Skin pigmentation is a problem that is commonly seen amongst all age groups – and especially in Asia, where it is deemed “beautiful” to have fair and flawless skin – having dark spots on one’s face can be highly distressing and frustrating for many.

Even though Asians are less likely to experience premature aging and wrinkles – our skin type is sadly more prone to hyperpigmentation¹.

Given that pigmentation is an easily preventable condition – understanding the underlying principles of what causes it, as well as the different types of pigmentation can support us in selecting the best treatment options to achieve our best skin possible.

What is skin pigmentation?

The keyword here to remember is “melanin” – natural pigments that are created by melanocytes present in the skin.

Playing a major role in producing the colors of our skin, hair, and even eyes – it is heavily influenced by various factors such as genetics and hormonal changes, as well as exposure to the sun – which can all work against us to overproduce melanin. 

It is this overproduction of melanin that causes dark spots and pigmentation to appear– leading us to look much more tired and older than we really are.

Being exposed to the sun without adequate protection is the biggest cause of pigmentation, and also worsens existing pigmentation. As we grow older, our skin becomes more sensitive to UV exposure, which is also why we often notice older men and women having age spots – even if they don’t spend much time under the sun.

Affecting all skin types, it is safe to say that no one is immune to pigmentation.

Types of skin pigmentation

There are many types of skin pigmentation, and they all vary in shape, color and size.

Here are 4 of the most frequently seen types:

• Freckles: tiny brown spots that form on the sun-exposed parts of the skin, most commonly found over the upper cheeks and the nose bridge. Can occur from childhood.
• Sun spots (Solar Lentigos): brown spots that are larger than freckles, are more distinctive in shape, and often form over the face and the upper limbs. Occurs over time due to sun exposure.  
• Melasma: brown patches that have less distinct borders and are commonly found over the temples and upper cheeks. Affects mostly women and those with darker skin tones. Affected by sun exposure and hormonal changes in the body.
• Post-inflammatory Hyperpigmentation (PIH): ill-defined and flat lesions caused by inflammation of the skin following a wound or injury, such as those left after an acne or eczema flareup.

Several types such as PIH may eventually fade on their own, but other types like melasma can be extremely stubborn and difficult to treat. This is because the pigment may be found in the deeper layers of the epidermis and dermis, making it  harder to reach – another reason why melasma has the highest recurrence and relapse rate as well.

While most pigmentation types are generally harmless, there are certain instances in which it can actually be a symptom of skin cancer. This is why you should consider getting your skin checked by a doctor to accurately assess and diagnose your condition.

A doctor may sometimes use a special light called a Wood’s light to examine your skin, or in certain cases, even request for a biopsy to be done. Whether it is skin cancer or just pigmentation – early detection is key to the best treatment results.

Possible solutions

There is a long list of solutions ranging from topical and oral medications, chemical peels, microdermabrasion, and laser treatments that can help to improve pigmentation.

Hydroquinone is a popular topical medication that acts to block the production of melanin in the skin. Despite its effectiveness, some users may develop paradoxical darkening called ochronosis, and patients with sensitive skin may develop redness and burning of the skin. This is why many patients often work with a dermatologist to devise a treatment plan that lasts no longer than 6 months.

While topical creams such as vitamin C and retinoids have also provided relatively good results, many of them take a long time to see significant results. Chemical peels and microdermabrasion also only work well on mild types of pigmentation and fairer skin tones.

This is where laser treatments can come in to fill the gap of treating challenging cases in a more efficient manner, while still being safe for all skin types, i.e., depending on which laser system you choose.

Pico lasers – the most advanced technology to treat pigmentation

Laser treatment for pigmentation works by focusing beams of pulsating energy to target the pigment molecules and shatter them into smaller fragments, which the body then removes via its own natural processes.

Initially designed to erase tattoos – pico lasers were later discovered to be just as effective in treating pigmentation. Today, they are also being used to treat acne scars, wrinkles, and support overall rejuvenation of the skin.

There are many types of pico lasers available in the market today – making it easy to get lost in the names and overlook the far more important, underlying reasons why pico lasers work so well.   

Two of the most efficacious pico lasers that you need to know about are the PicoSure and PicoWay lasers, both of which are FDA-approved for tattoo removal, pigmentation removal, wrinkles, and acne scars removal. Below are their specifications (which we will explain further below):  

PicoSure laser: Comes in a natural wavelength of 755nm, while using laser pump handpieces to convert to 532nm and 1064nm. Speed @ 750ps. 

PicoWay laser: Comes in 3 wavelengths (532nm, 785nm and 1064nm). Speed @ 300ps.  

The PicoWay laser also offers two distinct treatments depending on the style of the handpiece used – PicoWay Zoom and PicoWay Resolve – which works to either destroy pigments in the skin, or help the body to naturally fill with collagen and elastin for younger-looking skin. 

The most important thing to note is that pico lasers work in ultra-fast picosecond pulses (equivalent to one trillionth of a second) – which is 100 times faster than traditional lasers like the Q-switch. Because it is so fast, this means that it acts more so as a photoacoustic shockwave therapy – which is far more effective and less harmful to the surrounding tissues compared to using photothermal energy.

Another huge game-changer is the PicoSure laser’s powerful Focus Lens Array (FLA), which concentrates energy into small spots of up to 20 times stronger than normal lens – translating to faster results, less treatment sessions, and almost no downtime at all!

The biggest disadvantage with using ablative lasers, IPL, or even Q-switch is that there is a possibility of adverse side effects such as blistering, scarring, and hyperpigmentation due to the high energies used during treatment. In fact, Q-switch is often not recommended for treating melasma and challenging pigmentation cases due to the high risk of PIH².

On the bright side, another study showed that picosecond lasers at 755nm wavelength are effective in treating pigmentary lesions in Chinese patients, with a much lower risk of PIH³!

This makes pico lasers suitable for all skin types, and in the right hands, a much safer laser system to treat pigmentation overall. Since Asian skin is more susceptible to pigmentation and acne scars, using a treatment with the lowest incidence of side effects is even more vital in ensuring maximum results.

The best treatment for you

The thing about majority of over-the-counter solutions is that they do not attack the deeper layers of the skin, and are thus only effective up to a certain point – depending on the type and severity of your pigmentation.

Not everyone is recommended to use a laser for pigmentation – but should that be the case, factors such as the wavelength, power, and pulse duration of the laser is key to helping you determine which is the best treatment for you.

When performed under a qualified and experienced doctor, and dependent on the type of pigmentation being treated, most patients should be able to see a 50% – 90% pigmentation clearance in just a few sessions. Even for difficult-to-treat melasma, multiple lasers can be combined to provide even better results – especially when using picosecond lasers like the PicoWay and PicoSure laser to shatter the pigment using a photoacoustic effect, whilst minimizing thermal damage and lowering the risk of post-inflammatory hyperpigmentation in the skin which can lead to worsening of melasma.

Ideally, your doctor should work on a combination approach – this is backed by a 2017 study which demonstrated the effectiveness of using multiple treatment modalities in treating melasma – using pico laser with hydroquinone cream showed better results than just using the cream alone⁴.

Lasers for pigmentation and rejuvenation at AYD

At Angeline Yong Dermatology, we offer a wide range of powerful lasers that allows us to customize a treatment plan for every patient – while giving us full flexibility to utilize a combination approach for maximum results.

We provide both PicoSure and PicoWay at our clinic, as well as Q-switch and GentleMax Pro – a double platform long-pulse laser that utilizes the 755nm Alexandrite and 1064nm Nd:YAG wavelengths.

Committed to providing her signature personalized care to every patient – Dr. Angeline Yong has over 15 years of medical practice under her belt, and only uses the most leading-edge and rigorously-tested technologies on her patients. As a global faculty for multiple aesthetic laser devices, Dr Yong has been involved in various trials and in setting protocols for leading aesthetic laser companies such as Cynosure.

With proper aftercare and prevention, don’t let pigmentation stop you from being at your best! If you are ready to undergo laser pigmentation removal and treatment – contact us today and let us walk you through the next best steps to take towards spotless, younger-looking skin!

References
1) Lym CI, Azevedo LCM, Cohen S, et al. Characteristics of Asian skin–revision. J Dermat Cosmetol. 2018;2(6):127‒133.
2) Ho SG, Chan HH. The Asian dermatologic patient: review of common pigmentary disorders and cutaneous diseases. Am J Clin Dermatol. 2009;10(3):153–68.
3) Chan JC, Shek SY, Kono T, Yueng CK, Chan HH, et al. A retrospective analysis on the management of pigmented lesions using a picosecond 755-nm alexandrite laser in Asians. Lasers Surg Med. 2016 Jan;48(1):23-9.
4) Choi Y-J, Nam J-H, Kim JY, et al. Efficacy and safety of a novel picosecond laser using combination of 1064 and 595 nm on patients with melasma: A prospective, randomized, multicenter, split-face, 2% hydroquinone cream-controlled clinical trial. Lasers in surgery and medicine. 2017;49(10):899-907.