Facial Pigmentation 

Whether it bothers us or not, pigmentation problems affect almost all of us. Now that we're seeing more of the sun, pigmentation will be getting worse and some of us will be noticing our pigmentation for the first time. 

Unfortunately, treating pigmentation is tricky and there are no shortcuts Well, strictly speaking there are but you’ll regret them. Treatment also takes time and often some downtime (when skin is looking red, dry or flaky).

If you’re looking to improve your pigmentation, do your research and speak to someone who knows what they’re talking about (which isn’t always the same as someone who has strong opinions online)! Below is some general information to start your journey…

Lines vs pigment – which is worse?

Most of my clients come to see me about their lines and wrinkles. These are the things that we have been taught to look for and avoid – how many times have you seen the line “reduces the appearance of lines and wrinkles” on a moisturiser advert? The message: reduce lines and wrinkles and you’ll look younger. There’s no doubt that that is true but it’s not the whole story… An even colour to the skin (skin tone) is a greater measure of youth and beauty. Blotchy, patchy skin is never a good look and that’s why concealer / foundation is so popular. Another oversight in the messaging is the importance of texture – a smooth even skin can carry some lines and wrinkles and still look great. A rough uneven skin will never look as good, even without lines.

Blood and pigment (melanin)

The 2 main colours that affect are red and brown. The red comes from blood close to the surface of the skin e.g. broken blood vessels or very small ones or from inflammation e.g. acne spots. The brown colour is as a result of pigment made by cells at the bottom of the epidermis called melanocytes. These are amazing cells whose primary function is to provide our skin with protection from the sun – expose them to UV radiation (e.g. sunlight) and in most cases they will start producing pigment (melanin) within hours. This pigment absorbs the harmful wavelengths of UV radiation reducing the risk of burning and skin cancer (black skins don’t burn as easily as white and are less likely to suffer from skin cancer). This isn’t the case for everyone – we all know someone who is very fair, perhaps has red hair, who just goes straight to burn and never tans.

When melanocytes go wrong

Abuse your melanocytes with unprotected UV exposure (sunbathing or sunbeds) and eventually they start misbehaving. Of course, they can do this over time even without the abuse – it’s just the result of being alive long enough that you have received sufficient UV. Regardless of what caused this behavior, the result is brown spots or patches on the skin. Don’t confuse these with childhood freckles – even if you had these, the spots you have aged 30 or more are not the same - there will be more, and they will be larger.

There are other factors that can influence the behaviour of melanocytes, particularly hormones. Estrogen (a female hormone found in the contraceptive pill and prevalent during pregnancy) increases the production of melanin which explains why pregnant women and those on certain types of contraceptive pills are prone to pigmentation. The answer is not to stop your pill but to discuss with your doctor if you are concerned that it is having a negative effect on your skin.

Preventing more pigmentation

Before I mention treatment, whatever you do, slowing down the progression of the problem is really important... Ultimately, this is about avoiding the sun as best that you can and protecting yourself when you are exposed. This means a large brimmed hat, sunglasses, high necked tops and as much sun cream as you can manage. The official advice is to apply every 2 hours but has anyone ever managed that?! Remember, strong sun will always win the battle with SPF so avoiding it in the first place will always be most effective.

Treating pigmentation

There are 3 main ways to treat pigmentation: medical creams, lasers and IPL (intense pulsed light) and skin peels. The good news is that these treatments can be very effective if done well. The bad news is that none of the them are forever cures – the sun will always bring out more pigment in the future.

Medical creams

Over the counter creams just won’t cut through decent pigmentation. Only the faintest of pigmentation will be helped with these and even then, only when staying well away from the sun. Medical creams contain prescription strength (4%) hydroquinone and can only be prescribed by a qualified doctor or nurse - avoid using these creams from anyone else.

Lasers & IPL

Lasers and IPL use energy and heat to disrupt the pigment. Courses are usually needed with your face feeling hot and looking flushed/pink or red for minutes or hours after. The more aggressive your treatment, generally, the better results you’ll get. Have too much and you’ll burn so make sure you’re being treated with good kit and by someone who knows what they’re doing. This is important as treating melasma with these machines is rarely a good idea. 

Skin peels

Peels not only treat the pigment but have an all-round rejuvenating effect – expect smoother skin, fewer lines and general freshen up. It’s important to remember that as with the lasers & IPL, the more treatment you have, the better the results. A deeper peel (if done correctly) will also give better results than a light one but the price you’ll pay is more dryness and flaking of dead old skin in the days after. If you’re looking for a peel that will leave your skin looking normal for work the next day, it’s not going to be doing much for your pigmentation, texture or lines – that’ll be a choice that you will discuss with your practitioner.

 

Whatever you choose to do, have a consultation with someone who understands pigmentation, takes the time to talk to you and look at your skin, and that you trust and are comfortable with.

 

Consultations with a senior therapist at ASKINOLOGY are free of charge.

 

Dr Askari Townshend is a GMC registered doctor, qualified in 2002, and Member of the Royal College of Surgeons, England. He is founder and Medical Director of ASKINOLOGY in the City of London and has been practicing aesthetic medicine full time since 2008.