how can i treat hyperpigmentation a common concern for
patients of all skin types is the presence of
different forms of hyperpigmentation an accurate diagnosis
of the underlying cause for hyperpigmentation is
critical for the success of any treatment strategy
i'll discuss some causes of hyperpigmentation which i see
frequently and how i customize treatment plans
for different skin types in my practice I'm Dr Amiya Prasad I'm a
Board-certified cosmetic surgeon and Fellowship-trained
oculofacial plastic and reconstructive surgeon
I've been in practice in New York City and Long Island for
over 25 years a common cause for hyperpigmentation which i see in my
practice is the result of cosmetic procedures
such as laser treatments performed elsewhere
oftentimes these situations could have been avoided by the
practitioner if certain guiding principles were
adhered to for example in my practice i limit the
use of certain lasers and other devices on people whose
skin type is at greater risk for hyperpigmentation
i frequently see patients who were assured by their esthetician or other
type of practitioner that the laser being used for them was
safe for all skin types unfortunately their
skin reacted in a way that the practitioner
did not anticipate this type of scenario has been a growing
issue as aesthetic procedures are being
performed in greater numbers by non-physicians
who work unsupervised as far as terminology is concerned
hyperpigmentation refers to darkening of the skin while the term
hypopigmentation describes loss of pigment in the skin
hyperpigmentation is the result of an increase
in the skin pigment melanin melanin is the natural pigment in your
skin responsible for your skin color melanin production in the
skin is often in response to some type of stimulation
for example a suntan is an adaptive response
to ultraviolet light produced by the sun more melanin in the skin protects the
skin by absorbing ultraviolet light
in people with lighter skin in addition to a suntan
that can be the accumulation of clusters of pigment
within the skin which can remain long after the tan
fades these clusters of pigment are referred to as
solar dyschromias or solar lentigos solar lentigos and dyschromias can be
approached in several ways in general my strategy for this type of
hyperpigmentation is to perform the most effective
treatment with the least downtime and the lowest
risk of complication my strategy is to disrupt the pigment
into smaller particles using a non-ablative
laser such as a q-switch laser this approach
is actually comparable to the way we treat tattoos
where the tattoo pigment is disrupted into smaller particles in both of these
situations the smaller pigment particles are metabolized by
your body another common cause for
hyperpigmentation is post-inflammatory hyperpigmentation
commonly referred to as PIH PIH is darkening of the skin from
increased melanin production triggered by typically inflammation
the causes for post inflammatory hyperpigmentation include various types
of acne insect and animal bites or even
scratching the skin i've been seeing an increase of post
inflammatory hyperpigmentation as a result of
cosmetic treatments like lasers radiofrequency
microneedling and chemical peels although PIH is sometimes seen after
aesthetic procedures performed in a more medical or professional setting
there are a lot of people who are dealing with hyperpigmentation as a
result of their own at-home aesthetic
treatments for example it's easy to acquire
instruments such as dermarollers as well as medical grade
chemicals for chemical peeling it's not unusual to see the effects of
overly aggressive application of dermarollers or skin
infection due to sub optimal sterility practices at home
if your skin is over aggressively traumatized or infected with a dermaroller
post inflammatory hyperpigmentation can
occur and require further treatment i often find
that people with darker skin may not be aware
that they are more prone to hyperpigmentation
from the use of derma rollers or the application of chemical peels
for people with darker skin color like mine i
start with educating my patients about the need
to apply less inflammatory inducing strategies
and to be careful in avoiding anything that's too aggressive for example
for hyperpigmentation resulting from blemishes after acne or ingrown hairs
i recommend a procedure called HydraFacial
HydraFacial is similar to microdermabrasion
but instead of the application of crystals the device
uses water to more gently remove the top layers of skin
at the same time active ingredients such as glycolic acid
can be used to help facilitate resolution
of hyperpigmentation treatments can be done over several
sessions gently and gradually to reduce
pigmentation in darker skin types a very common area
of concern with hyperpigmentation is the under eye
area commonly referred to as dark under eye
circles this area where the eyelid skin is very
thin at about half a millimeter in thickness so my
approach is to optimize the skin quality with minimal
trauma for over 15 years i've been using platelet-rich plasma or PRP to help
people of all ages and all skin types improve
the area under the eyes with PRP PRP is composed of the wound
healing and growth factors that are present in blood and are responsible for
healing when you have an injury like a cut
when these wound healing and growth factors are
concentrated and applied to a given area there is an increase in blood supply and
collagen production resulting in better skin quality
making dark under eye circles appear lighter depending on the skin type of
the patient i also perform different types of laser treatments
such as a long pulsed erbium laser which we refer to as
smooth eye treatment Smooth Eye long pulsed Erbium laser is
very popular in my practice because there is no
downtime when compared to fractional or ablative erbium and co2 laser
treatment i often do use fractional erbium and co2
laser treatment when there is significant
wrinkling in addition to hyperpigmentation applying the same
principles for improving eyelid skin i also use PRP in other areas of the
face and neck to help patients with
hyperpigmentation improve their skin quality
since hyperpigmentation is often associated with some type of
inflammation or injury it stands to reason that
improvement in collagen and blood supply to the skin can help expedite the
resolution of hyperpigmentation the preparation of PRP is performed
after a simple blood draw like you would have when you go for a routine lab test
i customize different strategies to deliver the PRP
specific to that patient's individual situation
for example i inject prp just below the delicate skin of the under eye area
i also deliver PRP with a unique device that gently
creates micro channels in the skin without bleeding which we call skin
boosting i often combine laser and other thermal
energy device treatments with the application of PRP
to create a synergy between the stimulatory effect
of the energy delivery with the optimal healing process which is amplified using
PRP this often means that i can limit the
aggressiveness of the laser device and reduce the risks of complications
caused by higher energy delivery like pih
i've also found that prp placed strategically under the skin
can create a glow effect as a result of increased circulation and benefits to
the fatty cell layer just below the skin it's understandable
why people who have problems with hyperpigmentation feel
that they just want to take an eraser and wipe
away the hyperpigmentation in one single session
although there are situations where i can use a more aggressive modality
such as a fully ablative erbium or co2 laser
for certain skin types i have found that being strategic and minimizing risk and
downtime is better for many people in the long run
being patient is particularly important for people with darker skin
to avoid potentially making a bad situation
even worse a proper diagnosis and a detailed
treatment plan which involves observing the outcomes
as treatment progresses and making adjustments accordingly
is the key to long-term satisfaction for my patients who i treat for
hyperpigmentation i hope you found this information
helpful thank you for your question
you