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My guide to identifying and treating melasma and pigmentation
Realself reviews – if you want to know what I do
How to treat PIGMENTATION
If I can identify the cause of pigmentation, chances are I can treat it. This can only be achieved with careful real time examination and a history. There are over 150 causes of pigmentation including PIH from acne, chicken pox, inflammatory skin conditions, melasma, sun spots, freckles, birthmarks and many others. This video illustrates my daily laser procedures as to the most common cause of skin pigmentation I see. I will do another video on pigmentation involving the neck and body in the future, as this video only discusses facial pigmentation.
1. Melasma – I see 6 cases a day, sometimes up to 10. This is because Brisbane, Australia has a high amount of UV radiation. 95% of melasma can be successfully managed with lasers, creams, sun protection and VEGF-1 Modulation. Melasma is a medical condition and should be treated by specialists only. Incorrect treatment will make this worse. I prefer Revlite or Nano lasers, or the new Picosure,- Picoway – Enlighten laser. Laser parameters, coupled with tyrosinase inhibitors and SPF are critical to getting a good outcome. It is more about the end point settings and wavelengths than the brand of the laser.
2. PIH or post inflammatory hyperpigmentation is super common. PIH due to acne can be managed along the same lines as melasma. For MILD and EARLY acne scars I use pico lasers in an off-label setting. PIH due to other causes may take up to 12 months or longer before resolving. The key to treating PIH is with gentle treatments, time and absolute sun protection- especially in Brisbane.
3. Sun damage can present as pigmentation, as well as a combination of melasma. Very important to get the diagnosis correct as if the diagnosis is wrong, treatments such as IPL and Fraxel can worsen melasma or even trigger this condition. I use everything from Fractional lasers, Pico lasers, medium depth TCA peels, all the way to CO2 and erbium lasers to treat sun damage. Reduction of sun damage can decrease the chances of skin cancer.
4. Freckles are easy to treat- IPL, peels, Fraxel can all help, as can light laser treatments such as dermal toning combined with Vitamin A and AHA creams. Easy to treat but because it is genetic, recurrence is the rule. Sun protection is essential- especially in Brisbane.
5. BIRTHMARKS- again diagnosis is essential before I laser any birthmark. The most common BROWN birthmark I see is a CALM, other birthmarks such as Ota, Ito, dermal melanocytosis, Hori’s can also be treated. Birthmarks that do not respond well include congenital naevi, and speckled and lentiginous naevi, additionally Becker’s Naevi as well as mosaic pigmentation do not respond predictably. Please don’t comment as to how I can help you IF you have a birthmark- as my reply would be to see a dermatologist for a diagnosis. Thanks for your understanding as technology is not quite there for virtual laser – possibly in another 50 years time.
Thanks for viewing, I do one fun, education video on laser and aesthetic dermatology every week. Will be doing more VLOGs in the future. Please share, comment, like and by all means SUBSCRIBE. See you next week, Dr Davin Lim. Brisbane. Australia
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