The Surgeon Minute

Modern Methods to Treat Hyperpigmentation

Modern Methods to Treat Hyperpigmentation

No one feels attractive when their skin is covered in brown splotches. Hyperpigmentation, the official term for this condition, can be caused by any number of factors including sun damage, inflammation and hormones. Unfortunately, these things combine to make many look older than they years.

The skin is your body’s largest organ. Doing everything possible to keep it looking it’s best is a vital component of any anti-aging routine. The problem is that hyperpigmentation is both incredibly common and notoriously challenging to treat. Dr. Brad Calobrace of Louisville discusses the most important thing you can do to prevent hyperpigmentation as well as his multi-step approach for treating patients with issues of excessive pigment.

Prevent Hyerpigmentation with Sunscreen

If you read any health or beauty magazine then you know that the daily use of a good UVA/UVB sunscreen is the first line of defense against skin cancer. It’s also possibly the single best thing that you can do to prevent skin aging issues such as brown spots, redness, crepey textures, fine lines and wrinkles.

Fighting hyperpigmentation with sunscreen.


The sun has many positive qualities, including the fact that it’s the body’s best source of Vitamin D (and the whole powering all life on Earth), but UV light stimulates melanocyte production that results in melanin or brown spots. Wearing a high quality sunscreen everyday, rain or shine, is the ideal way to prevent future pigment issues. This makes it an important component of any hyperpigmentation treatment plan.

What Causes Hyperpigmentation?

Dr. Calobrace treats patients with facial pigment all the time as it is a very common problem. Part of the reason for this is that there are so many underlying causes, such as:

  • sun damage
  • inflammation
  • hormones

UV light causes the skin to produce more melanin which can result in those pesky sun spots that most patients start to see in their 30’s. Inflammation from a skin injury, such as a cut or acne, can result in excessive pigment at the wound site. And hormones are one of the root causes of melasma. Typically affecting the forehead, cheeks, upper lip, nose and chin, the brown splotches of melasma form a “mask” around the face, which is why it’s often referred to as the “mask of pregnancy”. It is not solely the domain of women, however, as men can suffer from it as well.

Utilizing a Bleaching Agent

Hyperpigmentation such as melasma is not just an eye sore; it is extremely difficult to treat. As discussed, being out in the sun causes the skin to produce more pigment. Since it is nearly impossible to completely avoid the sun, this makes eradicating pigment issues challenging. Furthermore, plastic surgeons often address hyperpigmentation with lasers. But the heat from the laser may make the pigment issues worse.


“The first step is to put the patient on a bleaching agent,” shares Calobrace, “but a bleaching agent doesn’t actually bleach anything.” What it does is shut down the melanocytes that produce pigment. This, in turn, stops your skin from producing any additional pigment.

“You know, to really get rid of a spot on your face, you probably have to spin the skin cycle around three times and a skin cycle takes 6 weeks,” says Dr. Calobrace. This means that it takes about 18-20 weeks to really see that spot fade. The problem is that patients start to get really bored around week 8 to 10. It’s crucial that patients be educated on what each different phase of their hyperpigmentation treatment plan is doing. Phase 1 is sunscreen to prevent further brown spots, and phase 2 is the use of a  bleaching agent to stop melanin production. It’s also critical that patients understand that the deeper pigment, the longer the treatment is going to take.

Hyperpigmentation Treatment Options

Once a patient has stopped the production of melanin with a bleaching agent and is vigilantly applying sunscreen to prevent any further spots, then the plastic surgeon can discuss treatment options. There are quite a few procedures that can help to eradicate brown spots such as:

  • chemical peels
  • lasers
  • skin care
  • facials
  • microdermabrasion

Laser treatments for hyperpigmentation.

Lasers such as intense pulse light (IPL) are probably the most common procedure for treating pigment issues. They can be highly effective, especially when combined with proper skin care. However, one laser treatment is not going to do the trick. It will take a series of treatments spaced out over time. If your pigment issues run deep, you may need to combine your laser procedure with another procedure such as a peel or microdermabrasion.

The right choice for you is going to depend on the degree of your pigment as well as your lifestyle. Not every patient can afford the downtime that a chemical peel requires. For that patient, a successful outcome may not be completely eradicating the pigment, but, rather, getting it to a point where it’s no longer the first thing that someone notices.

Excessive pigment is just hard to treat. It is going to require a lifelong commitment from the patient, but for those who are willing to commit the time, the skin can absolutely be transformed.

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