“Pigmentation” has many causes, and incorrect treatments by unqualified persons can give disastrous results. At Peach we get great results using the right treatments in the right circumstances.

Freckles from QLD
I came in for lip augmentation, then Dr Mahony asked me whether I liked my freckles. I said I hated them, so we proceeded with IPL. After just two full face treatments, and an additional Iriderm laser treatment to clear the freckles around my eyes, my face is clear.
Case study

Erbium laser resurfacing
The photos speak for themselves

Erbium laser resurfacing

Again, the photos tell the story

“Pigmentation” just means presence of colour. It is not a diagnosis. Any therapist who looks at a bit of brown and can’t call it anything more specific than “pigmentation” shouldn’t be treating your skin.

There are a wide range of causes of pigmentation and it certainly doesn’t do the topic justice to try to cover them all on a website. For starters, to do so implicitly encourages patients to self-diagnose and self-manage, which in this case can be quite dangerous. By way of example, there is a rare but potentially lethal condition called Addison’s disease (JFK had it) in which people commonly develop pigmentation. To treat Addison’s disease as a cosmetic problem alone without treating the cause would lead to disaster.

Of course, a far commoner problem in Australia is melanoma, a condition with which Dr Mahony is intimately familiar. Individual spots of pigment should not be treated unless a doctor is certain the spot is not melanoma. Furthermore, some pigmentation conditions in some patients can be actually worsened by the very treatments being applied to reduce the pigmentation!

And so we would always recommend that any person feeling they require treatment for a pigmentation problem should first consult a doctor, preferably one with an interest in skin. (Obviously, a medical consultation at Peach would well serve the purpose).

Having said all that, it remains that Australians of a northern or mid-European genetic background nearly all suffer to some extent (if they are old enough) from a condition called solar dyspigmentation. This is a mottley, freckley jumble of brown tan and white that typically occurs symmetrically over the sun-exposed areas of the face decolletage forearms and hands, in proportion to the degree of sun exposure. So, the forehead and cheek tops are worse than the lower cheeks.

The rest of this section relates to this very very common condition called solar dyspigmentation, and is presented for your information, but we stress again that anyone with a pigmentation problem should consult a doctor such as Dr Mahony about it.

Solar dyspigmentation anywhere on the face responds very well to our IPL (Intense Pulsed Light) treatments. This works by emittinig a flash of bright light that is specifically absorbed by the melanin (pigment) itself in the skin. Cells containing melanin get heated, whilst the surrounding cells are relatively unaffected. The treated pigmented cells darken, then over the next few days they work their way to the surface of the skin from which they are then shed. You will notice the brown spots darken, and you will thus look spottier for a few days or a week. Then the brown spots will seem to literally flake off your face, revealing much smoother skin.

Treating solar dyspigmentation around the eyes presents another challenge, as it isn’t safe to use the IPL within the orbit. In such a case we can use our Iriderm KTP 532nm laser to treat individual brown spots one-at-a-time whilst keeping your eyes well protected

Solar dyspigmentation on the neck is treated the same way as on the face, but the energy level needs to be lower as the neck skin is thinner and thus more fragile. Some patients have a pigment problem on the neck whereby the thyroid cartilage or “adam’s apple” is white and without pigment whilst the sides of the neck are quite brown. There is often a sharp line of difference between. IPL works very well to reduce this line of difference between white and brown, leaving a more even appearance.

Solar dyspigmentation on the shoulders, chest and upper back is also treated with IPL. The chest and the front of the shoulders respond very well. The back of the shoulders and the upper back can be more difficult, as the skin is thicker so it is more difficult for the flash of light to penetrate to the depths of the pigment. Reduction of pigment is still very good in the great majority of patients.

Solar dyspigmentation on the thighs and calves is successfully treated at Peach with the IPL. However, recovery is much slower than is the case with facial treatments. The brown spots may be darker for quite a few weeks before the benefit is fully seen. Autumn and winter are thus good times to get IPL treatments to the legs.

IPL treatments are well tolerated and perform well, but they rely on the colour difference between the target pigment and the surrounding skin to work. Therefore, it doesn’t help to be doing IPL in conjunction with pigment-reducing skin creams. Such creams work to temporarily reduce discolouration, sure, but this interferes with the benefit you can get from IPL.

On the other hand, some patients have pigment problems that are so slight that there isn’t a sufficient colour difference between the unwanted pigment and the surrounding normal skin for the IPL to well differentiate between them. In such a case, topical skin creams with one of our lines offers the best way to manage this pigment problem on an ongoing basis. These work by suppressing the formation of melanin and by facilitating the clearance of existing melanin in the skin. However, the creams do not, by themselves, permanently change melanin production, so IPL is preferable.

What about chemical peels? I’ve heard they are good for pigment problems?

We do some light to moderate peels at Peach, especially to improve skin texture and glow and to help treat acne, fine lines, dryness. And pigment. So in cases where we want to treat a number of problems simultaneously, and get some high levels of nutrient in to the skin at the same time, we will often recommend a peel.

The trouble with chemical peels is that they are colour-blind. The chemicals affect non-pigmented and pigmented cells alike. To remove all the pigmented cells from the base of the epidermis, for example, you have to remove ALL of the epidermis. So, for a given amount of pigment clearance, side effects can be worse. As well as this, it is inherently more difficult to fine-tune a chemical peel when it is strong, whereas with an IPL it is simply a matter of choosing an energy level. So IPL treatments can be performed confidently at significant levels of energy.

What about other lasers?

CO2 and Erbium lasers have been used successfully to remove unwanted pigment. Like chemical peels, they are colour-blind, and so work by removing ALL the skin cells to a certain depth to achieve their effect. Then again, fine tuning of the treatment is easier than with a chemical peel. Consequent to their mode of action, CO2 and Erbium lasers cause more side effects than IPL machines. Recovery is measured in weeks, whilst with the IPL you can return to work the next day with sufficient foundation to cover the temporarily darkened spots. Because they kill off melanocytes, these lasers can permanently interfere with your capacity to produce pigment.

However, for many patients the time comes when they find IPL treatments are not giving them the results they need, and they are keen to take the next step. By fractionating a CO2 or Erbium laser, treatments can be tuned to the degree of improvement required and the extent of down time tolerated.

Will the pigment come back?

IPL treatments do not kill off your melanocytes. So, if you decide next summer to spend time in the sun, then, yes, you will see pigment return. We think this is preferable to treatments that remove your melanocytes and give you a permanent degree of whitening but leave you more sun-susceptible.