Age Spots At A Glance
- Best Results1-3 treatments
- Treatment Recovery0-4days
- Procedure Time5 min
- Skin SpecialistDermal therapist, nurse
- Duration of ResultsYears
- AnaestheticNumbing to sedation
- Back to WorkImmediately
- Cost$-$$
Age Spots & Brown Pigment Treatments
Age spots are due to both chronological ageing & sun exposure. This form of pigmentation can be resistant to normal lasers, however can be treated with special types of lasers including nano, pico & ablative laser resurfacing. The best method depends on the type of age spot & your background skin colour.
FactsFacts on Age Spots & Pigment Treatment
- The most common age spots is called a flat senile wart or macular Seb Keratosis
- Other types of spots include solar lentigo spots
- Some forms of age spots including pigmented solar keratosis are precancerous
- Lentigo maligna melanoma can mimic ages spots
- Other common cause of pigmentation include regressing lentigo or lichenoid keratosis
- The ideal treatment depends on the diagnosis
Why is diagnosis of age spots vital before attempting treatments?
Age Spots & Brown Pigment Treatments
Knowing the level of pigmentation is essential to giving predictable results. Some forms of pigmentation are superficial, freckles are examples of surface pigmentation. Some types of age spots are deeper, whilst others maybe cancerous. Diagnosis before treatment not only improves outcomes, but increases safety margins.
What are effective ways of reducing or removing age spots?
Lasers are the most effective methods of removing age spots. Superficial spots are removed with Fraxel or Fractional Lasers, deeper spots are removed with erbium or CO2 lasers.
In ethnic/Asian skin I use Pico lasers, often in combination with fractional laser resurfacing.
Chemical peels including Jessner or Jessner TCA can also remove stubborn age spots. In lighter skin patients I also use BBL or IPL.
How many treatments will I require?
One to three sessions, depending on the diagnosis & your ethnicity. In lighter skin patients, one to two laser sessions will remove the vast majority of spots. For darker skin patients 2 to 3 sessions maybe required.
Note, melasma pigmentation is different from age spots. This special form of pigmentation must be treated gradually, or pigment flare ups are possible.
How long will it take to recover from laser treatment?
This depends on the type of laser we employ as well as laser settings. As a guide-
- Nano Q switch Spectra Dermal toning: No downtime
- Pico Lasers/Picoway/Picosure: 0-1 days
- LaseMD Ultra: 1-3 days
- Fraxel: 3-4 days
- Clear & Brilliant: 2-3 days
- CO2: 2-4 days
View our Treatment Gallery
Can creams be used to treat spots & pigmentation?
Creams are useful in prevention of age spots & treatment of some conditions such as melasma. Creams do not treat established skin lesions such as lentigo, or macular -flat seb warts.
Pigment prevention can be achieved with retinol, retinoic acid, niacinamide, ascorbic acid & other pigment inhibitors. The use of high factor SPFs can dramatically reduce pigmentation recurrence.
Can peels remove pigmentation?
As with lasers, it really depends on the diagnosis. Peels including AHA glycolic & lactic acid can reduce pigment. Deeper peels including Jessner & TCA can treat the vast majority of pigmentation. As a guide-
AHA Peels: 4-6 sessions
Jessner: 3-4 sessions
TCA: 1-3 sessions
Jessner + TCA: Only 1 session
Hori nevus treated with low fluence QSL
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👉Condition: Late onset dermal melanocytosis, commonly seen in Asian women 20-40 yo. Concurrent background melasma makes it challenging to treat in some
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🔫Effective treatment options: QSL nano, 1064> 532, Pico 1064> 532. Traditionally high fluence with 2-4 mm spot size (to get enough energy & end point). This patient responded to low fluence 1064 (failed pico at high fluence). This ‘low power’ technique has been reported in the literature, however most of us use the high power setting
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👌🏻This B+A from the combined talent of our nursing team at Cutis Dermatology
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👩🏽Pigment? Our nurses can manage most cases of pigment, from common causes, to rarer conditions including Hori, Ota, drug induced pigment, traumatic tattoos & constitutional cases. If you have pigment, book a consultation with them. I do get involved in complex cases
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😎Davin Lim
Dermatologist
Brisbane🇦🇺
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#drdavinlim #skincare #skincaretips #skincarescience #skingoals #melasmatreatment #dermatologistbrisbane #dermatology #horinaevus
#ethnicskincare
More on this tonight at Candela’s Frax Pro meeting @candelamedicalanz
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🔎Aim: Combine Picoway + Frax Pro, safely in Asian-Ethnic skin type
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🔫Lasers: Frax Pro 5-10 mJ, 30 % density with extra passes at session two for 60+ % in select areas. Picoway 532 + 1064
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2️⃣Sessions: two only (combined lasers in each)
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👉Comment: Still learning how far we can push the 1940 in the context of ethnic skin
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😁Concept: two superficial treatments may have different cytokine expressions that may be synergistic. We are not looking at pigment reduction (easy with the Picoway to achieve), we’re looking at collagen production & reduction of wrinkles in darker skin types with the minimal number of treatments & S/E
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👊🏻More tonight
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😎Davin Lim
Dermatologist
Brisbane🇦🇺
#frax #fraxpro #fractionallaser #candela #laserresurfacing #pico #picoway #Picolaser #ethnicskin #drdavinlim #davinlim #collagen
One session pico laser using the 532 nm wavelength by Alison @cliniccutis
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👉How we employ pico: Post inflammatory hyperpigmentation, general dyschromia in darker skin types, #Ota, enlarged pores in dark skin, early #acnescars with minimal volume loss
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🔫The device: Picoway, with 532 for #lentigos followed by 1064 for general toning
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🔬The logic: pico lasers in this skin type reduces unwanted side effects, namely post inflammatory hyperpigmentation. This is based on probability not possibility
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🧐When I still use nano/ QSL: CALM, #melasma, age spots & lentigines in skin type 1- 2 & some 3 (relative risk)
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👎🏼What pico is NOT great for: Atrophic acne scars, melasma (I prefer a higher predictability), solar keratosis, one session skin rejuvenation in lighter skin types (fractional laser does a much better job), deep wrinkles, skin laxity
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🧐Davin Lim
Dermo
Brisbane🇦🇺
@cliniccutis
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#dermatologist #drdavinlim #picosure #picoway #enlighten #agespots #picolaser #picotoning #skinlightening #skinbrightening #ethnicskin #cosmeticclinicbrisbane #dermatologyclinic
This is one of the most challenging cases in laser dermatology. Far more complex than vascular or ablative work, given the skin type. This was after ONE session using 532 +1064 wavelength by Alison at Clinic Cutis. Further improvement expected after another session💯
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🔬Skin science: This is a lentigo. It’s relatively easy to treat if you have light skin, but this is extremely complex for skin of colour, it is not about treating the lesion, it is about reducing the risks of dyspigmentation with the treatment of choice
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🔫Lasers: The safest is the pico laser. This provides fading with a low chance of post-inflammatory hyperpigmentation (about 5-8% in this skin type). Alison’s used two wavelengths on the Picoway, 532 for the lesion & 1064 for general ‘toning’
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👊 A second treatment will give better results
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👉Nano: can treat, but much higher risk of PIH
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👉Fractional lasers: Can treat, will take 4-6 sessions, far more effective & efficient ways
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🍌Peels: not a good idea
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🧴Creams: won’t do much, but tyrosinase inhibitors before and after can reduce PIH, SPF mandatory
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😎Davin Lim
Dermatologist
Brisbane🇦🇺
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#ethnicskin #pigmentation #skinbrightening #skinlightening #drdavinlim #picolaser #picosure #picoway #picotoning #skinrejuvenation
I find these lesions really hard to treat (with predictability). Lentigos in skin types 3+ & above is my pet hate, purely based upon the risk:benefit ratio of treatments coupled with the probability of resolution. On the contrary, this lesion in skin type 1-2 rarely poses any problems
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🤔Clearance vs PIH vs number of treatments: I used a 532 nano QSL for this job. If I treat 10 similar lesions of the same skin type, it’s a gold medal for 7, & crash & burn with post inflammatory pigmentation in 3. Luck was on my side for this case, so don’t think for a second I can predictably replicate this result 🎲🎲
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🔫Pico lasers: offer SAFER treatments with less PIH, but on the flipside, much less predictable cf nano lasers. For lighter skin types with lentigos, my preference is still nano over pico, but in darker skin types, a series of 2-4 sessions of pico can be effective. In some cases it is more of a ‘fade’. In thinner & smaller lesions, pico can completely ‘remove’. The answer may lie in shorter PD nano lasers with a better flat top beam profile
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😎Davin Lim
Dermatologist
Brisbane🇦🇺
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#dermatologist #brisbanedermatology #pigmentation #skinlightening #picosure #spectralaser #hollywoodspectra #skinbrightening #picolaser #picoway #agespots
I cringe at the words ‘natural’ & ‘organic’. Guilty of throwing them around to get the job done. Hydroquinone is one of the best pigment correctors, however there are 3 main (proven) problems with it.
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1️⃣Firstly it can be irritating to some, even in low concentrations. Hence why I prefer a stand alone as I can titrate
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2️⃣It is not widely available in Asia, Africa & some European countries
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3️⃣Long term use can lead to tachyphylaxis & exogenous ochronosis
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🍊Natural’ pigment inhibitors are useful during the off phase of HQ, as part of rotational therapy, or adjunct in the am. An example is L-ascorbic acid in am which functions as an antioxidant & as a tyrosinase inhibitor
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👉There are many novel ‘natural’ pigment inhibitor formulations including #Meladerm, #Melarase, #Melacream. Botanicals (technically lab made in some) such as liquorice root, citric acid, #arbutin, azelaic acid, kojic acid & bearberries are the main ingredients in these anti-pigment formulations
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👍🏻Melasma patients: Be guided by the nurse I have assigned to your case. They will guide you as to how to titrate your topicals & when to integrate non-HQ ‘organic’ topicals into your routine. Rotate & titrate as per their instructions. Your actual program will depend on what stage you are at in your treatment program
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😎Davin Lim
Dermatologist
Brisbane, Australia🇦🇺
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#dermatologist #melasma #skinlighening #skinbrightening #pigmentationtreatment #skincare #organicskincare #naturalskincare
Can microneedling remove pigmentation?
Microneedling can marginally improve some forms of pigmentation, however in the majority of cases, this treatment can make pigment worse– especially melasma. I do perform microneedling, however, employ this treatment for topical drug delivery- dermal drug delivery. There are far safer & better ways to treat pigmentation.
Will age spots return after treatment?
Yes, they are called age spots for a reason. In most cases the treated age spots will not recur in the same location. Given time, usually years, more spots will develop as one ages. Everyone will develop age related pigment at some time of their lift. The aim is to manage these spots early.
Small, early-age spots can be treated with lasers such as Pico or fractional lasers.
Why are sunscreen & skin care important when it comes to pigmentation treatments?
90% of pigmentation is contributed by UV exposure, the other 9% due to age & genetics. Rare causes such as drugs, focal PIH due to inflammatory disorders contribute the rare 1% of cases.
As a guide- use SPF 50+, twice a day regardless of UV exposure. Hats & sunglasses are the first line of defence.
Skin care ingredients such as ascorbic acid, antioxidants, & retinol can prevent recurrence.
90% of pigmentation is contributed by UV exposure, the other 9% due to age & genetics. Rare causes such as drugs, focal PIH due to inflammatory disorders contribute the rare 1% of cases.
As a guide- use SPF 50+, twice a day regardless of UV exposure. Hats & sunglasses are the first line of defence.
Skin care ingredients such as ascorbic acid, antioxidants, & retinol can prevent recurrence.
Who should you see if you have age spots?
For simple cases of pigmentation, including age spots, sun spots, freckles & melasma, book an appointment with my clinical nurses @cliniccutis. My nurses have had extensive training across all our laser equipment.
I am more than happy to review your age spots if you are contemplating fully ablative laser resurfacing.
Davin’s Viewpoint on treating Age Spots & Pigmentation
Pigmentation is one of the more difficult algorithms to treat as there are many causes. Treatment will depend on the diagnosis.
Flat seb ks. or warts, lentigo & partially regressed lichenoid keratosis are essentially spectrums of the same condition (in the context of clinical treatment, not histology). They can be resistant to ‘normal’ low downtime no downtime procedures. This form of pigmentation will respond to Q switch lasers, de-focused CO2 & pico. 1-2 sessions.
The caveat of all pigment is the lentigo maligna melanoma. This form of pigmentation can mimic many types of pigment. If in doubt you GP or dermatologist a take a biopsy, before referring you for treatment.
