Brightening the skin, eliminating dark spots, freckles and hyperpigmentation is a common concern heard by many dermatologists. Dr. Frances Jang of Skinworks in Vancouver, B.C. has been a qualified dermatologist for almost 25 years, devoting 100% of her clinical practice to cosmetic dermatology. She recently took time out of her busy schedule to answer a few of our questions:
CMDL: What is the primary cause for dark spots and hyperpigmentation?
FJ: Hyperpigmentation is caused when melanin is overproduced in certain spots on the skin, causing them to look darker than your natural skin tone. There are a couple of common causes: dark spots from sun damage, melasma often as a result from birth control hormones or pregnancy, and post-inflammatory hyperpigmentation, which happens after a pimple, bug bite, or other trauma to the skin once it heals and leaves a mark behind.
CMDL: Is it more predominant in certain age groups or races?
FJ: Aging skin will show more dark spots due to cumulative sun and environmental damage. People of Asian descent and those with darker skin tones are more prone to hyperpigmentation.
CMDL: What are the different ways to treat hyperpigmentation?
FJ: The key thing is prevention. 90% of visible aging in the skin is related to sun exposure, pollution and with current day environment stressors, sunscreen use may not be enough!
We know that UVA and UVB are damaging and this is where sunscreen use can be helpful but there is mounting evidence that infrared radiation which is also emitted from the sun is also damaging to the skin. Infrared radiation penetrates to the deep dermal layers creating free radical damage and subsequent skin damage. We need to protect our skin by taking and applying antioxidants that help to mitigate the effects of UV and other environmental stressors.
Antioxidants can be applied topically and directly onto the skin and more recently as ingestible nutricosmetics. Oral nutricosmetics is a new concept to the North American beauty market, but has been popular in Asia for years. These are non prescription, “natural” food sourced formulas. They treat the skin from the inside out, by supporting the structure and function of the skin which will improve the overall skin health and the aging process of the skin in general. Aging is an internal process and we need to treat the root of the problem, especially inflammation. By controlling inflammation in the body, premature aging can be reduced which influences many skin conditions such as pigmentation, acne, wrinkles, collagen and elastin production.
Topically, Vitamin C&E when applied to the skin help sunscreens work better. These vitamins protect against infrared A also emitted by the sun which creates sun damage but not covered by sunscreen.
The next step in skincare is simple exfoliation either through a scrub, chemical exfoliation, or use of exfoliating brushes. Exfoliation will help remove dead skin cells more efficiently while allowing better penetration of skin care products.
Retinols are also great to use as they will reverse sun damage by, restoring collagen and lightening brown spots! It is best to apply at night especially when there is a diminished risk of photosensitivity.
For those needing or wanting more than what skincare can provide, Intense Pulse Light Photorejuvenation (IPL) has been established as a safe, effective way to reduce both brown and red tones on facial skin. However, it is not recommended on tanned or darker skin tones, therefore great for fall!
For Asian skin tones, this is where Picotoning comes in. Originally a super fast laser engineered for tattoo removal, in recent Korean papers, it has shown that it can safely decrease unwanted brown spots, while firming skin and improving texture in Asian skin tones with no downtime!
Lastly, for those wanting more dramatic improvements and willing to take a few days out of the public eye, there are an entire family of Fraxel lasers that can help repair and restore healthier skin by removing tiny “pixellated columns” of damaged skin. Which means less brown tones, better texture, firmer skin as new collagen remodels!
CMDL: After treatment, is there a way to prevent dark spots from coming back?
FJ: Unfortunately, dark spots will occur again and sun protection is essential.
About Dr. Frances Jang
Dr. Frances Jang has been a qualified dermatologist for almost 25 years, devoting 100% of her clinical practice to cosmetic dermatology. As a lifelong early adopter, Dr. Jang was the first Vancouver dermatologist to employ many emerging innovations, notably the use of intense pulsed light for rosacea, microneedling, platelet rich plasma, and non-surgical body contouring including Coolsculpting and Belkyra. She is also a frequent aesthetic physician trainer, most recently participating in the Canadian launch for Restylane Skinboosters.
She has been a consistent Canadian leader since the industry’s infancy and takes special interest in the artful and subtle use of combined techniques to evolve the aging face over time. Her emphasis on ancillary skincare, combination treatments, and regular maintenance to create natural results has created an avid and loyal clientele throughout the Lower Mainland and beyond.
She is an active member of numerous dermatologic societies including the Canadian Society of Dermatologic Surgery, Canadian Dermatologic Association, and American Academy of Dermatology, to name a few. In the past, she has served on the Executive of the BCMA Section of Dermatology. In recognition of her significant contribution in support of dermatologic research, Dr. Jang has been granted lifelong membership in the Canadian Dermatologic Foundation.