Hyperpigmentation aka "brown spots": the new wrinkle

August 29, 2012

Not all skin spots are the same
Not all skin spots are the same

According to Elle magazine, September 2012, in the United States, we are very devoted to moisturizers and collagen-boosting serums, but our demand for brown spot lightening is steadily rising, especially since publication of a 2006 study, indicating that hyperpigmentation can impact on a woman’s perceived age by up to twenty years.

The Japanese spend a huge percentage of their beauty dollars on targeting “shimi.” Here we call them “spots” and they can apply to any skin discoloration, including freckles, UV-induced brown patches, melasma and those pinpoint spots that remain after a pimple has healed.

Elle spoke with the Pola Orbis Group in Fukuroi, Japan, which has some of the most extensive skin data in the world. Lesson number one is that not all brown spots are the same; there are those caused by 1) cumulative sun damage, appearing on cheeks, temples and the back of the hands; 2) freckles, which proliferate from sun exposure; 3) post inflammatory pigmentation, resulting from trauma to the skin; and 4) melasma (pregnancy mask, associated with fluctuations in female hormones), appearing in large symmetrical patches across the cheeks and forehead. Surprisingly, the sun’s rays are not the only culprits; allergies, heat and even stress can provoke brown spots.

According to Elle, some brown spots can be faded with at-home treatment while others require a visit to a plastic surgeon or dermatologist. Hydroquinone, available by prescription at 4 percent, or over the counter at 2 percent, is generally considered the gold standard for skin lightening. But, keep in mind, melasma responds well to hydroquinone but sunspots, which are at a deeper skin level, do not. For sunspots, you may need to visit a plastic surgeon or dermatologist for laser treatment.

A prominent Miami dermatologist prescribes an aggressive treatment of Retin-A (exfoliates so bleaching creams will better penetrate) and hydroquinone for melasma. He says that melasma is so difficult to treat because it has a memory; the slightest bit of sun will set it off. Not all lasers work well for melasma. Fraxel, which can be used on a gentle low energy setting, is effective and “Q-switched lasers are great because they have a short pulse-width. They’re attracted to the brown pigmentation, and they kind of explode it.”

Of course, the number one weapon in the battle for even-toned and spot free skin is daily sunscreen (SPF 30 or more). If you have a zit and you go out without sunscreen, you’re essentially tanning your pimple. The second thing to remember is that when it comes to melasma, not all lasers are equal. A board-certified plastic surgeon or dermatologist can select the correct treatment.


The mission of the American Society for Aesthetic Plastic Surgery (ASAPS) includes medical education, public education and patient advocacy. Plastic Surgery News Briefs are summaries of current stories found through various news and magazine outlets that relate to or mention plastic surgery and cosmetic procedures. The views expressed in these news articles do not necessarily reflect the opinions of ASAPS, but are merely published as an educational service to our members and the general public. For additional information on these subjects and other plastic surgery related topics, please go to www.surgery.org

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The American Society for Aesthetic Plastic Surgery (ASAPS), is recognized as the world’s leading organization devoted entirely to aesthetic plastic surgery and cosmetic medicine of the face and body.  ASAPS is comprised of over 2,600 Plastic Surgeons; active members are certified by the American Board of Plastic Surgery (USA) or by the Royal College of Physicians and Surgeons of Canada and have extensive training in the complete spectrum of surgical and non-surgical aesthetic procedures. International active members are certified by equivalent boards of their respective countries. All members worldwide adhere to a strict Code of Ethics and must meet stringent membership requirements.

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