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

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 

 

Table of Contents

 

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.

 

one face clinic types pigmentation  

 

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

Pigmentation types  

 

Have you ever heard of "freckles, melasma, age or sun spots"?

The very first step to effective pigmentation removal treatment in Singapore is an accurate diagnosis.

A common mistake many people make 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 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, pigmentation can become very complicated and pigmentation removal treatment becomes very 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 treatment

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, patients can see good results after 6 to 10 sessions, with 8 sessions(7) being the usual average. Each session is about 15 minutes long, and the full program might take 3 - 6 months.

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:

  • The clinical experience of your doctor.
  • The number of laser sessions you require.

 

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?

freckles treatment
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!

horis naevus
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 does not recur so readily once treated, while PIH should 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.

sun screen diagram

Here are some quick tips for sun protection measures:

  • Look for a sunscreen that is labeled as SPF 30 - 50. Anything more is excessive.
  • It should also be labeled as "PA+++", or "broad-spectrum coverage for ultraviolet-A & B"
  • Sunscreen should also be used even when you are indoors, or during cloudy days. 

 

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:

  • How many patients have you treated for this SPECIFIC pigmentation condition (e.g. melasma, solar lentigos etc)?
  • Do you have an ALBUM of Before/After patients’ photos who have been successfully treated? Don’t be satisfied with just a couple of photos.
  • Are there OTHER treatment options besides lasers?

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

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.