Ultimate Guide to Facial Pigmentation Treatments in Singapore by Dr. David Ng C H

Ultimate Guide to Facial Pigmentation Treatments in Singapore by Dr. David Ng C H

Dr David Ng C H

Warnings!

This pigmentation guide is a really long read, but it has plenty of vital information. This is written and dedicated to people suffering from facial pigmentations:

1. who are seriously considering to seek the right pigmentation treatments in Singapore,

2. who wish to stop wasting further money, time, and efforts on their ineffective treat-ments.

As a doctor with many years of clinical experience treating various types of pigmentation, it’s my personal goal to help educate the larger public on what skin pigmentation really is and to introduce various effective treatment options currently available. 
As of now, this version is my most updated and contemporary guide available.

So let’s get started!

Many people in Asia desire flawless skin, especially the ladies. A fair, unblemished complexion is highly sought after in most countries in the orient. Yet, the tropical nature of many South-east Asian countries means we’re exposed to the harsh ultraviolet rays of the sun all year round, and this includes Singapore as well. Thus, pigmentation strikes, causing us to develop undesirable skin blemishes like freckles, melasma and sunspots. For many years in the past, these pigmentation issues were perceived as unavoidable, natural occurrences with no recourse available.

Asian woman with great skin

Nothing could be further from the truth! DO YOU KNOW that facial pigmentations are consid-ered skin diseases. And with all diseases, the right way to deal with them is to turn to proven medical treatments from an accredited and experienced doctor. Only he or she can understand the severity of your condition and other important factors like the right diagnosis, skin types and your lifestyles in order to prescribe a suitable and effective treatment.

One lesser known fact is that patients with unsightly pigmentations on their face may at times suffer from emotional distress and unhappiness. They become self-conscious in social settings and their self-confidence can plummet. When a readily treatable condition like this has such harsh effects on their social life, daily activities and even self-esteem, I believe it’s our duty as doctors to step in and treat these people. Many believe that pigmentation is “just another cos-metic problem” or is “no big deal!” I beg to differ. While some of these benign facial pigmentations don’t necessarily have an adverse effect on health, the potential to affect a patient’s mental well-being means that such conditions should not be taken lightly.

 

What type of skin pigmentation do I have?

Not all types of pigmentations are the same. The treatment for freckles, sun spots, or melasma are all different. If you’re diagnosed wrongly, you’ll be spending lots of time, money and effort for a treatment that will in all likelihood be ineffectual.

To the layman, it’s very difficult to tell the difference. Even experienced doctors can make mistakes! So please, avoid any self-diagnosis and go visit a trained professional to give you a proper diagnosis. Let’s go through some of the most common types of facial pigmentation you’ll encounter in Singapore.

Types of Pigmentations

Melasma

  • Usually present as dark brown patches that can be found on both sides of the face
  • Patches are usually symmetrical
  • Tends to affect people of darker skin tone and middle-aged women
  • Some people are genetically predisposed to developing it
  • Hormonal changes due to oral contracep-tion or pregnancy might trigger it
  • Other factors include age and chronic sun exposure
  • Tends to resemble a “country border”
freckles

Freckles

  • Brown, small speckled dots that are usually multiple
  • Most commonly found around nose and cheekbones
  • Tends to develop in adolescence and youth
  • Is most commonly triggered by sun expo-sure
  • Looks like “pepper sprinkled on skin”

Solar Lentigo

  • Round, discrete spots with a uniform color
  • Can be larger in size
  • Triggered by ultraviolet (UV) radiation and sun exposure, hence the name “Solar Len-tigo.”
Hori's Naevus

Hori’s naevus

  • Deeper and greyer than most facial pigmentations
  • Usually found in clusters
  • Commonly found on cheekbones, forehead and nose
  • Generally middle aged women in Asia suffer from this
  • May be genetically predisposed

Post-inflammatory Hyperpigmentation (PIH)

  • Discoloration that looks feathery
  • Is a direct result of post-skin injury related inflammation.
  • Can be triggered by abrasions on the skin, acne that didn’t heal properly, poor treatment of pimples, wrong use of cosmetics, post skin procedures etc.
Seborrheic keratosis

Seborrheic keratosis (“age-spots” or “pigmentation bumps”)

  • Brownish and coarse bumps that create a “greasy” appearance on the skin.
  • Tends to affect middle aged people more than youth
  • Often mistaken as moles
  • These bumps are often raised, and can be felt on the skin.

I’m sure if you took away my descriptions, most of you wouldn’t be able to tell the difference between one to another. And that’s not your fault. All these types of facial pigmentations are incredibly similar visually and it takes an expert to tell the difference.

The longer you leave pigmentation untreated, the harder it can be to tackle them. So it’s im-portant to seek treatment from the RIGHT doctors as soon as possible. Don’t wait any longer!

A Few Practical Tips for You

laser pigmentation treatment

Don’t be so quick to go for laser treatments.

“Hey Doc, I read online that lasers can give me instantaneous results with no drawbacks! Almost like magic!”

In recent years, laser treatments have gotten lots of publicity in various media outlets, so much so that you may also have seen videos of laser treatments that can “instantly” remove any dark spot on your face, almost like the eraser tool in Photoshop. If only it is so simple in reality.
Lasers DO NOT “erase” the pigmentation immediately!

What lasers actually do is that they fragmentize the pigmentation into smaller particles. Think of it like breaking a giant lump of coal into many small pieces. These smaller pieces are then left there to be naturally wiped out by your skin’s immune system over time.

Many people are seduced by the idea of a high-tech, instant solution to their skin problems and chase after such laser treatments right away, thinking that it’ll be a quick and easy solution to their problems. More often than not, these patients can end up wasting a huge amount of time and money for ineffectual laser sessions that don’t tackle their facial problems correctly.

For quite a number of my patients, I would say laser treatments are not even needed as a first line solution. There are many forms of sunscreen protection and topical lightening creams that are already more than sufficient in treating the pigmentation found in many of these cases.

My main piece of advice: Lasers DO work but they are just NOT ALWAYS necessary. So don’t waste money and time on laser treatments unless you’re sure they’re the best solution to your problem.

For more information on this topic  https://www.onefaceclinic.com/myth-debunked-lasers-cure-pigmentation/

Is the “latest laser technology” really that effective?

“Hey Doc, there’s this new technology, a high-tech laser that I heard is really effective. It has to be the best thing on the market, right?”

Aesthetic technology moves at a breakneck pace, and newer laser technologies are being introduced into the market all the time.
They can account for really interesting and useful effects on pigmentation removal, but beware. From my experience, newer doesn’t always mean better.

laser technology

Here’s the crux of the matter: new technologies can often take time to master. For effective results, the performing doctor needs to be well versed and practiced with the new technology, understanding and navigating deftly through its strengths and limitations. Aesthetic machines and lasers, especially those that require delicate and precise energy settings, generally have a steep learning curve. Even the most veteran doctor is going to need time and practice to fully master handling of the apparatus.

Here’s the question: is your doctor adequately versed in the usage of the latest laser machines?

Here’s my years of observation. I have seen doctors who have used supposedly “outdated” or “traditional” models of laser technology and have achieved AMAZING RESULTS on their pa-tients. Yet, there have also been instances of others who have used the supposedly “latest” or “trendiest” laser machine to hit the market, and yet achieved almost NO RESULTS! Even worse still, as some ending up with complications!

Another interesting observation to highlight is that, while one doctor can produce wonderful results, another one is far from producing the same desired results EVEN with the SAME laser model performed on the SAME patient’s skin problems.

doctor David treating melasma

Take this analogy; simply owning the most modern, fine-tuned Ferrari F1 vehicle does not guar-antee that you’ll become an F1 champion, as the car has to be piloted by a professional driver with the skill to manifest its capabilities. Without the requisite skill, it’ll just be a car accident waiting to happen!

Newer lasers DO NOT GUARANTEE superior results and are generally MORE EXPENSIVE for the patients! If your doctor recommends that you go for a new laser treatment, be it the latest picosecond, nanosecond laser, etc, here are a few questions you will want to ask him/her:

1. How many clinical cases has he/she handled using this particular laser?

2. How long ago did he/she start using this laser?

Remember, you’re also entitled to ask to see before/after photos for cases treated using that particular laser. Remember, you’re the one paying, so you have the right to make certain reasonable demands to ensure you’re getting what is recommended by the clinic.

For more information on this topic:

Myth: “Lasers” are also available at beauty salons and spas.

Doc, I just did a “laser” treatment at my neighborhood beauty salon, and my friend also did hers at a downtown medi-spa. What’s the difference compared to your clinic’s laser?

There is a HUGE difference between a “spa-grade laser” and a medical-grade laser. Beauty service providers (e.g. beauty salons, facial spas, medi-spas, etc) commonly use spa-grade devices eg Intense Pulsed Light (IPL) to try to treat various skin issues including pigmentations.

One Face Clinic treatment room

Medi-spas usually differentiate themselves from beauty salons by providing “more advanced” spa-grade devices and skincare treatments, but technically, they are STILL NOT considered as medical clinics because there are no doctors in-house. In Singapore, ONLY certified doctors housed in medical clinics are able and allowed to operate medical-grade lasers.

IPLs are often mistaken by patients to be the same “lasers” used by doctors, because they CAN look and feel similar to the layman during treatment. However, IPLs are NOT lasers in terms of physics, configurations and how they work (just like how a bicycle is different from a motor car), and hence IPLs results are thus NOT ON PAR with medical-grade lasers.

If you have mixed pigmentations or are unsure about what you have, it is still better to consult your doctor first to get the correct diagnosis. Furthermore, medical-grade lasers are certainly much more effective than IPLs to clear a wider range of pigmentations.

Pigmentation is actually a SKIN DISEASE that needs to be addressed by doctors, and even amongst doctors, experience in treating pigmentations also vary. Thus in essence, non-medical beauty service providers (e.g. beauty salons, facial spas, medi-spas etc) are generally positioned for skincare MAINTENANCE or milder skin issues, but in terms of TREATMENT of pigmentations, they are NOT going to be as effective as medical treatments or lasers done by experienced doctors.

For more info on the 8 commonest misconceptions in pigmentation treatments: https://www.onefaceclinic.com/8-common-myths-on-pigmentation-treatments/

Should I just go for OTC (over-the-counter) skincare products then?

Skin care products and creams

“Hey Doc, my friend simply purchased a skincare product online and told me her pigmentation cleared up just like that! Should I just go for a simple cream off-the-shelf instead?”

Over-the-counter (OTC) topical skincare products can be very effective in PREVENTION of pigmentation developing. For instance, sunscreen and cosmeceutical range of moisturizers are incredibly essential in preventing pigmentation when you’re exposed to the harsh rays of the sun.

Here’s where the confusion or misconception lies

The fact is that OTC/online skincare products or even oral skin supplements are generally inef-fective in the TREATMENT of skin pigmentation.

Do you know that OTC or online products are in a different category from medical-grade creams (e.g. hydroquinone)? The latter is not found in retail stores as it is only allowed to be prescribed by a certified doctor only, at least under Singapore’s regulations.

Medical grade creams (e.g. hydroquinone) have a strong medical formulation specifically to tackle pigmentation. These creams have generally undergone stringent clinical trials to prove their efficacy and should not be used flippantly due to its potency.

On the other hand, OTC products or oral supplements are meant to be sold to the mass market, so they cannot be made too potent, unlike medicated creams.

For more info on the 8 commonest misconceptions in pigmentation treatments: https://www.onefaceclinic.com/8-common-myths-on-pigmentation-treatments/

So, what do doctors in Singapore do to treat pigmentation?

From simplest to most difficult:

Seborrheic Keratosis (Seb K), often known as “age-spots” or “pigmen-tation bumps”

patient with Seborrheic Keratosis age spots

Seborrheic keratosis or “age-spots” is a relatively easy condition to tackle. Generally, procedures like electrocautery or ablative laser surgery is used to remove them.

How many sessions are required?

In general, only 1 or 2 sessions are needed for full removal. Each session should take some-where between 10 to 20 minutes maximum.

Is there any pain?

This is one of the simpler and stress-free procedures. It’s almost completely pain-free as usually an application of a numbing cream is all the anesthesia you need.

What’s the downtime like?

Expect a downtime of skin healing between 3 to 5 days. Post treatment discomfort is limited to only mild scabbing, which should heal quickly. The great news is that this particular condition has almost no chance of reoccurrence after correction, at least in the near to midterm.

How much should I expect to pay?

Seborrheic keratosis treatments in Singapore cost around $250 to $950, depending on the se-verity of the condition.

Solar Lentigos & Freckles

What freckles look like during downtime, post-laser treatment

In general, the go-to procedure that most doctors would endorse for both freckles and solar lentigos would be laser treatments.
But did you know that these two particular conditions can be tackled with topical medicated creams (e.g. hydroquinone)? Yes, topical treatments can be effective for certain cases of freck-les or solar lentigo! Always consult with your doctor to see if you qualify for a non-laser treat-ment before going for lasers. For more persistent cases, certain lasers like the Q-switched Nd:yag lasers have proven to be effective.

How many sessions are required?

It usually takes 2-3 sessions of lasers over 2 to 3 months to see really good results.

Is there any pain?

For laser treatments, a topical numbing cream will be applied before treatment, so the treatments will be generally pain-free.

What’s the downtime like?

Expect a downtime of around 1 week due to the typical dry scabs that will form post laser treatment.

How much should I expect to pay?

In terms of pricing, you should generally expect to pay around $850 to $1650 for the entire treatment.

A tougher nut to crack: How to tackle Hori’s naevus

A tougher nut to crack: How to tackle Hori’s naevus

Hori’s naevus is a condition where deep and dense pigmentation clusters are found in the skin. Unlike the conditions previously outlined, topical creams aren’t going to cut it. You will have to undergo laser therapy in order to correct a case of Hori’s naevus.

How many sessions are required?

As far as pigmentation cases go, Hori’s naevus is generally tougher to treat and patients will need to buckle in for a longer, protracted treatment cycle. You’ll need to attend anywhere be-tween 4 to 10 sessions of laser treatment with about a 4-6 week interval in between treat-ments. This generally results in a treatment cycle of around 4 to 10 months to attain visible and desirable results.

Is there any pain?

For laser treatments, there will usually be a numbing cream before treatment, so the treat-ments will be generally pain-free.

Horis Naevus

What’s the downtime like?

Expect a post-treatment downtime of around 3-5 days, with minor redness and swelling on the treated areas.

Keep your spirits up! As a doctor, I often see my patients disheartened due to their conditions persisting longer than they expect. The secret is to have patience! The good news for patients is that after going through such a long treatment cycle, you can generally rest assured that it should not recur in the short to midterm. Thus Hori’s naevus is tougher to treat, and also tougher to reoccur!

How much should I expect to pay?

As this is a long treatment, costs may vary due to the severity of your condition and how well you respond to treatment. Expect to pay around $3000 for the entire course of treatment.

Hori''s Naevus after treatment
patient with melasma

Melasma – the hardest to treat!

Melasma can be a tricky and volatile pigmentary condition, that sometimes can be worsened due to hormonal and sun exposure, or for unknown reasons despite appropriate treatments. In the medical realm till now, many doctors and scientists still don’t fully understand the exact root causes of melasma. What we do know is that melasma is caused by complex interactions between age, genetic predisposition, hormone levels, vascular and sun or ultraviolet(UV) expo-sure, to name a few factors. This is the reason why melasma is one of the most difficult pigmentary conditions to treat.

To patients who are undergoing hormonal therapy such as oral contraceptive pills, they may need to consider the option of going off their medications and use other non-hormonal alterna-tives (if available), should they be facing the development of persistent melasma. This option has to be discussed with their primary physician first.

The choice of treatment for melasma cases usually depends on the severity and depth of the pigmentation. For cases where the pigmentation is superficial and less severe, I usually recom-mend the use of sunscreen as well as medical-grade creams such as hydroquinone to manage it.

Combinations of different medical grade creams have proven to be quite effective in managing melasma. Side effects may occur like redness, dryness, itching or a smarting sensation around the target areas. As usual, you have to be patient as lightening of the melasma usually only oc-curs after 6 to 8 weeks of treatment.

As far as cost goes, these topical creams usually cost around $65 to $185. Doctor recommended sunscreens (SPF 30-50, PA+++) usually cost about $40 – $100.

But Doc, my melasma isn’t going away. What can I do?

For persistent cases, lasers would have to be the next option. There are also other options of using chemical peels or oral tranexamic acid.

How many sessions are required?

Expect to see results after around 4 to 8 sessions of laser treatment. Each session is around 10 to 20 minutes long, with generally a month’s interval in between treatments. For the full program, expect around a 4-6 month treatment cycle.

Yes, if you still don’t know by now, you certainly DO NOT NEED WEEKLY lasers!

What’s the downtime like?

The good thing about lasers for melasma is that you usually won’t encounter any downtime, unlike the laser treatments outlined for above mentioned other pigmentations.

The full course of treatment for a case of melasma would cost around $1600 – $2900. This usu-ally varies based on the experience of the doctor and how many sessions you require to proper-ly address your melasma.

melasma digital photo analysis

What about Post-inflammatory Hyperpigmentation (PIH)?

Post-inflammatory Hyperpigmentation (PIH)

The good news is that PIH is self-resolving, but will take a long time, especially for patients with darker skin types. This could mean months, or even years!

The treatments (e.g. creams and lasers) I mentioned above for melasma often can also be ap-plied to PIH. Both of these conditions have similar treatment plans in general.

Will I have flawless skin after pigmentation treatment?

Of course, no doctor can promise their patients perfectly flawless skin post-treatment. However, depending on the pigmentation diagnosis and severity, you should expect an improvement of around 50 to 90% in terms of the visibility of your facial pigmentation.

It’s important to manage your own expectations. Even in the hands of an expert, for cases of severe or chronic pigmentation (e.g. melasma, Hori’s naevus), the effort required to treat it will naturally be much greater.

Don’t expect an amazing transformation in just a few weeks! Remember to comply with your doctor’s orders and be patient and consistent in attending treatment sessions to correct your pigmentation, and I can assure you that results will usually follow.

Yay, I’ve finally gotten rid of my pigmentation! But Is it going to reoccur?

beautiful asian woman

“Doc, I was so happy to finally have clear skin again. Yet after my trip to Bali, my pigmentation suddenly came back! What happened?”

As I’ve outlined before, much of facial pigmentation is aggravated or triggered by exposure to sunlight and the harsh UV rays of the sun.

Some of these pigmentations may reoccur should you aggravate them unnecessarily, or if you don’t follow post-treatment care guidelines.

Think of skincare like managing your weight. Once you put in the effort with dieting and exercising to shed the pounds, you’ll STILL have to maintain a healthy lifestyle in order to keep that body shape and weight. If you go back to your old habits, it’s no surprise that weight gain is going to reoccur!

Luckily, there’s a lower chance of Hori’s naevus or age-spots recurring once treated. PIH is also unique because it’s linked to facial skin injuries, and it shouldn’t be an issue unless reinjury takes place.

My advice is to make it into a two-step process. Treat your pigmentation problems first, then prevent recurrence by taking care of your skin. The two biggest things you can do is to adhere to your doctor’s post treatment care orders and also to adopt a good skincare routine like ap-plying sunscreen and practicing sun protection measures in order to maintain a clear complex-ion and healthy skin.

My personal tips & tricks for pigmentation prevention with sun protection measures

As much as you can, just avoid the harsh rays of the sun, as though you were a vampire! Of course, if that’s going to be impractical in your daily life, you can at least do the following:

  • Use a sunscreen that is labelled as “SPF 30–50” and “PA+++”, or “broad-spectrum cov-erage for ultraviolet- A & B”
  • When applying sunscreen, be generous about it! Make sure all areas are covered.
  • Staying indoors? Is the sky overcast? Apply sunscreen nonetheless! Even on a non-sunny day, harmful UV rays will still find their way to your skin.
  • For extended outdoor activity, use a water-resistant broad-spectrum sunscreen
  • Cover up with clothing, including a broad-brimmed hat and UV-blocking sunglasses.
  • Use an umbrella when you are outdoor
  • Lifestyle changes e.g. exercise in the early morning, late evenings or indoors in the gym
  • Use curtains or blinds for windows near to your work desk
one face sun screen

How to save money while solving your pigmentation woes

one face clinic treatment room

Myth: Doctor’s treatments are so EXPENSIVE!

You will be surprised. It’s NOT TRUE that patients have to spend a huge amount of money on visiting an experienced doctor to treat or solve their pigmentation woes. In fact, it’s very feasi-ble that someone could just spend $250-300 for a proper topical cream to help tackle their pigmentation. Even for more severe cases, patients should be paying around $1,000 – $3,000 for a full course of pigmentation laser treatments.

dr David consulting with patient

This is highly reasonable if you are paying for ACTUAL results!

It has come as a RUDE SHOCK to me before, that some of my patients have recollected painful stories of having spent ABOVE SGD $10,000 for a variety of pigmentation treatments at various non-medical beauty service providers (e.g. beauty spas, facial salons, medi-spas, etc). Needless to say, they did not get the results that they desired.

Sadly, there aren’t any Medisave or government subsidies for pigmentation treatments as they’re regarded as optional aesthetic procedures. Here are 3 tips I tell my patients to try and cut costs:

Tip #1: Don’t go straight for laser treatments. Check your options beforehand.

Ask your doctor for alternative treatments to lasers. As I’ve shown you, there are available medical-grade creams that might be just as effective.
The difference in price between these two treatments are HUGE! We could be talking about a 1,000% increase in price! $300 for topical creams vs. $3,000 for a course of lasers. Invest in laser treatments only if absolutely necessary.

Tip #2: Don’t go straight to new and trendy laser treatments. Pay for results instead.

Again, newer doesn’t necessarily mean better. From my experience, conventional lasers (like the Q-switched Nd:yag) are still extremely effective treatments for many of the pigmentations outlined above. There will always be pressure from the advertising market to push their new-fangled technologies like nanosecond or picosecond lasers, etc.

patient looking at mirror

For being “cutting-edge”, bringing in these newer lasers can cost the clinic a huge amount. That forces clinics to charge a higher amount than usual to the patients. An entry level treatment package for these new lasers may cost upwards of $4000-5000!

Again, there’s NO GUARANTEE that these new laser technologies are more effective than con-ventional lasers!

Tip #3: Put your doctor to the test with 4 simple questions.

There are plenty of aesthetic clinics in Singapore. I’d suggest you do your due diligence and pose these questions to any doctors you’re considering to let him/her conduct the treatment on you.

Do you have before/after photos of patients who have been successfully treated?

Don’t be satisfied with just a couple of photos, try and ask them for an album of their past clients. Most doctors will have one handy to display their handiwork, if they’re proud of it.

What other treatment options besides lasers do I have?

How many patients have you treated successfully for this specific pigmentation condition (e.g. melasma, solar lentigos etc.)?

How many years of relevant experience do you have in treating skin pigmentation?

Often times, you’ll be able to be referred to a proper doctor through friends and family who’ve had good treatment experiences. If you don’t have someone to give you a word of mouth referral, there are user-driven reviews posted online by fellow patients that might lead you down the right direction.

Dr David Ng C H

Final thoughts

Only the RIGHT doctors with the correct experience will be able to confidently provide you with valuable advice and insights on pigmentation treatments, and can at the same time help you save on your time, money and effort to avoid a disappointing treatment experience.

Dr. David Ng C. H. is born and bred in Singapore. He has more than 15 over years of medical experience, and has done over 10,000 aesthetic lasers and treatments. He has a deep passion and long career in treating challenging skin and aesthetics issues affecting many Asian women and men e.g. pigmentations, acne and facial anti-ageing.

He has also appeared in the Singapore media as an expert guest sharing valuable insights in these areas of aesthetics medicine. He strongly believes in a holistic approach to treatments and achieving the best results for his patients. Apart from discussing medicine, he is an avid foodie and would travel near and far with his family to gratify his appetite on weekends.

His blogs can be read on https://www.onefaceclinic.com/blog/

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