1. What is the best way to remove freckles?
The most effective way to remove freckles is with a high quality IPL. Not all IPLs are created equally, and not all operators know how to use or get the best out of their machine. These are the 2 reasons why most clinics who claim to perform freckle removal cannot actually perform the treatment successfully. As many patients find out after multiple disappointing results, it is a very specialised treatment.
The reason we typically choose IPL over laser as a first line treatment for freckle removal is that (especially in Australia) most commonly, patients don’t usually have isolated freckles on a skin with a perfect background, ie if you just remove the dark freckles themselves, you’re left with a mottled, sun damaged background, which doesn’t look much better. The background also needs to be removed. Good quality IPL/BBL will remove this background pigmentation.
2. How many treatments of an area do I need?
Typically, only 3 treatments are required. The results from 1 treatment are excellent, but often there are missed areas, and a second treatment is required to pick these up. It is like a second coat of paint. It just looks more polished. Often, freckles on the back and chest will require up to 3 or more treatments, as they can be quite stubborn. Even though 2 treatments are often effective, better results can be achieved with 3 or more. On some patients more are required to achieve the patient’s expectations. The end point is where the patient is satisfied and patients have varying expectations.
3. Does the freckle removal treatment also treat capillaries/blood vessels/redness/sun spots or moles and other lumps.
Freckle removal treatment does not usually remove capillaries or blood vessels. When performing freckle removal, we are using a wavelength that is attracted to brown. If we wish to remove anything red, we would use a wavelength that is attracted to red. However, when a patient has a sundamaged neck and chest that is quite red, we will always use the wavelength that is attracted to brown first, as often it will pick up the red sun damage significantly. It is best to do it that way, because we have had less success attempting the reverse (ie aiming for the red first)
Any flat brown lesion has the potential to be improved by freckle removal treatment, eg solar lentigos. However, any lesion with thickness to it, eg moles or lumps, won’t be removed by this treatment, although, their pigment may be changed. To remove raised lesions, we would use our ablative laser, a single spot Erbium laser or our Pelleve.
Any suspicious lesions should not be treated by laser.
Our order for treating a body are with these multiple problems is as follows:
First: freckles and pigmentation removal, ie flat brown lesions removed
Second: Raised lesion removal, then
Finally red lesion removal
4. Is it painful?
To get really good results, the freckle removal treatment has to be reasonably painful. Most patients would give it a rating of 6-7 out of 10 on the pain scale. Some doctors like to use topical anaesthetics, eg emla, but we don’t use emla with laser pigmentation and freckle removal. There is a risk of going too high with powers and causing hypopigmentation (white or paler areas) or scarring. We want to avoid this. We have seen many patients who have been left with hypopigmentation on the chest after too aggressive treatments by other practitioners for freckle removal.
5. Can peels work to remove freckles?
For the face, deep peels can be used to remove freckles. However, it is unsafe to use that depth of peel required for freckle removal on the body. There is a significant risk of problems with healing, hypopigmentation and scarring. Peels should not be used on the body or neck for freckle removal.
6. Is fractional laser good for freckle removal?
Fractional laser is not the gold standard for freckle removal treatment. With a fractional laser, it only covers approximately 10% of the skin surface area per treatment, so the results can only reflect this. We have done several cases where I have treated half the freckled body with one treatment of fractional ablative laser and the other side with one treatment of IPL/BBL. The freckle removal results on the BBL/IPL side were vastly better than the fractional laser side. We love fractional laser and have 2 fractional lasers at The Manse Clinic, but we wouldn’t consider it the efficient and cost effective choice, for freckle removal.
7. Can I go in the sun afterward?
Now that is a difficult question. Obviously for those who are predisposed, there is a risk of post inflammatory hyperpigmentation (PIH) post laser. Most of the freckled clients we treat are not at risk of this, because they are so fair-skinned. So PIH isn’t as high a risk for them. The sun is the reason you have the freckles and sun damage, so if you continue to see sun, you are causing the same damage again.
8. Is freckle removal permanent?
Another difficult question! After treating freckles for many years, we find we do not see a patient for several years for body treatments. When they do come back, their skin has definitely not gone back to where they started. In some ways, they are just raising the bar. Time continues to pass, aging continues to occur, and the damage from the decades-old sun exposure continues to emerge. For these reasons, it is hard to say that it is permanent, but as far as cosmetic procedures go, it is on the permanent side of things. In a perfect world, the face, neck, chest and hands should be treated once yearly for maintenance.
9. What are the risks of freckle removal?
Pigmentation changes, lighter/darker skin, prolonged redness, infection and scarring. Tiger stripes are an issue with freckle removal, and can be improved by having subsequent treatments (at the cost to the patient). Rarely light-appearing tiger stripes are still there after the highest settings on the device is achieved. Once the device cannot go to higher setting, this will be the end result. Also, one common problem in our practice, because the Sciton is such a beautiful laser for removing freckles, is demarcation lines, ie the results are so good, that where the treatment stops is adjacent to a really freckled area. This is so common, and probably the reason that we perform a lot of whole body freckle removal.
Another issue with freckle removal (especially low contrast freckle removal) is prolonged redness, which is not uncommon. This occurs more commonly on the legs and can also occur on the shoulders and back and other areas. Patients need to be patient and aware that this can happen and they should not worry, and should give their skin time enough to heal. Permanent redness is possible but uncommon. If the redness was not associated with any blisters or burns from the device, then it is unlikely to be permanent.
10. How much does freckle removal cost?
At The Manse Clinic in Paddington, Sydney, the costs (as of 15/5/2011) are as follows: Test patching $240, full face freckle removal $680, chest freckle removal $850, forearm freckle removal $850 per treatment, upper arm $850 per treatment, shoulder $850 per treatment. Other large area body treatments $850 per treatment. Patients are all given the opportunity for test patching, so that they can see the results for themselves before investing in the treatment. If they are not happy with the test patching or the side effects risk, they should not go ahead with the treatment. There are no complimentary treatments for freckle removal. Striping or skipped zones are charged at a normal rate.