Also known as Lumigan 0.03%, this comes as drops. It is used to increase the length of the eyelashes, but it can also stimulate pigmentation. Bimatoprost can be used after microneedling. See the DIY section for more information.

In Australia, bimatoprost requires a prescription (from any doctor), you can be resourceful & find it online.

This is a calcineurin inhibitor. It reduces skin inflammation, however in the context of white or hypopigmented scars, it accelerates melanocyte migration. In some cases I will prescribe this cream, along with phototherapy. You can be resourceful & source it online. It is also known as Protopic. See below.

The theory behind lasers is three-fold.

1. Enables transepidermal delivery of pigment stimulating creams. As the pigment cells are in the epidermis one does not need a superhero deep laser to get to this level. My go to lasers are thulium 1927, & CO2 fractional
2. Lasers stimulate germ cells in the area to differentiate, hopefully to melanocytes. The latter produces pigment.
3. Lasers can stimulate existing cells (low in number) to wake up and produce pigment. Think of it as iatrogenic post inflammatory hyperpigmentation.

About 3-8, it really depends. If you have mild hypopigmentation, 1-3 sessions will do. For more extensive areas, additional sessions may be required.

Lasers can stimulate melanin production via increased absorption of chemicals that stimulate these cells. Addition of medical phototherapy can compound pigment production.

Yup, sure do. Even though I have over 30 lasers at my disposal, sometimes simple treatments are the best. I prefer microneedling with a dermaroller over pen-stamps. Why? Because I have been microneedling for two decades and old habits die hard. My nurses like derma pens, but for home use, a dermastaper is safer.

The most important concept to understand is that longer is not better (that’s what he says). The pigment cell is in the basal epidermal layer. Hence with adequate pressure, 0.1 to 0.2 mm will get you there. Microneedling is designed to deliver topicals & (in theory), release growth factors, cytokines & chemokines to stimulate pigment cells.

For microneedling, you may require 6-10 sessions for optimal pigmentation (that is if you have viable melanocytes in the first place).

Not everyone has access to a dermatologist. Home DIY treatments can be effective in a small number of patients. The most important aspect of home remedies is safety, so I will only address sensible treatments. Try this if you are desperate, can’t see a dermatologist or cannot afford treatments at this moment in time.

1. Buy yourself a dermastamping tool from Amazon or eBay. Stamps are preferred compared to skin rollers. Look for 0.1 to 0.2 mm lengths. Do not go deeper.
2. Get some Latiesse eye drops (bimatoprost). Apply 3-10 drops within 10 minutes of microneedling. Cover with gladwrap. Do this twice a week. 
3. Another option is to get some tacrolimus (Protopic), apply this to the hypopigmented areas on the days of your microneedling. If you are using 0.1 mm needles, you can do this up to twice a week.
4. Home UVB light sources can be helpful. They are not as powerful, nor as accurate as clinical sources.

This is a medical treatment that delivers special light therapy to the areas of hypopigmentation. It is vastly different from usual light sources as it concentrates one band of light (UVB at 311 nm). This can stimulate pigment cells to increase their output of melanin.

Phototherapy is under Medicare. Patients undergo 2-3 sessions per week. It can take weeks to months for optimal results. This treatment should be considered as adjunctive therapy after surgical procedures including micrografting, punch, suction blister & ReCell treatments.

If you are undergoing laser re-pigmentation or microneedling, you will require between 3-6 sessions over the course of 4-7 months. For surgical procedures, I try to complete the treatment in one session,

In the context of phototherapy, between 4-9 months is ideal.

Yes. Cosmetic tattoos are different compared to traditional tattoos. Medical tattooing uses different pigments. They are semi-permanent & frequently require touch ups every 12-24 months. Finding a good medical tattooist who can colour match is essential for a good result.

Note: sun exposure will fade your cosmetic tattoo & also increase the contrast between pigment.

Methamphetamine use can give a unique scar pattern, namely gouged out hypopigmented scars. This is because with ice use one can experience hallucinations & altered sensations (creeping, crawling, itch), a person can pick, gouge & scratch without feeling pain. I see at least one of these scar patterns every few weeks.

The burden to the patient can be significant as it reminds them of the days of addiction. Most ex-addicts would want these removed to reduce the physical & mental anguish. 

Meth-ice scars can be challenging to treat as they have elements of atrophy (divots) as well as decreased pigmentation. I employ one of a few strategies to reduce scarring-

1. Blend in the surrounding skin with lasers (creates less contrast)
2. Dermal grafts or fillers for atrophic scars
3. Fractional lasers & pigment stimulators for hypopigmented areas
4. Micrografting for white/loss of pigmentation

Third world countries have neat tricks to help stimulate pigmentation. This applies to areas of vitiligo as well as hypopigmentation from many other causes including infections such as leishmaniasis. Your dermatologist may prescribe some DIY methoxy psoralen creams. Listen to them, I have no experience with this method.

This will be available in the future as mainstream treatment, namely autologous cultured melanocytes. The rules & regulations will differ with your country. Essentially-

• Harvest some pigment cells
• Chuck the in a petri dish
• Give them some food & light
• They have a party & multiply over 2-6 weeks
• Go back & harvest the offspring
• Replant them in white areas.

Depending on the severity of your scars, some treatments are covered under Medicare. The medical insurance system in Australia is based upon objectively severe scars, meaning the government only cares on what you look like objective, & not how you feel.  

• Micrografting & split grafts- POA, depending on the area.
• Fractional lasers – from $490 (Nurse)
• Microneedling & topicals- from $440
• Phototherapy – no charge. Bulk billed under Medicare