Thank you
for your question.
You submitted your question without a photo.
You describe in the details of your question that you want to remove freckles and brown
spots all over the skin which is, as you described, pale.
And that currently you’re on Vitamin C and hydroquinone as well as sunblock.
And further, you have had a Fraxel treatment done by your dermatologist which appears to
have some benefit initially but many of the pigmented areas appear to have returned.
And you’re asking about whether or not there are other laser options for these brown spots.
Well again, in the absence of photos, I think from your description, I think I conclude
what’s likely the issue, I can give you some guidance as to how I treat my patients
in my practice.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I have been in practice in Manhattan and Long Island for over 20 years.
Helping people with their skin is a big part of my practice within our practice.
We do a lot of things in addition to the surgeries that involved skin products as well as various
different ways to help the skin with lasers and light devices as well as microneedling,
PRP and other things.
So I would say that, first begin any strategy with a diagnosis and it seems your dermatologist
clearly is on there right track that what you are dealing with mostly is something called
solar dyschromias.
And these are brown spots that are the result of the exposure of the sun and your body’s
response to that exposure.
And these spots can be round or irregular.
And certainly, I can see from your description that you did have a response with the Fraxel
because the Fraxel laser whether it was either the Erbium or CO2 laser essentially took off
the top layer of skin and if some of that pigment happened to be at that level, well
then it looked better until the pigment came back.
Further, there is another part of the equation which you didn't mention and may not be the
situation with you but I would simply have you discuss this with your dermatologist is
how much of this pigmentation may be due to something called melasma.
Melasma which is pigmentation that is hormonally induced has a different pattern compared to
sun exposure or solar dyschromias and sometimes it can be a little difficult to differentiate
and this can of course overlap where pigmentation and melasma can affect the upper lip, the
cheek, the chin and the forehead area in what’s described as a geographic pattern.
And the dyschromias can be like spots.
You may be dealing with some residual effect, residual melasma which is more difficult to
treat.
At the end, the strategy is already there from the pharmaceutical standpoint or the
skincare standpoint where sunblock is critical as well as some other ways to help turnover
your skin and get some of this epidermal pigmentation to be reduced.
As far as some of the other laser options for the skin, you can think of intense pulsed
light or IPL.
You can also think of something that we use in our practice a lot which is a Q-Switch
laser.
And a Q-Switch laser can be customized to do something like laser toning which is basically
breaking up pigmentation kind of in a more even way at a certain energy level or directly
treating the brown discolorations also with a Q-switch laser but with a different wavelength.
And so, we can always customize this type of treatment.
And as is often the case with a lot of different dermatologic procedures we do, there are certain
procedures we do for maintenance and there are certain procedures we do just to get rid
of specific spots.
But I find that the Q-Switch laser is very useful in my practice to help people with
this very discrete brown discolorations and they basically have a day or so of redness
and within a few days, they see an improvement.
So I think it’s worthwhile having this discussion with your dermatologist.
I would be surprised if the dermatologist is using a lot of lasers in their practice
that they wouldn't have a Q-Switch laser.
Essentially, when it comes to skin, I think most doctors who are doing treatment in any
consistency are essentially obliged to have a certain set of lasers and light-based devices
in order to really treat the common concerns and of course, with the most up-to-date devices
that will provide the most optimal results with the minimum downtime.
So that’s something that I think is worth having that discussion with your doctor about
and again, I would be surprised if they didn't already have some of the devices that I described.
Discuss this with your doctor and if they don't have Q-Switch laser or a pulsed light
device, then you may want to consider the options in conjunction with the skincare regimen
that you are currently under.
But again, I think this is a discussion that you should have with your dermatologist who
I think is probably on the right track and maybe wants you to do more Fraxels because
they have the perspective of knowing your skin and having a treatment strategy in mind.
So I hope that was helpful, I wish you the best of luck and thank you for your question.