Usually accentuated during summer time, pigmented spots are present all year long and result from years of multiple sun exposure. It is therefore logical that they are one of the most delicate skin conditions to fade or remove. A lot of education towards your clients is necessary and even if the technologies that we are going to cover are interesting options, nothing will ultimately work without proper sun protection.
Reminder on pigmented spots
Melanocytes that are found in the basal layer of the epidermis are cells responsible for our pigmentation, and therefore pigmented spots. They have extensions resembling fingers called «dendrites» that transfer the melanin synthetized to the surrounding keratinocytes. After several years of over exposure to the sun, the DNA of the melanocytes is altered to the point of causing an excessive production of melanin leading to the apparition of brown spots. Since the epidermis has 4 layers (5 on the palm of hands and feet), the melanin pigments can be present at different levels. It can even be possible that a melanocyte becomes so full of melanin causing it to tilt making the dendrites point down and creating a dermal spot. This is the case for dermal melasma.
This is why working with light-based technologies with different wavelengths allows to target different layers in the skin and treat different shades of spots. Let’s see the most efficient options.
Intense Pulsed Light (IPL)
IPLs emit a light between 400 and 1400 nm. A lot of manufacturers sell IPLs that range between 520 and 1200 nm in average. The benefit of IPLs is that they are absorbed by many chromophores such as the melanin. If we look at the absorption curve of the melanin (green line from the chart), melanin is not absorbed equally between 520 and 1200 nm as an example. A lot of IPLs have similar filters, but we see more and more IPLs with shorter wavelength bands, for instance between 500 and 600 nm. These short bands are therefore absorbed in a much more concentrated way, between a traditional IPL and a laser. The short band is selected according to the highest points of the absorption coefficient. It is possible that you come across next generation IPLs called AFT for Advanced Fluorescence Technology). IPLs are contraindicated for the treatment of melasma, an affection aggravated by the heat caused by IPLs. In this case, it is wiser to use Q-Switched (QS) Nd:Yag lasers or fractional radiofrequency.
Certain Alexandrite lasers offer the ability to work on pigmented spots. There is a certain absorption by melanin that is fantastic for hair removal and provides some results for brown spots. However, being of 755 nm, it is not the optimal wavelength for pigmented spots compared to lasers with wavelengths of 532 nm, 570 nm or 585 nm for instance. Furthermore, yellowish age spots that are particularly harder to treat because they are lighter, respond well to a KTP laser (532 nm).
There is also Nd :Yag 1064 nm in Q-Switched mode that works in nanoseconds instead of milliseconds; this speed creates acoustic vibrations that destroy pigments. Being used for tattoo removal and for skin rejuvenation, it’s in the family of non-ablative fractional lasers. However, in theory, at 1064 nm there is an inferior absorption by melanin and the light penetrates passed the layers of the epidermis. It is therefore more efficient for melasma or dermal spots, as well as to lighten pigmented spots for dark phototypes. Luckily, the technology continues to evolve and we can now find tips with different lengths that offering versatility in focal distance, allowing the 1064 nm laser to penetrate more superficially or deeper. We can also find 532 nm laser in Q-Switched mode. In reality, the Nd : yag 1064 nm laser is the source, the frequency is simply doubled; 1064 being the double of 532. Beware, if you look at the chart, 532 nm is more aggressive in terms of melanin absorption and the penetration in the skin is more superficial; it is therefore convenient for fair skins.
Looking at more aggressive lasers, ablative types (fractional or not) like Erbium Yag 2940 nm or CO2 at 10,600 nm, they are obviously more efficient since they perform skin ablations which causes the new skin being regenerated to be lighter. However, we have to proceed with caution as the skin will become more sensitive to the sun. Also, darker skin types are not good candidates because of the high risk of hyperpigmentation. Phototypes 4 are the limit and should always receive peelings before to limit the risk. CO2 laser is operated by doctors only.
Fractional Radiofrequency (RF)
Probably the most interesting option according to comparison studies of different technologies to treat
melasma, fractional RF is a technology growing in popularity and is like micro-needling. It has a tip, sometimes a roller or stationary, that creates micro punctures in the skin without the use of needles. Plasma, responsible for these controlled lesions, is created by the contact of nitrogen in the air and the RF sparks. Since it’s not light-based, fractional RF can be used on all skin types, serving as a great alternative to Erbium Yag and CO2 lasers. And beware, fractional RF can be just as aggressive, therefore, give the same results as those lasers, especially if the fractional RF is unipolar. The RF can be unipolar or bipolar, this is a detail to verify with the manufacturer.
The micro-needling treatment is a rotative device with fine needles that create channels in the skin in order to stimulate production of new collagen and allow a better absorption of active ingredients in the skin. These two phenomena can help reduce pigmented spots. Even if it’s not light-based, sun protection is still mandatory. Hygiene and sterilization are essential criteria to micro-needling and to avoid infections.
A lot of articles can be written about peelings since there are so many forms. Since they are not devices, I won’t go into details about peelings from which you already know the benefits for the skin and pigmentation. However, it is an interesting treatment to use in preparation for technological treatments or in combination (alternating).
In this category, I would like to address microdermabrasion and hydradermabrasion. Microdermabrasion, just like superficial and medium peelings, allows to remove a few layers of the epidermis, therefore lightening sun spots. It is however rare to be able to remove them completely. It is also an interesting technique to combine or to use prior to a technology such as light-based technologies or fractional RF. It’s an option worth exploring. Hydradermabrasion uses projected water to create the dermabrasion. You may have heard of SilkPeel or Hydrafacial MD? Hydrafacial MD has gained a lot of visibility in Canada and the United States. The system has a patented technology, infuses interesting ingredients and has LED lights to treat different conditions including hyper-pigmentation.
We have seen different technologies that you might be working with already, the most important is to
respect our professional limits according to each system, be realistic towards client’s expectations from each technology and to apply the ABCDE method for sun spots assessment. When in doubt, refer to a dermatologist. The combination of different technologies is always a winning strategy because it allows you to attack the problem from different angles. For instance, you can do a series of peelings or hydradermabrasion followed by IPL sessions or fractional RF. If you bill packages of treatments in advance, why not include sun protection? You can also make your clients sign a refusal consent form for the purchase of sun protection that stipulates your professional recommendations and that the products you use are professional and increase the treatment’s success rate. This will protect you and increase your sales at the same time!
** Article by Elgha Centeno, founder of ProFusion Coaching by Elgha Centeno and specialized esthetics expert, as seen in the Spring-Summer 2018 issue of Les Nouvelles Esthétiques Spa Canada **
The variety of available sunscreen products raises many questions. Does a high FPS guarantee better protection? Are mineral filters more efficient than chemical ones? Is price an indication of quality? Spray or cream? Following is an overview of the main issues regarding sunscreen and the undesirable effects of UVA and UVB rays on the skin.