Laser Treatment of Pigmented Lesions

Melanin is what gives our skin its color. Pigmented lesions are dark in color simply because melanin is abnormally concentrated in one area of the skin. High concentrations of melanin can be due to various factors. Some types are present at birth, but most occur with age or as a result of overexposure to the sun’s damaging rays.

Lentigenies or age spots are premature aging brown marks, which appear on the backs of hands and the face. Sunburn freckles are the result of sun damage and occur on the back, upper chest and shoulders. Most are harmless but all are aging and may be unattractive. Nevus of Ota and other flat pigmented birthmarks are localized areas of increased pigmentation in the skin, which are present at birth.

Although most brown spots are easily ignored, many are quite conspicuous and can detract from your skin’s natural beauty. Most brown birthmarks will fade with treatment but some recur. These may require additional treatment to keep pigmentation at bay. Brown age spots often fade or disappear with one to two treatments.

Thanks to CoolGlide Xeo intense pulsed light skin therapy, you (usually) don’t have to live with unwanted freckles, age spots, or pigmented lesions for the rest of your life.

What types of brown spots or pigmented lesions will be removed?

It is most commonly used for removing brown age spots, “liver spots”, freckles and many brown birthmarks. The doctor will identify your specific type of lesion and explain what can be done to help you look and feel better. We do not use lasers for treating cancers or suspected cancers. If in doubt, we will biopsy any suspicious spots to make sure there is no skin cancer.

How does the laser remove pigmented lesions?

Energy from the laser is very well absorbed by cells containing excessive concentrations of pigment – and not well absorbed by normal tissue – so the CoolGlide Xeo stimulates your body to eliminate the unwanted excessive pigment while having little or no effect on other tissues or on normal skin color. If the area to be treated has a fresh sun tan or has been treated with self-tanning lotion, it is best to wait a couple of weeks for the tan to fade before having treatment, because the tan will absorb and waste some of the laser energy intended for the pigmented lesion. A fresh sun tan (or color from a recent application of self-tanning lotion) could also absorb enough laser energy to increase the risk of skin irritation or blistering.

If you take ASA, alcohol or vitamin E during the week before your pigmented lesions are treated with the laser there might be a bit more bruising in the treated area.

Most people find that laser treatment of pigmented blemishes is not particularly painful – each pulse of laser light is similar to the snap of a thin rubber band, or tiny specks of hot bacon grease on the skin. There may be less discomfort if a second treatment is needed because as the freckles and age spots fade, there is less pigment to absorb laser energy.

Most patients do not require anesthesia, but ice packs, anesthetic creams or local anesthetic can be used if necessary. If there is a large or sensitive area to be treated, a couple of plain Tylenol can be taken to raise your pain threshold somewhat before laser treatment.

No other special preparation is needed. The high power of the laser allows large diameter, deeply penetrating beams to be used, and will help to speed up the resolution of your pigmented lesions.

What will happen after treatment?

For the first half-hour after laser treatment, the treated area may feel hot (like a sunburn) and it might be red for the rest of the day. Occasionally (depending on the severity of your sun damage) the treated spots will become darker in color and over the next week or two will flake off. This is a normal process as the body works to eliminate the pigmented blemishes.

There may be some lightening or darkening of the treated area for several months after laser treatment. This is usually not very obvious. Protect the treated area from sun exposure until the skin is completely healed and the skin color has returned to normal. Gentle cleansing of the skin and application of an antibiotic ointment will help the treated area heal quickly after treatment. Watch for unusual redness, pain, or swelling which might be a sign of infection, and please call us right away if you think an infection is developing. Avoid picking at or irritating the skin after treatment.

How many treatments are required?

About 60%-80% of common freckles and age spots resolve after one treatment. Some need a second treatment, and a few need to be treated more than twice. Some blemishes do not disappear completely, but will be significantly lighter in color after treatment.

Because there is a great deal of variability in the size, depth and darkness of freckles, age spots and pigmented nevi, and because there is some variability in people’s natural ability to clear away pigment after laser treatment, it is not possible to “promise” you that a certain result will happen after a fixed number of treatments. How well your lesions respond depends on several factors. Superficial lesions such as freckles and age spots tend to respond more quickly as compared to deeper, more complex lesions.

How long should I wait between treatments?

It is best to wait at least 4 to 8 weeks between treatments so that the maximum amount of fading can take place. Will the freckles and age spots disappear completely?

In many cases the freckles and age spots can be made to disappear or fade to the point where you are the only person who can find a trace of them, because you know where to look.

What are the risks of treatment?

In most cases, the laser treatment leads to satisfactory fading or complete removal of the freckles and age spots without significant side effects.

The most common problem is incomplete removal of brown spots or pigmented nevi. Some spots are relatively resistant, although there is almost always a worthwhile amount of improvement.

Scarring is very rare. Infection is also very rare and is usually prevented or treated by using antibiotic cream. Loss of pigment from normal skin is rare and usually minimal.

You can reduce the chance of irregular tanning – and reduce the chance that the freckles and age spots will come back — by protecting the treated area from sun exposure.

Hypo-pigmentation (lightening of the skin) or hyper-pigmentation (darkening of the skin) are quite infrequent, and are almost always temporary.