Melasma and skin pigmentation can be difficult to treat. We have many lasers in our practice to treat pigmentation. We have a melasma program that patients can use.
Here is a patient with an interesting history of several different pigmentation issues.
1. Freckling
Which has been present for many years.
2. Other Brown Spots
These are getting worse over the years. One of them the patient had approximately 5 treatments at another laser clinic, with no result, prior to coming to our clinic
3. Melasma-like Pigmentation
This is the symmetrical “mask”-like background pigmentation over cheeks and jawline and forehead. This had a recent onset (<2 years). She was told by another practitioner that this was untreatable. which turned out to be incorrect
4. Areas of Hypopigmentation
in amongst the dark pigmentation are areas with white spots, which look worse because of the pigmentation surrounding them.
Assessment, consultation and discussion
When I met this patient I really under promised in terms of expected results. I wasn’t sure how much improvement we were going to get easily. I was cautiously optimistic, but I wanted to prepare her for the worst case scenario of minimal improvement after a series of treatments, given her previous history
We have quite a number of laser/light devices in my practice which were options for this case. With her history of poor satisfaction with previous laser treatment, I really wanted to safely get as big a result as possible as quick as possible…..
There were freckles and recent onset of the mask-like pigmentation, so I thought that I would try test patching with my IPL i.e. BBL, and I thought that it might hit the freckles adequately and the melisma-like pigmentation if we were lucky. I thought it more likely that we would have to use multiple treatments of our Q-switched laser for the background pigmentation after removing the freckles.
Treatment
First we put the patient on our topical lightening protocol and then performed some test patching with BBL
The results of the test patching was fantastic see below
From these test patches, it was clear that incredible results were going to be achieved in even one treatment, although, at least 2 treatments would be advised.
The freckles were improved, the background pigmentation was improved and another interesting achievement was how much better the hypopigmented areas looked after treatment because there was so little contrast with the surrounding areas when the pigmentation was improved.
We performed the treatment. Here are the forehead results after 1 treatment
We performed a second treatment 3 weeks later and I will write a follow up story when the patient comes in for her review in a month
Plan
I will also write about how her laser treatment plan changed after we saw her results from the BBL treatment. We decided that a great option instead of a 3rd BBL is a series of fractional lasers, which will be great for texture, scarring and fine lines