Why isn't my melasma improving even after trying Pico laser in Singapore? 

“The unsightly dark brown melasma patches on my face since my early 40s seem to defy every attempt at concealment. Frustrated, I decided to try Pico laser treatments, which have caught my attention on social media due to their promising results for pigmentations like melasma. 

Unfortunately, after undergoing various Pico laser sessions at different clinics in Singapore, I don't see the expected obvious improvement to my melasma issue. I’m losing hope now, preparing to live with it for life” — Melani.

Introduction

Melasma is a common unsightly pigmentation issue occurring primarily on the face, especially in middle-aged women. It is a complex skin pigmentary condition influenced by multiple external and intrinsic factors, including excessive sun exposure, hormonal influence, female gender, age, and genetic predispositions [1].

melasma skin damage
Melasma is a common pigmentation problem that occurs primarily on the face.

Over 10 years as a skincare doctor, I've encountered countless patients (like Melani) grappling with melasma, often persistent and distressing. A common theme shared during the consultation with me is that many of them have previously undergone various treatments or multiple sessions of laser therapy (including Pico or Picosecond laser) without substantial improvement.

Also, these patients experience much frustration and disappointment as their melasma often rebounds with a vengeance after stopping their laser treatments. As such, they wonder if laser treatments are required in the long term to control their melasma.

Furthermore, as a common misconception, many take up laser therapy (including Pico laser), thinking that lasers will eradicate their melasma once and for all, so they will never have to deal with it anymore.

Thus, these stories have motivated me to find a more effective and sustainable solution for patients struggling with melasma. Empathising with the despair of patients who have placed their only hope in laser treatments, I strongly believe in a more holistic treatment approach to help melasma patients sustainably in the long run. 

For more background information about melasma, read about how Dr David has helped 3 tough cases of melasma

Can Pico lasers really treat hyperpigmentation like melasma in Singapore?

This is a frequent enquiry from patients. Pico lasers have a treatment role in addressing hyperpigmentation like melasma (especially with 1064 nm wavelength) [2,3]. Its exceptional ultra-short (10-12 second) pulses and precise targeting are particularly effective in breaking down skin melanin particles to lighten pigmentation.

Nevertheless, Pico laser is just one of the newer technologies used to treat pigmentations like melasma. Many patients may not be aware of other types of laser or energy-based device technology [4] with long-standing history proven for treating melasma, e.g. fractional 1550-nm non-ablative laser, pulsed dye laser (PDL), copper-bromide laser, Q-switched Nd: YAG toning mode, and intense pulsed light (IPL).

Please don’t get me wrong. I warmly welcome and get hyped up with new medical technologies and believe that the spirit of constant technological innovation is essential for the healthy progress of medical aesthetics treatments.

However, I still believe that hyperpigmentation, like melasma, should be approached holistically instead of just relying on laser therapy alone. Factors such as sun protection, proper skincare, lifestyle choices, and uncovering triggering factors also play equally significant roles in the success of any laser treatment.

picosecond laser
Laser therapy (e.g. Pico laser) is often used to treat melasma. 

So why don’t you see improvement in melasma after Pico laser in Singapore? 

Based on my clinical experience over the years, various factors may have contributed to patients not getting the desired improvement in their melasma despite undergoing laser therapy (including Pico laser). 

  1. Inaccurate diagnosis of melasma

Different hyperpigmented spots (e.g. melasma, Hori’s naveus, lentigines, etc) on the skin can look very similar, but they behave differently and require different laser settings for effective results. 

Furthermore, patients often have mixed pigmentations on their faces, so diagnosing them can be challenging. If an incorrect diagnosis is made, inappropriate Pico laser settings may be used; thus, one will not achieve the desired treatment results.

  1. Clinical experience with lasers

The outcome of Pico laser treatment also depends on the clinical experience and expertise of the doctor, which can take months or years to master. Inappropriate parameter settings (e.g. wavelength, power, end-points, or treatment intervals) can affect the effectiveness of the laser therapy. Different practitioners would inevitably have varying competency and experience in handling the Pico laser device.

  1. Inadequate pre and post-laser care

This aspect is solely within the control of patients. To get the best results with Pico lasers, patients must closely follow the pre and post-laser care instructions. For instance, melasma results will certainly be affected if patients are NOT compliant with the correct application of sunscreen and sun protection measures and yet still receive excessive sun exposure during laser treatments.

  1. Melasma cases are unique in their own way

As mentioned at the start, melasma is caused by multifactorial external and intrinsic influences[1]. Triggering factors (e.g. hormonal) for the particular patient should be addressed as well.

As such, the type or severity of melasma will vary amongst different individuals, which makes it challenging to achieve uniform results with just a one-size-fits-all approach – like depending on Pico laser treatment alone.

Thus, each patient has to be treated according to their unique melasma condition, skin type, lifestyle and treatment response. 

For more details, please read: Why your pigmentation is not improving after laser treatment
sun exposure pigmentation
Persistent melasma issues can be due to excessive sun exposure or hormonal influence.

Any potential side effects of laser therapy (including Pico laser) when treating melasma? 

Laser therapy (e.g. Pico laser) can indeed bring positive results for various indicated skin issues. 

However, it's also essential for patients to be aware of potential side effects from lasers, ESPECIALLY with melasma, a challenging pigmentation.

For instance, there is a real risk of post-inflammatory hyperpigmentation (PIH, i.e. darker spots) or confetti hypopigmentation (i.e. abnormal white spots) [5]. This can occur especially if the laser settings are not appropriately adjusted (e.g. set too intensely with much redness, scabbing downtime) or if laser sessions are scheduled too closely (e.g. weekly sessions) [5]. 

Post-Inflammatory Hyperpigmentation (PIH)
Hypopigmentation

So, is there any alternative treatment for melasma?

Many patients have the misconception that laser therapy (including Pico lasers) is the ONLY treatment (if not the Holy Grail treatment) to treat melasma, which is far from the truth. There are ALTERNATIVE effective treatments [4,6] for melasma, including topical medical creams, chemical peels, oral medications, microneedling, and sun protection measures. 

I recommend treating melasma cases by starting with simple topical medical-grade creams like hydroquinone [4,6] and basic sun protection measures. The advantages of topical creams are that they are easy to use and cost-effective (usually cheaper than Pico laser therapy for a given treatment duration), and you may be pleasantly surprised that sometimes they can lighten melasma as well as laser, if not better

Topical medical creams may cause temporary skin irritative side effects (like redness or peeling) in some susceptible individuals. Still, these issues can be EASILY managed or prevented with the correct application techniques and under the doctor’s supervision. Not a big issue at all! 

topical melasma treatment
Topical medical-grade creams such as hydroquinone are simple and cost-effective treatment options for melasma. 

What happened to Melani in the end?

During the detailed consultation with Melani, I had identified underlying hormonal influence as a significant contributor to her persistent melasma. She had noticed her melasma become more prominent after she started taking oral hormonal pills from her gynaecologist to regulate her menstruation cycles. She was still taking the hormonal pills while receiving Pico laser treatment for her melasma.

Thus, in Melani’s case, her concurrent oral hormonal pill therapy [1] was clearly exacerbating her melasma, so no amount of treatment (including Pico laser) was going to effectively clear her melasma if the underlying hormonal influence trigger was still not addressed. 

My approach for Melani involved co-managing with her gynaecologist to treat her melasma and handhold her while waiting for her oral hormonal pill regimen to be completed in a couple of months. Furthermore, I had also prescribed Melani a simple regimen of topical medical creams (e.g. hydroquinone) [4,6] and basic skincare and stressed the importance of rigorous sun protection measures. 

melasma management asian
Self-confidence regained after overcoming melasma.

There is really no point wasting time and money in considering laser therapy (including Pico laser) when her hormonal pills regimen was still exacerbating her melasma at the same time. I had also educated Melani on the chronic nature of melasma and the need for long-term sun protection and maintenance to minimise its recurrence.

As expected, once Melani was taken off her hormonal pills by her gynaecologist, within 2-3 months, her melasma improved remarkably together with the topical skincare regimen prescribed, without the need for laser therapy. Needless to say, she was extremely thrilled and liberated as her face finally cleared up radiantly. 

Not too long ago, she had lost all hope and was about to give up hope on treating her melasma, being prepared to live with it for the rest of her life.

Please refer to this article for more information on why your melasma is not improving.
melasma treatment
At One Face Clinic, we provide a comprehensive yet personalised approach to treating melasma and pigmentation issues.

A one-size-fits-all approach is often disappointing for melasma

As mentioned above, melasma is due to the complex interplay of multiple factors, so each case is unique in its own way.

Thus, taking time to understand the circumstances and triggers of each patient is essential because a one-size-fits-all approach (e.g. just depending on laser therapy like Pico laser) often falls short in treating melasma.

With more than a decade of clinical experience focusing on melasma and pigmentation treatments, our cornerstone approach at One Face Clinic is to provide personalised and practical care to our patients. The journey begins with the preliminary consultation, which helps us understand the patient’s melasma issues in depth. By discovering the triggering causes of their melasma, we gain important insights to develop the targeted treatment plan for each individual.

In addition, effective management for melasma typically also involves a comprehensive approach, such as:  

  1. Sun protection: Consistent use of broad-spectrum sunscreen (SPF 50, PA+++) and practical sun avoidance measures are fundamental.
  1. Lifestyle changes: Maintaining a healthy lifestyle, including a balanced diet, proper sleep and stress management, may positively support melasma management.
  1. Identifying triggers: Uncovering and avoidance of triggers, whenever feasible. For instance, hormonal factors in Melani’s case.
  1. Professional guidance: Consulting with the right doctor and team in melasma management is absolutely essential for the right personalised treatments, and to handhold the patients throughout the journey to achieve the eventual real and sustainable results. 
melasma management singapore
Sun protection and lifestyle changes are part of the effective management of melasma.

Conclusion

Melani's stubborn melasma case highlights the importance of uncovering triggering factors via thorough consultation, an individualised treatment strategy, and comprehensive care to improve melasma outcomes significantly. 

Remember, effective and sustainable melasma management is achieved through a holistic patient-centric approach rather than a one-size-fits-all or standalone treatment, such as depending on laser therapy alone (including Pico laser treatment).

If you also suffer from persistent melasma concerns like Melani or have any questions regarding your melasma and pigmentations, feel free to WhatsApp me at +65 9822 2989 or call me at +65 6222 2262. You can also email me at: askdrdavid@onefaceclinic.com 

All the Best,

Dr David Ng C. H.

References 

  1. Melasma.
    DermNet NZ New Zealand Dermatological Society Incorporated; Last updated Oct 2020  https://dermnetnz.org/topics/melasma
  1. Christina S M Wong, Mandy W M Chan, Samantha Y N Shek, Chi Keung Yeung, Henry H L Chan Fractional 1064 nm picosecond laser in treatment of melasma and skin rejuvenation in Asians, a prospective study. Lasers Surg Med. 2021 Oct;53(8):1032-1042
  1. Jiangfeng Feng, Sihao Shen, Xiuzu Song, Wenzhong Xiang
    Efficacy and safety of picosecond laser for the treatment of melasma:
    A systematic review and meta-analysis
    Lasers Med Sci. 2023 Mar 10;38(1):84
  1. Apratim Goel​, Nishi Trivedi
    Current updates on melasma treatments
    CosmoDerma 2023;3:79.
  1. Yisheng Wong, Siong See Joyce Lee, and Chee Leok Goh
    Hypopigmentation Induced by Frequent Low-Fluence, Large-Spot-Size QS Nd:YAG Laser Treatments
    Ann Dermatol. 2015 Dec; 27(6): 751–755.
  1. Krupa Shankar et al
    Evidence-Based Treatment for Melasma: Expert Opinion and a Review
    Dermatol Ther (Heidelb) December 2014, Volume 4, Issue 2, pp 165–186

Melasma Treatment Singapore – Dr. David Ng C. H. shares how he tackled 3 tough cases

Introduction

I’ve devoted over a decade of my medical career towards treating melasma. Many patients approach this particular skin pigmentation completely wrong. I know how this skin condition, while seemingly superficial or “not a big deal”, can take a huge toll on the patient’s self-esteem or self-confidence at times.

One of the reasons I started this blog is to help those suffering from melasma and other pigmentary conditions to dispel their misconceptions, to get accurate information, and to seek the right medical opinion and treatments.

What is melasma

Melasma is an inherently tough skin pigmentation condition, often wrongly believed to be untreatable and unavoidable.

  • common pigmentation disorder
  • unsightly symmetrical dark brown patches
  • primarily on the face
  • resembles a “country’s border”

Factors:

  • middle-aged women
  • darker skin complexion
  • genetically predisposed
  • vasular
  • chronic sun exposure
  • hormonal changes
    (e.g. pregnancy, intake of oral contraceptives)

Frustrating skin problem

While melasma is a benign condition(1), I know from experience that it can cause emotional distress by adversely affecting the self-esteem and quality of life(1) for some patients.  The story often builds up in the same disappointing manner. Many of my patients often tell me they’ve exhausted a myriad of costly and ineffective treatments before coming to see me.

I sincerely hope that by sharing the following stories of 3 patients suffering from tough melasma that it closes the gap between existing melasma patients and their knowledge of effective medical treatments.

Case #1: “The amount of money I have spent could have paid for an around-the-world holiday!”

Madam MR, 59 years old Malay lady, educator

Madam MR
Patient had tried:

  • Facials, chemical peels
  • micro-dermabrasion
  • intense pulsed light (IPL)
  • over-the-counter (OTC) skincare products
  • oral supplements
  • YouTube-inspired home remedies.

This patient’s 10-years CLASSIC struggle with melasma is one of the main reasons why I started this blog. By the time we met, she had already tried all sorts of non-medical treatments (as mentioned above) at over-the-counters and beauty salons, but to no avail. One of the treatments she had undergone was IPL, which she mistakenly thought was identical to the lasers used by aesthetic doctors!

Can you just imagine the resultant financial and emotional toll on her? She was obviously very dejected and told me her story whilst holding back tears. Mostly she was very mad at herself, and also very upset by the money she felt she had “wasted”.

Dr David’s Solution

Needless to say, she had used the wrong methods to treat her melasma! At first, she was understandably very sceptical about any treatment I had suggested. To reassure her, I started her on basic topical lighteners (e.g. hydroquinone), gentle laser treatments and encouraged her to apply sunscreen and practice sun protection, while reassuring her that she should see good results in 5-7 weekstime(2).

Sooner than I expected, in just a few weeks, she was already texting me excitedly that she had seen significant improvement. That newfound confidence, like renewed faith, was a catalyst that boosted her journey towards getting rid of her melasma.

Key Takeaways from This Case

1. Be careful NOT to confuse over-the-counter (OTC) products or oral supplements with medical creams for pigmentation.

Many OTC products, while useful for pigmentation prevention (e.g. sunscreen), are often not very effective when it comes to treating pigmentations. Whereas, medical-grade creams (e.g. hydroquinone(1)(2)) are proven scientific formulations with studies to back their effectiveness in dealing with pigmentation issues.

2. Understand the HUGE difference between “spa-grade lasers” and “medical-grade lasers”.

Under Singapore’s regulations, only certified doctors are qualified to operate medical-grade lasers. What some claims to be “laser treatments” can be just spa-grade Intense Pulsed Light (IPL), which are NOT the same lasers used by doctors in terms of their functionality and thus do not yield the same results for pigmentation treatments.

Case #2: “People have asked me why my face looks so ‘barbecued’?”

Madam CJ, 49 years old Chinese lady, office administrator

Madam CJ
Patient had tried:

Various laser treatments over a span of more than 1 year, which instead of helping, seemed to exacerbate her condition, causing her to develop skin redness and sensitivity (3).

She was also prescribed many bottles of skincare products which she had a hard time following through.

This patient’s condition was rather severe, so I was very keen to investigate her treatment history first. I learned that the patient was very (perhaps overly) enthusiastic in seeking out “new treatments” and very diligent in undergoing lasers that showcased the “newest technology”.  In total, she had gone for 18 laser sessions, with her previous clinic. Each time, 2-3 different types of the “newest” lasers were used, including “picosecond lasers”, which were relatively new back then.

She had also endured these 18 laser sessions patiently over more than 1 year, and always hoping for some form of reasonable improvement that would be worth her wait, but it didn’t really happen unfortunately.

Having spent a lot of money on these high-tech treatments, coupled with the fact that the repeated exposure to unnecessary “strong lasers” had caused disconcerting skin sensitivity on top of her dark brown melasma patches, the patient was understandably very upset when we first met.

She was sure her condition was “beyond hope” and she even shared her heart-breaking experiences… “People had asked me why my face looks so ‘barbecued’” she said, a seemingly innocuous statement, but one that had visibly chipped away at her confidence tremendously. Again, it’s seeing such cases that really ignite a fire in me to tell their story.

Dr David’s Solution

My first thought was that her treatment regimen was overcomplicated, so I prescribed her a simple regimen of lightening creams and a basic sunscreen routine that was easier for her to abide to.

I studied her condition and concluded that just using conventional laser treatments with a long-standing history in the medical realm (e.g. Q-switched Nd:yag laser(1)(4)) would be enough to see some positive results. I also adjusted the laser settings without affecting the results, so that it wasn’t too harsh on the skin and didn’t have any downtime at all (eg redness, swelling, peeling).

Turns out, the patient had a way easier time with the topical regimen upkeep. She was also very thankful for the fact that she did not need to deal with pain or post laser redness or sensitivity, allowing her to continue all social activities of the day.

It took around 3 months, and her melasma has cleared up almost completely!

Key Takeaways from This Case

1. Just because a laser device is marketed as the “latest” or “newest”, it is DEFINITELY NOT an indication that it GUARANTEES results.

Please dont get me wrong. Of course, I’m open to and excited with new technologies and believe that constant technological advancement is extremely important in the evolution of medical aesthetics treatments.

However, I still believe treatment fundamentals are ULTIMATELY essential to the outcome, for instance:

  • Getting the correct diagnosis
  • Using the correct power and settings of the laser
  • Timed approach to treatment at the correct intervals
  • Knowing the strengths and limitations of the particular laser device

Only a doctor with the relevant clinical experience in treating melasma, and who has mastered that laser device (which may take years!) can fully address all these fundamentals and get optimal results.

Case #3 “After lasers for melasma, I started to develop these strange white spots on my face.”

Madam DC, 40 years old Filipino lady, healthcare worker.

melasma patient
Patient had tried:

Repeated intensive lasers at close intervals (2 sessions per week).

After speaking to this patient, I then understood that her treatment history included repeated intensive lasers at close intervals. Just in the last 4 weeks alone, she had gone for lasers 2x per week; that’s 8 sessions in a month!

This patient had already undergone a series of intensive laser treatments at a clinic in Singapore, before seeing me. However, not only did her melasma worsen, what left an impression on me when I first met her, was the disturbing mosaic-like appearance of unsightly contrasting dark and white spots on her face. Upon closer examination of her face, she actually had darker patches of melasma associated with scattered confetti white spots (hypopigmentations) on her cheeks and forehead.

She noted very clearly that these strange white spots had developed only after she had done the series of intensive lasers. She had felt so embarrassed whenever she looked into the mirror while hoping they would just somehow disappear miraculously. Afraid that other people may mistake these white spots to be some contagious skin infections, she had to spend time camouflaging them with thick concealer and makeup every day.

Dr David’s Solution

I could totally empathise with what this patient was going through. I made her STOP ALL laser treatments immediately, then prescribed her a gentle lightening cream (with hydroquinone) to improve her melasma, and asked her to follow a basic skincare routine to heal her skin first.

In less than 2 months, her condition improved significantly! Today, the mosaic-look caused by the contrasting dark and white spots has reduced substantially and her skin has become clear and attractive once more.

She felt so liberated and thankful that she now can go out and face the world brimming with confidence, with just application of light makeup!

Key Takeaways from This Case

1. Avoid doing laser toning treatments too frequently (e.g. weekly sessions)(1)(5). Personally, I don’t ask my patients to undergo ‘strong’ laser or toning sessions on a weekly basis.

While medical lasers are recognized treatments for pigmentations, I would advise a certain degree of caution. Lasers can be a double-edged sword.

With the wrong power settings or scheduling laser intervals too closely, there is the very real possibility of causing complications such as post-inflammatory hyperpigmentation (PIH) or confetti hypopigmentations(1)(5) (which can last for years), like in this case.

Why is it so hard to treat melasma?

Till now, doctors and scientists still have not decisively figured out all the factors that lead to melasma.

We do know that a complex interplay of factors can lead up to it, including age, female gender, genetic predisposition, vascular, hormonal changes and ultraviolet (UV) exposure from sun.

Thus, melasma is inherently a tough-to-handle skin pigmentary condition that can often be tenacious and may fluctuate and recur(1), especially so if you do not practice sun protection measures.

known factors of melasma illustration

Furthermore from my experience, melasma treatment results can also be affected or even worsened due to other factors like:

  1. Common misconceptions:
    • that melasma can be effectively treated by non-medical means
    • that the “newest” laser technology guarantees results
  2. Inappropriate or over-zealous laser treatments under inexperienced hands.
  3. Patient’s non-compliance to treatment regimen or sun protection measures to minimise its recurrence.

Cost of melasma treatment in Singapore

You should not have to spend tens of thousands of dollars (SGD) like some of the melasma patients I have encountered.

In fact, these are some of the estimated treatment costs.

Generally from my experience, patients can expect to see results between 3 to 6 laser sessions averagely, and of course, the really severe cases may require more eg. 8 sessions(6).

In a nutshell

Facial pigmentations like melasma are also considered skin diseases. So, the right way to deal with them is to seek medical treatment, from skincare medical professionals trained in this field.

For a condition that can have such a harsh effect on one’s social life and self-esteem, I see a personal duty as a skincare doctor to raise awareness on the availability of its treatments. I know that skin problem can greatly reduce someone’s quality of life. Any condition that affects a patient’s mental and emotional wellbeing should not be taken lightly.

Good news for melasma patients!

No matter which treatment stage or severity you are in, if you have melasma and are FRUSTRATED in not getting the desired results, please DO NOT lose hope!

Follow these steps first:

1. Sun protection measures e.g. regular use of sunscreen(2) with (SPF 50, PA+++), avoid prolonged sun exposure.

2. Pick the RIGHT DOCTOR with the relevant clinical experience in treating melasma,

  • whom you are most comfortable speaking to.
  • who can understand your skin and lifestyle issues, to customize a feasible treatment plan for you personally.
  • who will handhold you in this treatment journey.

Singapore has great doctors for treating pigmentations like melasma but ensure you do your due diligence before committing to one.

Experienced doctors will be able to provide you with the right information, insights and bring you REAL results, so going to the RIGHT doctor can help you to save time and money, and to avoid disappointment when seeking melasma treatment in Singapore.

Dr David of OneFace Clinic

Dr. David Ng C H, in his 15 years of treating skin and other aesthetic conditions, has done over 30,000 aesthetic laser treatments for his patients.

He has a firm belief that a holistic approach towards treatments helps to achieve the best results for his patients. Apart from a deep interest in aesthetic medicine, Dr. David is a self-proclaimed foodie who travels the island with his family to satisfy his appetite with the delicious foods Singapore has to offer.

If you have any questions or need advice on melasma treatments, please feel free to contact me over WhatsApp @ +65 9822 2989, or call in @ +65 6222 2262, as I enjoy sharing my knowledge on skincare and medical aesthetics in general.

You can also email me at: askdrdavid@onefaceclinic.com

Cheers!

Dr. David Ng C H


References

01. Swapnil D. Shah and Sanjeev J. Aurangabadkar
Laser Toning in Melasma
J Cutan Aesthet Surg. 2019 Apr-Jun; 12(2): 76–84.

02. Krupa Shankar et al
Evidence-Based Treatment for Melasma: Expert Opinion and a Review
Dermatol Ther (Heidelb) December 2014, Volume 4, Issue 2, pp 165–186

03. Laser resurfacing
Mayo Foundation for Medical Education and Research.
Last accessed 9th April 2020.
https://www.mayoclinic.org/tests-procedures/laser-resurfacing/about/pac-20385114

04. Rashmi SarkarSanjeev AurangabadkarT Salim, et al
Lasers in Melasma: A Review with Consensus Recommendations by Indian Pigmentary Expert Group
Indian J Dermatol. 2017 Nov-Dec; 62(6): 585–590.

05. Yisheng Wong, Siong See Joyce Lee, and Chee Leok Goh
Hypopigmentation Induced by Frequent Low-Fluence, Large-Spot-Size QS Nd:YAG Laser Treatments
Ann Dermatol. 2015 Dec; 27(6): 751–755.

06. Gokalp H, Akkaya AD, Oram Y
Long-term results in low-fluence 1064-nmQ-Switched Nd:YAG laser for melasma: is it effective?
J Cosmet Dermatol. 2016 Dec; 15(4): 420–426.

Pigmentation Removal Treatments: A Guide by Dr. David Ng C H

 A Note to Readers:

Dr. David Ng C. H. is proud to be the original author of this article, which was first published on 12th May 2018.

Content is distilled from more than 15 years of his clinical experience in pigmentation treatments in Singapore.

This current article is an updated version by Dr David Ng with actual cases’ photos.

©2020 One Face Skin & Aesthetics Clinic.

All Rights Reserved 

Problems finding good pigmentation removal treatments in Singapore?

You’re not alone.

Singaporeans, especially those with darker skin types, are highly predisposed to getting pigmentation due to excessive ultraviolet (UV) exposure from the year-long sun in our tropical climate.

Women, in particular, are highly susceptible to pigmentation issues such as melasma, freckles, and Hori's naevus.

However, despite the widespread pervasiveness of pigmentation, a lot of patients I see seem to think that a simple “laser zapping” pigmentation removal treatment session will solve everything.

In truth, pigmentation removal in Singapore is much more complex and requires careful tailoring according to your condition and skin type. This post explains in detail how you can get the most results from pigmentation removal treatments.

Are laser treatments always required?

A common misunderstanding many people have is to go straight for laser treatments. Everyone seems to think that ALL pigmentations are the same and that lasers are the best and only option.

THIS IS UNTRUELaser treatments are NOT always needed, so don’t waste your money (and risk unnecessary side effects) if you don’t have to. Different pigmentations require VERY different pigmentation removal treatment methods. The problem is they all look pretty similar to the untrained eye, so it can be hard for you to tell one from the other.

The RIGHT pigmentation removal treatment should start with the CORRECT diagnosis.

The very first step to effective pigmentation removal treatment in Singapore is an accurate diagnosis. Have you ever heard of "freckles, melasma, age or sun spots"?

The followings are the most common types of pigmentation amongst Asians(1), and also amongst patients whom I have seen in my practice in Singapore:

The most common types of pigmentation problems Dr David sees in Singapore

Pigmentation Types

melasma

Melasma

  • Patches on both sides of the cheeks or forehead
  • Often in middle-aged, Asian women of darker skin types
  • Related to age, genetics, hormonal, vascular and sun exposure
  • Looks like “boundary of a country”
freckles

Freckles

  • Tiny spots over the cheekbones and nose
  • Often in younger people
  • Looks like “dashes of pepper scattered on the skin”
solar lentigo

Solar Lentigo

  • Solitary or a few dark spots on the face
  • Spots are usually roundish, well defined and uniform in colour
  • Usually occurs in those with prolonged exposure to the sun
  • Looks like a “bronze coin”
Horis Naevus

Hori’s naevus

  • Cluster of dark bluish-grey imprints on the cheekbones, nose, or forehead
  • Can be inherited from family members
  • Often in middle-aged, Asian women
Post inflammatory Hyperpigmentation

Post-inflammatory Hyperpigmentation (PIH)

  • Ill-defined, feathery-looking pigmentations
  • Occurs after injury, inflammation or infection to the skin (eg. acne outbreak, inappropriate squeezing of pimples, skin procedures, unsuitable cosmetics, etc)
Seborrheic keratosis

Seborrheic keratosis (“age-spots”)

  • Rough, warty looking bumps with a stuck-on appearance,
  • Common in older folks (especially those with a family history of them)
  • Often mistaken as pigmentation or moles
  • You can feel these bumps when you run your fingertips over them

Can You Spot the Difference?

Do you see what I mean? They all look EXTREMELY similar!

It is also possible to suffer from more than one condition simultaneously (eg. melasma with Hori’s naevus), which makes diagnosis even more difficult.

If left unchecked, pigmentations can become complicated and pigmentation removal treatment becomes more difficult. It would be wise to seek expert treatment from trusted doctors as early as possible.

Are over-the-counter (OTC) pigmentation removal treatment products and supplements effective?

over the counter products pigmentation

"Doctor, can I self-medicate with over-the-counter creams? I can save a lot of money!"

Although some over-the-counter (OTC) products are useful for PREVENTING pigmentation (especially sunscreens), OTC skincare products or oral skin supplements are generally POOR FOR pigmentation removal treatment.

OTC products should not be confused with medical-grade creams (e.g. hydroquinone), which are specially formulated for pigmentation removal treatment. The latter has undergone rigorous clinical trials to prove their efficacy, and can only be prescribed by doctors in Singapore.

Let’s Start! How is melasma treated?

melasma digital photo analysis

Treatment for melasma depends on severity and depth. For less severe cases, medical-grade creams and sunscreen are usually sufficient.

Medical-grade creams like hydroquinone(2) are very effective for treating melasma. Often, a doctor will prescribe a combination(2) of different creams for optimum effect. These doctor-prescribed creams need to be monitored for side effects like redness, itching, and stinging of the skin. Lightening of melasma is expected after 5 - 7 weeks(2) of treatment.

Topical creams generally cost from $60 to $180. Good sunscreens (SPF 30-50, PA+++) cost around $50 - $100.

What if you have more severe melasma?

laser pigmentation removal treatment for melasma

Lasers are often the next line of treatment for more severe melasma cases. Other modalities that may be used to treat more severe melasma include chemical peels(3) or oral tranexamic acid(4).

Generally from my experience, patients can expect to see results between 3 to 6 laser sessions averagely, and of course, the really severe cases may require more eg. 8 sessions(7).

That sounds rather long, but on the upside, lasers used to treat melasma usually do not have any downtime.

The cost of laser pigmentation removal treatment in Singapore for more persistent melasma ranges from $1500 - $2800. 

The final cost depends on two main factors:

How is Post-inflammatory Hyperpigmentation (PIH) treated?

Post inflammatory Hyperpigmentation

The above-mentioned treatment modalities for melasma (i.e. topical medical creams, chemical peels, and lasers) can also be applied to PIH.

Since the treatment methods are so similar, much of the effectiveness comes down to the doctor’s skill and experience.

How is seborrheic keratosis or "age-spots" treated?

age spots

“Age-spots” bumps are usually removed using electrocautery or through ablative laser surgery.

Treatments (about 10 to 20 mins) are performed after topical numbing cream is applied. Usually, only 1-2 sessions are needed.

Despite the scary sounding names of the treatments, the process is quite straightforward and almost pain-free with the help of numbing creams.

A slight downtime of 3 - 7 days is expected for the post-procedural wounds to heal, but the good news is that you can expect almost instant results right after.

Treatment for “age-spots” bumps in Singapore costs around $300 to $1000.

What about pigmentation removal treatment for freckles and solar lentigos?

Downtime of freckles treatment with lasers​
Downtime of freckles treatment with lasers​

Many clinics in Singapore recommend a laser package when they see a patient with freckles and solar lentigos.

But do you know they can also be treated with simple, topical medicated creams like hydroquinone?   Always ask your doctor for this option before signing up for any laser package.

For more persistent cases, lasers like the Q-switched Nd:yag laser(5)  can be used. This will carry a downtime of around 1 week due to the dry scabs that form.

It usually takes 2-3 sessions(8) of lasers over 2 to 3 months to see good results. Cost-wise, you can expect to spend around $800 to $1600.

If you ONLY have freckles or solar lentigos, you can also consider Intense Pulsed Light (IPL) devices(6). It’s cheaper ($100-200) and usually takes the same number of sessions as medical-grade lasers.

If you are NOT SURE what kind of pigmentation you have, or if there are mixed or deep pigmentations, it would be advisable to see a doctor instead.

Medical grade lasers (e.g. Q-switched lasers) are much more effective at clearing a comprehensive range of pigmentations compared to IPLs(1).

Hori’s Naevus – Let the REALLY experienced laser doctor tackle this!

Downtime of Hori’s naevus treatment with Lasers
Downtime of Hori’s naevus treatment with Lasers

Hori’s naevus are deep pigmentations, so their nature alone already rules creams out as an effective removal treatment. You WILL have to undergo lasers(5)  for this.

Redness and swelling post-treatment usually last for a few days.

asian woman clear skin

Compared to other pigmentation types, Hori’s naevus can be tougher to treat, so 3 - 10 sessions of lasers might be needed. 

It also takes about 3 to 10 months (!!!) to see really good results. Don’t be disheartened if your condition doesn’t improve immediately.

The treatment cost varies depending on the severity, but most patients usually don't spend more than $3000 on lasers per se.

How much improvement should you expect after pigmentation removal treatment?

Generally, you can expect visible improvements of about 50% to 87.5%(8), depending on the type and severity.

I cannot stress this point enough; if you have an extremely severe case of pigmentation, it’d be wise to look for the RIGHT doctor, and comply with his/her instructions which is CRUCIAL in getting the desired results.

Will your pigmentation problems recur after treatment?

Hori's naevus should not recur so readily once treated, while PIH does not recur unless there are further skin injuries or inflammation.

On the other hand, pigmentation aggravated by sun exposure (especially freckles, solar lentigo, melasma) tend to recur if there’s insufficient post-treatment maintenance.

In such cases, adhering to the doctor's post-treatment instructions and having a good skincare regime (sunscreen and sun protection measures) are imperative to sustaining long term results.

Good sunscreen is VERY IMPORTANT and worth paying $50-$100 for!

patient looking at mirror

How to prevent your pigmentation from worsening?

The sun is the biggest culprit when it comes to worsening pigmentation problems.

Listen to your doctor's pre and post-care advice carefully and adhere to the recommended skincare regime.

How to prevent pigmentation from worsening

Here are some quick tips for sun protection measures:

3 money-saving tips for pigmentation removal treatment in Singapore

Generally speaking, there are no government subsidies for pigmentation treatments in Singapore, but you CAN save on costs with the following 3 tips:

Tip 1: Check if you really need laser treatment

Simply ask your doctor if you need lasers, since PIH, melasma, solar lentigos, and freckles often respond well to topical creams.

If your condition is not too serious, topical creams alone can often get the job done when it comes to treating pigmentation. We’re talking about big savings here ($300 creams vs $2,200 lasers)!

one face clinic treatment room

Tip 2: Pay for results instead of technology

Another aspect is the cost of technology. Every now and then, new techniques or laser technologies arise in the world of aesthetics. In reality, patients can get really confused about the pros and cons of the myriad of laser models and technology available in Singapore.

Although new devices might have their benefits, conventional lasers with a long-standing history in the medical realm (eg Q-switched Nd:yag) under experienced hands can STILL produce wonderful results in pigmentations treatments. Thus this can turn out to be even more cost-effective for you.

Because at the end of the day, the overriding key factor to getting the desired results ULTIMATELY still hinges on the particular doctor's personal clinical experience in pigmentation treatment and handling of the laser devices.

Tip 3: Look for the RIGHT doctor with these 3 questions

Finally, I'd suggest for you to enquire from a few trusted doctors to get a variety of opinions, and ask these questions before signing up for any treatment:

Experienced doctors will be able to provide appropriate advice, insights and REAL results, so going to the RIGHT doctor can save you a lot of money and disappointment if you ever decide to seek pigmentation removal treatments in Singapore.

dr David consulting with patient on customised pigmentation removal treatments plans

Dr. David Ng C. H. has a deep passion and long career of more than 15 years in treating skin and aesthetics issues eg. pigmentation, acne and anti-ageing. This includes him having done over 30,000 aesthetics lasers and treatments for his patients.

He strongly believes in a holistic approach to treatments and achieving the best results for his patients. Apart from discussing skin aesthetics, he is an avid foodie and would travel near and far with his family to gratify his appetite on weekends.

If you have questions or need advice on treating pigmentations,

Feel free to WhatsApp or WeChat me at:
+65 9822 2989.

You can also email me at:
askdrdavid@onefaceclinic.com
.

Cheers!
Dr David Ng C H

References


1. Jong Min Park, Hensin Tsao, Sandy Tsao. 

Combined Use of Intense Pulsed Light and Q-Switched Ruby Laser for Complex Dyspigmentation Among Asian Patients. 

Lasers in Surgery and Medicine 40:128–133 (2008)

2. Krupa Shankar et al

Evidence-Based Treatment for Melasma: Expert Opinion and a Review

Dermatol Ther (Heidelb) December 2014, Volume 4, Issue 2, pp 165–186

3. Rashmi Sarkar, Shuchi Bansal, and Vijay K Garg

Chemical Peels for Melasma in Dark-Skinned Patients

J Cutan Aesthet Surg. 2012 Oct-Dec; 5(4): 247–253.

4. Lee HC, Thng TG, Goh CL.

Oral tranexamic acid (TA) in the treatment of melasma: A retrospective analysis.

J Am Acad Dermatol. 2016 Aug;75(2):385-92.

5. Neodynium YAG laser treatment.

DermNet NZ New Zealand Dermatological Society Incorporated; Last updated July 2014.   

6. Zain Husain and Tina S Alster. 

The role of lasers and intense pulsed light technology in dermatology.  

Clin Cosmet Investig Dermatol. 2016; 9: 29–40.

7. Gokalp H, Akkaya AD, Oram Y

Long-term results in low-fluence 1064-nmQ-Switched Nd:YAG laser for melasma: is it effective?

J Cosmet Dermatol. 2016 Dec; 15(4): 420–426.

8. Sau Nguyen Huu, et al

Successful Treatment of Freckles by Alex Trivantage Laser Wavelight 755 nm in Vietnamese Patients.

Open Access Maced J Med Sci. 2019 Jan 30; 7(2): 287–290.

The attack of adult acne in the 30’s – 40’s: Do I need to go for acne treatments in Singapore?

The period of teenage/adolescence to early adulthood is the period where one is most prone to acne. As acne is a chronic recurring skin condition, even adults in their 30s or 40s, especially women, may also suffer from adult acne.

Acne treatments Singapore - Causes of adult acne

Acne vulgaris is a chronic inflammatory skin disease of the pilosebaceous (oil gland and hair follicles) unit in the skin, usually occurring on the face, chest and back. They are sometimes known to layman as "pimples" or "zits". Acne has a spectrum of manifestations ranging from excessive oiliness, clogged pores, inflamed pimples to acne marks and pitted scarring.

Stages of Acne
Image credit to: Marcia Hartstock

Adult  and teenage acne are similarly caused by the complex interaction of genetic factors and hormonal imbalance. The acne condition is largely dependent on the oil production of the sebaceous glands which can clog up the skin pores or hair follicles. Hormonal imbalance can cause the excessive production of sebum or oil by the sebaceous glands, enlarging the pores, and subsequently, the remaining sebum and dead skin cells on the skin will form blackheads and whiteheads (medically termed “comedones” or “clogged pores” in laymen’s term).

Gradually, comedones or clogged pores become inflamed, and infected by acne bacteria (p. acne), resulting in painful inflammation and red swellings (layman termed as "pimples" or “zits”) with or without pus, and more serious large fluid-filled cystic acne. These inflamed acne problems can eventually leave reddish-brown acne marks, and permanent pitted depressed scars on the skin.

Adult Acne Types

Circumstances that can exacerbate acne in adults

Q&A Session on Acne Treatments in Singapore

Q1
Is acne more prevalent in men or women?
Is it more prevalent in adults or teenagers/adolescents?

More than 80% of teenagers and adolescents may suffer from acne problems.(1) In about 20% of male and female teenager and adolescent acne patients, their acne problems can continue into adulthood. (1)

Generally speaking, most adult acne patients suffered from acne during their teenage years, but for most of them, their condition will often gradually stabilize in their 20’s. Conversely, there are some patients who may not have acne or severe pimples in their teenage years, but only develop severe acne in their 30’s.

Adult acne or pimples is more likely to appear on the lower half of the face (U-zone), especially on the side of the cheeks, jawlines and chin, around the mouth, and neck, while teenage and adolescent acne is more likely to appear on the forehead, nose, and centre of the face (T- zone). (1)

When men have acne or pimples, their condition tends to be more serious than in women. In addition, people with oily skin are also more likely to suffer from acne, because oily skin is more prone to comedones formation, and as such the probability of suffering from inflammatory acne is also higher.

Teenager and adolescent acne area: T-zone
Adult acne area: U-zone
Patient suffering from acne at U zone
Adult acne at the jawline
Q2
What are the most effective acne treatments in Singapore for adult acne?

Although acne is a chronic recurring skin disease, there are still several effective ways to treat and control it.

A good daily skincare routine can be used to control acne through the use of medical skincare products that aim to reduce excessive oil secretion and comedones on the face. Speak to your doctor about it.

Topical treatments such as acne cream can also be effective. Many of these acne creams or pimple creams contain 5-10% Benzoyl peroxide or Salicylic acid. Some of these acne creams can be found over the counter in Singapore.

Comedones extraction by professionally trained aestheticians via facial treatments are also to a certain degree, effective in removing mild clogged pores and cleansing the pores to remove accumulated debris on the skin.

Extracting the clogged pores
Comedone extraction

Patients should be reminded that they should avoid squeezing or extracting the inflamed acne or pimples by themselves because inappropriate squeezing can cause the affected acne to be prone to infection and inflammation, which can further aggravate the acne or even cause acne marks or permanent scars to form.

Oneface Acne Spot Cream & Comedone Control Serum
OneFace acne medication pills
Topicals and oral medications for acne

For more severe cases of acne, especially for patients with a lot of inflamed or cystic acne and scars, it is best to be treated by experienced skin and aesthetic doctors. In such cases, oral medications such as antibiotics or isotretinoin (high dose vit-A medication) may be needed as a suitable treatment.

Female patients can also consider to take anti-androgen (anti-male hormones) medications as part of the treatment for this condition. Experienced doctors should be consulted, so that the patient can best understand the use of these oral medications and their associated side effects.

Q3
If I do not wish to take oral medications, are there any other options to treat my acne?

Other than oral medications, acne treatments such as chemical peels, intense pulsed light (IPL), lasers, and steroidal injections into the inflamed acne, etc. are also possible treatments in Singapore.

Speak to your doctor to find out if these treatments are suitable for your case, if you prefer not to take oral medications.

Q4
What are some undesirable aftereffects of acne in Singapore?

If acne vulgaris left untreated, the active acne may leave unsightly reddish-brown marks on the skin. This is medically known as post-inflammatory hyperpigmentation (PIH) or post-inflammatory erythema (PIE). Acne inflammation can also lead to skin damage, causing the skin cells to fail to regenerate properly, which can form the appearance of unsightly permanent pitted depressed scars.

The best way to prevent acne marks and scars is to seek acne treatments in Singapore as soon as possible. As the root cause of acne scars is the active inflamed acne, it is crucial to seek effective acne treatments to prevent the condition from worsening and progressing into full scale acne pitted scars.

Adult Acne scars
Acne scars
adult acne Reddish-brown acne marks
Reddish-brown acne marks
Q5
What kind of psycho-social effects or impacts on one’s quality of life are there caused by acne or acne scars?

Adult or teenage acne is a common skin problem. Regardless of the type of acne you have, if acne treatments are not administered early, unsightly acne marks or pitted scars can develop on the face.

This may cause a certain degree of emotional and psycho-social distress to some adults or teenagers. The impact of having acne or deep acne scars may affect their self-esteem, acceptance from peers, or even unwillingness to engage in social activities etc, thus hurting their overall quality of life(1).

Conclusion: Know where to seek help, keep your acne far away!

Adult acne is a very prevalent skin problem for those in the 30’s or 40’s (especially so for the ladies), and many may suffer in silence not knowing where to seek real help. Do not despair or lose hope, as there are effective and proper treatments available for you, with the right and experienced doctors.

It is in your best interest not to delay seeking proper acne treatment in Singapore, as early treatment can provide you the golden opportunity to achieve the most optimal results, and to significantly reduce the impact of permanent acne scarring, thus improving your quality of life.

As the saying goes, prevention is better than cure.

If you have any inquiries about acne issues, feel free to WhatsApp me at +65 9822 2989 or call in at +65 6222 2262, I’ll be happy to address all of them.

You can also e-mail me at:
askdrdavid@onefaceclinic.com

Cheers!

Dr. David Ng C H


References

  1. A/Prof Chua S. H. and Dr Hazel Oon H. B.

    A to Z about Acne & Zits: The Complete Guide to Clear Skin. (Published by Straits Times Press)

Acne: 10 Most Common Myths in Singapore — by Dr. David Ng CH

Years ago, acne wasn’t regarded by many as a condition that required medical treatment. Today, perhaps due to better awareness or higher standards of skincare, treating acne has become so commonplace that more and more people would actually consult a doctor for this skin condition that affects many adults and teenagers in Singapore.

Yet, I’m surprised that there are still common myths surrounding acne in this day and age! Whether it’s diet or skincare routine-related, it is such myths that can cause added anxiety for patients. 

Previously, I have written an article on pigmentation treatment myths which was extremely well received. I have since received quite a number of requests for me to do one on acne myths.

In this guide, you’ll realise that acne is a very manageable condition and you CAN have healthy clear skin with a sound treatment approach with the right doctor. 

Myth #1: Acne only happens in teenagers 

Lady with forehead acne

Definitely not true! Adult hormonal acne (which can develop in women from aged 21 to 50 years old i.e. young adulthood till peri-menopausal period) is actually very common and is often more severe in men. For more details on this topic, check out a recent article I wrote on adult acne in Singapore. 

Here are the common factors that can aggravate adult acne: 

Myth #2: Acne is caused by poor skin hygiene

Girl with dirty hands

Acne is actually caused by excess oil and comedone buildup (from hormones, genetics), and skin inflammation with bacteria proliferation. So, trying to “wash away” your acne with harsh soaps and cleansers —which are NOT friendly to the face at all— can actually lead to worsening of skin irritation and acne issues. 

Instead, you should cleanse your face with a mild gentle cleanser twice a day, and seek appropriate medical treatments to address the underlying acne causative factors mentioned above. 

Myth #3: Sun exposure worsens acne

Lady suffering from redness around face

There is no definite evidence to suggest a link between sun exposure and acne outbreaks. 

However, excessive sun exposure may cause more severe post-acne pigmentation on the skin, so make sure to apply non-comedogenic sunscreen (SPF 30 to 50 with PA+++) daily to protect your skin. 

On the flipside, some also believe that sun exposure will clear up your skin. Again, there is no supportive evidence. Moreover, I do not recommend sitting under the hot sun to clear your acne because application of topical acne skincare with ingredients like benzoyl peroxide and retinoids may cause more skin irritation with sun exposure. 

Myth #4: Eating greasy food worsens acne

Fried Chicken

I’m sure you’ve been told to avoid “heaty” food that is fried, oily, spicy or chocolates because they can trigger acne breakouts. However, there is no solid evidence that proves such food can worsen acne. For health’s sake, that does not mean you should over-indulge in such food as well. 

Having said so, there is some evidence that suggests food high in glycemic index (e.g. white rice, soft drinks, sweet desserts) and dairy products may aggravate acne outbreaks. Thus, acne patients are encouraged to reduce their intake of such food. 

I sometimes would recommend to my patients to keep a food log to observe any changes in their acne status with regards to their diet, and slowly eliminate food that they think might be causing their acne outbreaks. 

Myth #5: Dark-coloured food intake causes dark spots or hyperpigmentation after acne outbreaks

A cup of coffee

This is what I would consider as an old wives’ tale.

Post acne hyperpigmentation (or post-inflammatory hyperpigmentation/PIH) is the result of your skin’s natural response to acne inflammation and skin recovery, and NOT from the food you eat (e.g. coffee, soy sauce). As such, the more inflamed your breakout, the larger and darker your PIH spots tend to be.

Additionally, PIH tends to be more prominent in darker Asian skin types.

Furthermore, you should not undergo acne treatments that are not suitable for you. Yes, procedures like chemical peels, microdermabrasion and laser resurfacing are all highly effective treatments, provided they are done appropriately during the different stages of acne activity, otherwise over-treatment can also cause PIH.

So, be very careful and selective with your acne treatments, and choose the right doctor or clinic with rich clinical experience in this field who can guide you properly. 

Myth #6: You should not apply makeup if you have acne outbreaks

Lady apply skincare

I do not discourage my patients from applying makeup when they go through acne outbreaks, as I know how concealing of the acne blemishes by makeup can greatly boost their confidence at work or in social situations. 

However, remember to avoid oil-based makeup or thick foundations that may potentially clog pores and worsen your acne outbreak. 

I recommend choosing loose powder or mineral makeup from reputable brands that are oil-free, water-based, non-comedogenic and hypoallergenic. These are more suitable for acne prone skin. 

Most importantly, remember to remove your makeup thoroughly with an effective makeup remover and cleanser before going to bed. If you are unsure on how to do it with proper technique, speak to a skincare professional. 

Myth #7: Self-squeezing acne or pimples speeds up the healing process

Acne myth, does Self-squeezing acne or pimples speeds up the healing process ?

Definitely not! It may be “satisfying” to do so on your own, but very often this can lead to even more damage and inflammation to the skin structure, causing deeper pitted scars, or bigger and darker post acne hyperpigmentation. 

Instead, try to use topical medicated creams to resolve any inflamed pimples at the initial stage of the outbreak. If it doesn’t get better, please seek help from the right doctor experienced in treating inflamed acne. 

I’ve written an entire article on the dangers of popping your pimples by yourself, do check it out. 

Myth #8: Facials help to clear acne

Lady having facial treatment

This really has to depend on the severity, type of acne and skill of the practitioner. 

Simple facial procedures like cleansing and gentle extraction of mild clogged pores on skin is usually fine. However, the professionalism and extraction techniques of the beautician or aesthetician performing your facial treatment plays a huge role in your outcome. 

They should avoid excessive or forceful extraction of huge inflamed acne bumps; these should be treated medically with a doctor instead. 

Myth #9: Taking antibiotics for acne treatment is not good for health

Slab of pills

This is a common misconception that needs to be addressed. I have personally taken oral antibiotics to treat my acne issues in my younger days during adolescence. 

A short course of oral antibiotics is sometimes needed to control more severe acne inflammation which does not improve with topical creams. They MUST be taken under a doctor’s supervision to prevent the issue of drug resistance (i.e. drug efficacy will diminish over time, leading to the use of stronger drugs down the road). 

One can at times experience some potential side effects (e.g gastric upset, etc) or allergy reactions from antibiotics, but they are usually transient. However, if your acne keeps recurring after the initial course of antibiotics, then antibiotics are definitely not a long-term solution. 

Another medication called isotretinoin may have to be considered as a more appropriate longer-term treatment, which will be discussed by your doctor.

Myth #10: Everyone around me has acne issues, so it’s alright not to seek treatment. Anyway, the acne will go away by itself eventually.

Lady wearing mask due to covid looking outside the window

Some patients do not see the urgent need to seek acne treatment because they may think that; 

As a doctor, I have to strongly disagree. Patients should be mindful that if left untreated, acne can cause: 

  1. Unnecessary pain and discomfort on the face from the active inflammation, which can affect daily activities.
  2. Unsightly acne marks or pitted scars which can be permanent 
  3. Emotional distress with affected self-confidence.
Inflamed acne
Side cheek acne
Reddish-brown acne marks
Acne scars
Pitted acne scarring

Conclusion

I hope this article has helped to dispel some misconceptions you have about acne. If you have any questions or need advice on acne-related myths or treatments, please feel free to contact me over WhatsApp @ +65 9822 2989, or call in @ +65 6222 2262

You can also email me at: askdrdavid@onefaceclinic.com

Cheers!

Dr. David Ng C H

References


  1. The Complete Guide to Clear Skin: A to Z about Acne & Zits.  Authors: A/P Chua Sze Hon, Dr Hazel Oon Hwee Boon. Published by Straits Times Press

Freckles Removal Treatment by Laser – A Patient’s Experience in Singapore

Introduction

As a skincare doctor, it’s heartening to see my patients take a keen interest in their skin improvement journey. Recently, I had a patient named Mr SJ, a 29 years old male, who is willing to share his laser freckles removal treatment experience at my clinic.

In this article, SJ’s treatment experiences and journey will be featured with my own comments alongside. This will allow readers to understand from both perspectives: the patient’s and the doctor’s.

I hope this article can serve to answer frequently asked questions (FAQs) on this topic of freckles removal treatment by lasers in Singapore.

What are freckles?

What are freckles :

Freckles are common type of pigmentation occurring on the face.

Appearance:

  • mutiple small brown speckled dots
  • look like "pepper sprinkled on skin"
  • mostly around nose and cheekbones

Factors :

  • often develop in adolescence
  • due to genetic predisposition
  • aggravated by sun exposure

Why do I have freckles?

SJ’s Experience:

“My name is SJ, a 29-year old guy of both Chinese and Indian heritage, and I work in the IT industry. I was referred by a friend to see Dr David Ng at One Face Clinic wishing to remove the dense freckles on my face.

Since teens, I enjoyed playing basketball after school with my friends. I never once thought the sun could do any real damage to my skin other than simply giving me a tan. Only nearing my 30’s did I realize what constant exposure to the sun’s ultraviolet (UV) rays have done to my facial skin, such that I have developed thick and dense freckles all over my nose and cheeks. My parents and siblings also have freckles, so I probably have inherited the freckles genetically as well.”

Dr David’s comments:

This is true for many patients! Exposure to the harsh UV sun rays is the one of the biggest causes of pigmentation issues. To lessen the damage, always apply sunscreen as part of your daily skincare routine before you leave the house.

The essential factor determining whether a person develops freckles is a genetic predisposition(1). Although freckles can be found in individuals with Caucasian skin types, we also do see young individuals of Asian and darker skin types having freckles.

Should I get my freckles removed?

SJ’s Experience:

“Initially, my freckles didn’t bother me much. Some of my friends even said that they were ‘cute’. But as I grew older, I became more conscious of them. Then I realized that skin pigmentation is really not a simple issue to just brush aside.”

Before treatment
Dr David’s comments:

Yes, this is a common story.

As freckles don’t pose health issues(2), it is often a personal decision whether or not to get them removed. Freckles have been described to be “cute or attractive”, depending on the concept of beauty or aesthetics in that person’s culture.

Many individuals in Asia believe that a fair, unblemished skin tone is more ideal and desirable. Thus, it is up to you to decide if you wish to remove your freckles for appearance reasons.

What are the treatment options to remove my freckles?

SJ’s Experience:

“I read on One Face Clinic’s website that freckles treatment options include topical lightening creams or laser treatments, with sun protection measures.

Initially, I was quite apprehensive. You mean lasers like the “Light-Sabers” in the Star Wars movie, that can cut through virtually anything?! That sounded so scary! If the doctor didn’t know what he was doing, I would be scarred for life.

Tropical Medical Lightening Cream
Dr David’s comments:

On top of regular sun protection measures to control freckles, you can also consider the simple and cost-effective option of using topical medical lightening creams e.g. hydroquinone(2). Other modalities include chemical peels(2) and intense pulsed light (IPL)(2).

For SJ, because his freckles are rather thick and dense, laser removal would be a more viable option. Conventional lasers (e.g Q-switched lasers(2)(3)(4)) have a long-standing history of treating freckles effectively. Other lasers (e.g. picosecond lasers) can also be considered, provided that the doctor is experienced in handling these devices.

How does consultation process with the skincare doctor feel like?

SJ’s Experience:

“First came the consultation with Dr David Ng, who asked me about my personal details like my lifestyle, how often I’m out in the sun, etc.

Dr David and his staff were very friendly and reassuring, who took time to walk me through the entire process, including how to administer the skincare regime and sunblock. I perhaps naively thought that all my freckles would magically disappear with just one-day treatment! Apparently, a customised skincare regimen with sunscreen had to be applied regularly before the laser treatment scheduled later on.”

Dr David’s comments:

As a professional medical team, we have to know our patients well, and to be fully aware of their skin problems, lifestyles and preferences. Indeed, after successful pigmentation removal, many of our patients have become our good friends.

Also, as patients don’t know what to expect for their laser treatment process, we will address such concerns during consultation. So, don’t be afraid to clarify if you have any burning questions regarding your treatments!

How many laser sessions are required? How much should I expect to pay?

SJ’s Experience

“I was recommended 3 laser sessions by Dr David to clear up my freckles, spanning over just a few months.

For a working executive like me, I found the prices at One Face Clinic to be very reasonable.”

Digital analysis image
Dr David’s comments:

Yes, most patients with the average freckles would require 2-3 laser treatments. However, for Mr SJ, as his freckles were quite dense and widespread, I would probably need an extra laser session to be able to clear his freckles in their entirety.

Generally, with the right experienced doctor, you should be able to see obvious freckles results after 2-3 laser sessions(2), nothing more usually.

Freckles removal by lasers in Singapore can cost anywhere between $250-$400 per session. This may vary due to factors eg. freckles severity, the number of laser sessions required, the type of laser used, and the experience of the performing doctor.
For instance, patients often have to pay even more when they opt for recently introduced lasers (eg picosecond lasers) in the market.

How is freckles removal by laser actually done? Is it painful?

SJ’s Experience:

“On the day itself, Dr David’s assistant prepped me first by applying numbing cream on my face. After around 30 minutes, I could feel my entire face become remarkably numb.

While Dr David was doing the laser, I had protective metal eye-shields placed on my eyes as the laser was incredibly bright.

To be honest, I was quite afraid that the laser procedure would be very painful, but to my surprise, I felt almost no discomfort at all. All I felt was a very light “rubber band snapping” sensation as Dr David targeted my freckles with his laser. To me, the comfort level was very acceptable.”

Dr David’s comments:

People often associate doctors with painful treatments (think injections that they had as a kid!). This misconception is often translated to laser treatments for pigmentations as well.

The truth is laser treatments for freckles are very comfortable. Especially so with the concurrent usage of numbing cream, you virtually will not feel any sensation.

Post-laser, patients are often pleasantly surprised on how tolerable or comfortable the session was.

What’s the downtime like for freckles removal by laser? Any side effects?

SJ’s Experience:

“Immediately after treatment, my skin did look quite red and swollen but after a few hours, the redness had mostly subsided and all that remained were little grey dots where scabs had begun to form. Frankly, it wasn’t that bad at all. I had seen photos of patients who had acne scar removal treatments and they looked even scarier!

Surprisingly, my colleagues couldn't even tell that I had a laser treatment done. The post-laser cream provided also helped my skin heal faster. Within 3 days, the dense scabbing of freckles had almost completely disappeared, and I can notice the improvement of freckles on my nose in particular, just after the 1st laser session.”

Redness right after laser (freckles removal)
Scabbing after laser (Day 3) - Freckles removal
Dr David’s comments:

Immediately post-laser, the freckles will look slightly red and perhaps swollen for a few hours, which will usually subside within half a day. Thereafter, the dry scabs that have been formed will drop off averagely in 5-7 days’ time.

(see attached downtime photos as above)

In fact, my patients can resume normal activities or work the following day of the laser, with concealer if really required. Of course, they will be instructed on post-laser skin care as well.

If the laser settings are not done properly under inexperienced hands, or if the patient does not adhere to the post-laser care and sun protection measures, sometimes side effects like post-inflammatory hyperpigmentation (PIH)(2) may occur, whereby the treated areas appear darker. Fortunately, PIH is usually temporary and lightens back with time.

How much improvement can I expect for freckles removal by laser?

SJ’s Experience:

After completing the laser treatments, my dense freckles are now indeed visibly lighter, noticeable even to my friends and colleagues. Especially on my left cheek, the improvement was very marked. I still have a few tiny freckles scattered around my nose bridge and below my eyes, but that is fine to me, as I’m so glad that most of the obvious ones have been removed.

After freckles removal procedure photo
Dr David’s comments:

With the right doctor, one can expect visually obvious improvement to the freckles from about 50% to 87.5%(2).

Will freckles recur after treatment?

SJ’s Experience:

Nowadays, I’m more mindful of applying sunscreen as part of my daily routine before I leave the house. I also try to play basketball at indoor courts instead and avoid going out into the hot sun as much as possible.

I much prefer my clearer face for now, so I’m doing my part on skincare maintenance to prevent the freckles from recurring.

After Freckles Removal treatment photo
Dr David’s comments:

As freckles can be aggravated by sun exposure, it is important for successfully treated individuals to adopt a sound sun protection regimen to ensure that the freckles results are longer lasting and sustainable, and to prevent a recurrence.

The analogy is like a newly remodelled shiny car. If you don’t make an effort to clean or maintain it, its appearance would return to an unappealing state with time.

In Conclusion

I hope that you now have a much more in-depth understanding on freckles removal treatment by lasers in Singapore, and the journey you can expect to go through.

If you have any inquiries about freckles removal treatments, feel free to WhatsApp me at +65 9822 2989 or call in at +65 6222 2262, I’ll be happy to address all of them.

You can also e-mail me at:
askdrdavid@onefaceclinic.com

Cheers!

Dr. David Ng C H


References


  1. Brown spots and freckles
    DermNet NZ New Zealand Dermatological Society Incorporated; Last updated Oct 2018. https://dermnetnz.org/topics/brown-spots-and-freckles/
  2. Sau Nguyen Huu, et al
    Successful Treatment of Freckles by Alex Trivantage Laser Wavelight 755 nm in Vietnamese Patients.
    Open Access Maced J Med Sci. 2019 Jan 30; 7(2): 287–290.
  3. Zain Husain and Tina S Alster.
    The role of lasers and intense pulsed light technology in dermatology. Clin Cosmet Investig Dermatol. 2016; 9: 29–40.
  4. Jong Min Park, Hensin Tsao, Sandy Tsao.
    Combined Use of Intense Pulsed Light and Q-Switched Ruby Laser for Complex Dyspigmentation Among Asian Patients. Lasers in Surgery and Medicine 40:128–133 (2008)