Lasers for Pigmentation - Why isn’t there any improvement?

Lasers for Pigmentation - Why isn’t there any improvement?

 

 A Note to Readers:

Dr. David Ng C. H. is proud to be the original author of this article, which was first published on 22nd November 2017.

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 

 

“Doctor, how come my skin didn’t improve after doing lasers for pigmentation? Does laser pigmentation removal really work?”

 

In my years of skin and aesthetics practice, I’ve met lots of patients who asked me this question.

The answer is simple; there are 4 factors that determine successful laser pigmentation removal. When any of these go wrong, you will NOT see results.

 

1. Pre and Post Care Compliance during Laser Pigmentation Removal

This is the ‘easiest’ factor because it is within your control. To get the best results with lasers for pigmentation, you ABSOLUTELY have to follow your doctors’ instructions. Make sure you are compliant with skincare products like lightening cream, sunscreen (especially!) and sun protection measures, both before and after treatment.

A big reason for pigmentations not improving, or turning worse (getting darker instead of lighter) is a failure to comply. Listen to your doctor’s pre and post-care advice carefully and adhere to the maintenance regime.

See what happens below when you don’t respect sun damage enough:

Key Advice #1: If you can’t avoid the sun, make sure you apply sunscreen at least 1-2 times daily.

 

2. Correct Diagnosis

Diagnosis is the basic skill of a skincare doctor but does not take it for granted. Different types of pigmentation require different kinds of treatments.

“But a qualified skincare doctor should be able to identify my condition easily, right?”

Not really. People often have mixed pigmentation on their faces so it can at times be difficult for a doctor to diagnose. The doctor’s clinical experience (vs. just studying theories from textbooks) in pigmentation is very critical to applying the correct diagnosis and thus, suggesting the most effective laser method.

 

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:

A Strong diagnosis is VERY important as the doctor will be able to advise on a specific type of treatment, the number of sessions, costs required and what kind of results to expect.

Key Advice #2: Research on your doctor and be sure he/she is very experienced with pigmentations.

 

3. Clinical Skill with Lasers for Pigmentation

This is a big reason why patients complain of poor results. Most laser treatments (e.g. Q-switched Nd: Yag laser) look like regular zapping. It’s not that simple as the doctor has to decide on which treatment settings to give optimal results.

I had a patient with Hori’s Naevus who complained that her previous doctor hardly gave her results but complimented that there was almost no downtime. I immediately realized that her previous doctor had set the laser strength TOO LOW. Why? Because Q-Switched laser on Hori’s Naveus will need to create redness and swelling for at least a few days to get desirable results. If the strength is too low, then, of course, there’s also no downtime!

Conversely, if the laser is set TOO STRONG during the hyperpigmentation treatment, it can create complications like post-inflammatory hyperpigmentation(2) (darker spots) and confetti hypopigmentation(3) (white spots).

These can take months to years to resolve.

PIH (darker spots) on the left and Hypopigmentations (whiter spots) on the right.

Question is, how to tell if the doctor can give results BEFORE signing up for laser pigmentation removal?

Key Advice #3: Ask the doctor for their before/after photo album of previous patients. Make sure it is substantial and not just a few photos.

 

4. Laser Pigmentation Removal Technology

I get worried for patients who ask “Does your clinic have this XYZ laser for pigmentation?”

Not because I don’t have it, but because they think that having a new, high tech XYZ laser alone can give magical results.

It does not and usually only results in higher prices for the patients. For example, I use Q-Switched Nd Yag Laser(4) vs. a new technology laser.  The Q-Switched laser is much more affordable yet skilled doctors will still be able to deliver the same results or better.

In medical school, our professors always reminded us to focus on clinical skill and experience while borrowing suitable technology to deliver the best results. I totally agree, so I keep my lasers updated but I do not like to advertise having new machines.

laser skin pigmentation procedure

Key Advice #4: Latest laser technology DOES NOT guarantee results. Don’t blindly pay more for nothing.

 

How to tell if my doctor can deliver results on pigmentations?

From personal experience, word of mouth is best. Online reviews can also give a good idea about what to expect from the doctor. However, individual experiences can differ greatly. Your close friend might get amazing results, but 10 others might have been disappointed in the same doctor.

Thus, the most important thing you should do is to ask your doctor for his before/after album of previously treated patients. (Doctors are NOT allowed to show this to you online or they will get a warning letter from the Ministry of Health very soon!)

Singapore has good doctors for treating pigmentation but makes sure you do due diligence before committing to laser treatment.

 

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. Neodynium YAG laser treatment.

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

Available from https://www.dermnetnz.org/topics/ndyag-laser-treatment/

3. Yisheng Wong, Siong See Joyce Lee, 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.

4. 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.