oral birth control pills or other hormonal therapies, melasma may naturally subside either after pregnancy or once the hormonal medications have been discontinued respectively. However, for many patients, melasma is a chronic condition that will require some type of treatment in order to reduce the associated hyperpigmentation. Sun spots, overall sun damage, and age spots, typically require chemical peels or laser treatments to remove.

Sunspot treatment with AlexTrivantage

How to get rid of facial hyperpigmentation?

There are a number of different treatment options available for treating facial hyperpigmentation. Topical skin lightening products, chemical peels, Cosmelan peels, Mesopeels, HydraFacials, microdermabrasion, Fraxel laser, eMatrix laser, Clear + Brilliant laser, AlexTrivantage laser, and the VBeam laser are just a few of Dr. Green’s favorite ways to address dark patches of skin caused by hyperpigmentation. Ultimately, the right treatment for your hyperpigmentation will depend on your skin type, skin tone, and the type of hyperpigmentation which you are experiencing.

Can a facial reduce pigmentation? Does a facial help with hyperpigmentation?

Yes, a facial like the HydraFacial can help reduce the appearance of hyperpigmentation. The HydraFacial is a three-step medical grade facial that helps to improve the overall look and feel of the skin. The HydraFacial focuses on deeply cleansing, gently exfoliating, and intensely nourishing the skin. The gentle, unique vortex fusion technology of the Hydrafacial allows for powerful extraction of impurities from the pores while simultaneously infusing beneficial antioxidants into the skin. The result is a radiant and healthy glow in just one thirty minute treatment with no downtime involved. By customizing your HydraFacial treatment with a Britenol booster, you can further improve the complexion by evening and brightening your skin tone. The Britenol booster is formulated with Vitamin C, bearberry extract, and alpha-arbutin to effectively provide the skin with radiance while minimizing the appearance of hyperpigmented spots.

What is the best facial or facial treatment for hyperpigmentation?

The best facial for hyperpigmentation is the HydraFacial MD. This facial will detox your skin, exfoliate dead skin cells, and keep your skin hydrated. Your skin will be infused with various serums and antioxidants that will leave your skin glowing and help with hyperpigmentation. The HydraFacial can be supplemented with a Britenol booster which is a retinol-based skin brightener that can minimize the appearance of dark spots and sun spots. It contains ingredients like alpha-arbutin, vitamin C, and bearberry extract.

Are facial peels worth it?

Yes! Facial peels like the HydraFacial are great at addressing a wide range of skincare issues from acne to rosacea to hyperpigmentation. In addition, they are one of the most affordable non-invasive skin treatments on the market and cost significantly less than a chemical peel or other alternative cosmetic procedures. This multi-step process will work to cleanse, exfoliate, and infuse your skin and is beneficial for all skin types. The HydraFacial can also help with dry skin, enlarged pores, blackheads, general facial redness, wrinkles, fine lines, and poor circulation, among other skincare concerns. If you have deeper hyperpigmentation, other cosmetic procedures may also be recommended to more effectively remove it.

How to get started with facial hyperpigmentation treatment today?

Dr. Michele Green is a world renowned expert in cosmetic dermatology with over 25 years of experience treating varying types of facial hyperpigmentation, among other skin conditions like dermatitis. She is also an expert when it comes to dermal fillers, dermabrasion, ablative and non-ablative laser, skin biopsies, hair loss, and countless other cosmetic procedures. Whether you are struggling with melasma, post-inflammatory hyperpigmentation, sun spots, sun damage, or other forms of hyperpigmentation, Dr. Green is here to help. Dr. Green has been consistently voted as one of the best cosmetic dermatologists in NYC by Castle Connolly, the New York Times, New York Magazine, and Super Doctors.  To schedule a consultation to treat your melasma, sun damage, or facial hyperpigmentation, please contact us online today or call our New York City based office at 212-535-3088.