Rejuve Medical

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Hyperpigmentation Vs Melasma

Hyperpigmentation and Melasma are both skin conditions which generally affect the face.  Hyperpigmentation is an area on the skin which is darker than the surrounding area.  Pigments caused by sun exposure are often referred to as sun spots, age spots, or liver spots. Hyperpigmentation can be caused by inflammation caused by acne, trauma, chemicals, skin products, or by a procedure ie. laser, cauterization, etc.


Hyperpigmentation can be easily treated by the use of IPL (intense pulsed light), Fraxel, or even chemical peels.  IPL is a non-invasive, non-surgical treatment which uses specific wavelengths of light to target the darker pigment on the skin.  The pulses of light essentially heat the pigment, fragmenting these pigments to allow them to surface to the skin.  They eventually flake off without leaving any scars.  The IPL treatment also stimulates the collagen of the skin improving the quality of the skin, fine lines, and can even improve pores.  The IPL treatment can also improve broken capillaries and redness caused by acne rosacea as well.  One benefit of this type of treatment is there is no downtime.  It normally requires at least 3 or 4 treatments performed 2 to 3 weeks apart.

Agespot/hyperpigmentation treatmentsFraxel Re:fine is another type of laser treatment that treats pigmentation.  It sends beams of energy into the deeper layer of skin (dermis).  Instead of targeting pigment, it creates channels to allow for pigments to be pushed up to the surface.   It is very effective for hyperpigmentation and it is FDA cleared to treat melasma.  Like IPL, it stimulates the body’s own mechanisms for rejuvenation, such as producing collagen, but because there is more heat involved, it is more effective in skin texturing and treating mild to moderate lines and wrinkles and mild to moderate scars.  The Fraxel also requires a series of 3-4 treatments done 1 month apart.  There is some redness that occurs after the treatment for about 3 days but there is minimal to no swelling.

The results from using Fraxel can take up to 3 to 6 months to see, although differentpatients can have different timeframes of seeing final results, as no two patients are alike.

Another option for hyperpigmentation is SmartXide.  SmartXide is an ablative laser using CO2 technology.  It differs from other the IPL and Fraxel in that the laser has more impact on the surface of the skin and it can go deeper in the dermis.  This results in fewer treatments but does have more swelling and redness depending on how aggressive the treatment.  The use of SmartXide also produces the most skin texturing allowing for more skin tightening and is used treat the deepest lines and wrinkles and scars.  Depending on how aggressive the treatment, there is redness and swelling for 3 -7 days.  For hyperpigmentation, only 1 treatment is usually necessary but for patients who have deep lines, wrinkles, or acne scars additional treatments may be needed.  The Smartxide can only be done on patients who have light skin because there is a risk of hyperpigmentation in patients with darker ethnic skin ie Blacks, Asians, Hispanics, etc.


Melasma, another skin condition seen on the face, is characterized by brown patches found in a characteristic pattern on the face which is usually on the forehead, cheeks, and upper lip.  It is believed to be estrogen driven which means that only women are affected.  There is no definitive reason as to why a person will develop melasma, but it is usually begins with an exposure to estrogen such as pregnancy and birth control pills.  There could be other triggers as well but this causal relationship is not well understood.  Melasma is worsened by sun exposure, heat, and estrogen. This skin condition is due to the fact that for some unknown reason the pigment cells in the skin called melanocytes are mysteriously activated and are constantly stimulated to produce pigment.  There is no shut off valve that deactivates these cells found in the skin. Treating melasma is much more difficult than treating hyperpigmentation, as there is no cure for it at this time.  Unlike hyperpigmentation, Melasma requires constant maintenance.  Treatments can include Fraxel, chemical peels, or bleaching.  Fraxel is FDA cleared to treat melasma.  For patients who have concurrent lines, wrinkles, or scars this may be a viable option.  The Fraxel is very effective in treating the superficial form of melasma but it may worsen the deep Melasma in some patients.  Usually 3 treatments are required 1 month apart are needed.  Dr. Tang will help determine whether this is the right treatment option at your consultation.


A chemical peel is a procedure in which a solution is applied to the facial skin causing the top layers to ‘peel’ off.  When the skin exfoliates, the dark pigments found in this layer of skin also peel off leaving smoother skin and fewer signs of the hyperpigmentation and melasma.


For a more conservative approach to melasma, there are bleaching systems such as Cosmelan or the Spot Peel.  These work by blocking the production of melanin in the skin.  Although they essentially do the same thing, there are differences in the ingredients.  Cosmelan is hydroquinone based and the Spot Peel is non hydroquinone based.  These bleaching systems require an in office application followed by a home care system lasting 1-3 months.


For anyone looking for improvement of pigments, it is best to consult with Dr. Tang to first diagnose which type of discoloration is occurring.  After knowing which type of skin condition it is, it’s then possible to proceed to determine which type of treatment is best.  Although many patients initially want to treat the discoloration, many also find their skin rejuvenated overall.  Finding the proper treatment for either hyperpigmentation or melasma is only a consultation away.