Hyperpigmentation Treatment

Pigmentation occurs when the skin produces too much melanin, the pigment responsible for skin color. Chronic sun exposure is the leading cause of dark spots, often referred to as sun spots or age spots. Over time, ultraviolet (UV) light accelerates melanin production, leading to small, flat brown areas most visible on the face, hands, shoulders, and chest. Other factors such as inflammation, hormonal changes, certain medications, and injury to the skin can also trigger uneven pigmentation, including melasma or post-inflammatory hyperpigmentation.

A comprehensive skin evaluation helps determine whether the pigment lies in the superficial or deeper layers of the skin, as this distinction guides treatment choice. Dr. Freedman carefully evaluates each patient’s skin tone, history, and goals to design a treatment plan that achieves visible improvement while maintaining skin integrity.

For many patients, topical treatments are the first step toward fading unwanted discoloration. These medical-grade products contain active ingredients that either suppress melanin production, promote skin turnover, or both.

• Prescription-strength hydroquinone remains one of the most effective topical agents for lightening hyperpigmentation. It works by inhibiting the enzyme tyrosinase, which is necessary for melanin synthesis. Dr. Freedman may recommend hydroquinone alone or as part of a combination formula with a retinoid and a mild corticosteroid to enhance penetration and reduce irritation.
• Alternatives for those seeking non-hydroquinone options include azelaic acid, kojic acid, arbutin, tranexamic acid, and niacinamide. These ingredients work more gently but can deliver meaningful results with consistent use.
• Topical retinoids such as tretinoin or adapalene improve skin turnover, helping pigment gradually lift from the skin’s surface while refining texture and tone.

Patients who commit to daily topical therapy typically begin to see improvement within 8 to 12 weeks. Continued use under medical supervision can prevent recurrence and maintain results long-term.

Chemical peels are a common in-office procedure to improve discoloration and rejuvenate the skin’s surface. During a peel, a controlled solution—such as glycolic acid, lactic acid, salicylic acid, or trichloroacetic acid—is applied to exfoliate the upper layers of the skin. As old, pigmented cells are shed, new, evenly colored skin emerges.

Superficial peels can safely treat mild to moderate pigmentation with minimal downtime. Medium-depth peels, often using higher concentrations of trichloroacetic acid, can reach deeper pigment but require several days of recovery. Dr. Freedman selects the peel type and strength based on the patient’s skin tone, level of pigmentation, and tolerance for downtime. Regular peel sessions spaced several weeks apart can yield significant improvement in skin brightness and texture.

Advances in laser technology have revolutionized the management of pigmentation. Lasers target melanin directly, breaking up pigment particles so the body can gradually eliminate them.

• Intense Pulsed Light (IPL), often referred to as a “photofacial,” is one of the most popular non-invasive options for sun spots and age spots. IPL uses pulses of broad-spectrum light to target dark spots, redness, and uneven skin tone. The treated pigment darkens temporarily before flaking off within about a week, revealing clearer skin beneath.
• For more stubborn or deeper pigmentation, fractional lasers and Q-switched lasers deliver focused energy into the skin to fragment melanin deposits. These treatments stimulate skin renewal while minimizing damage to surrounding tissue. Depending on the device used, most patients experience mild redness and flaking for a few days before the skin looks smoother and more even.

Dr. Freedman utilizes his expertise in aesthetic laser medicine to make personalized recommendations of which types of treatment would be recommended based on skin type, pigment disorder, and patient goals.

Microneedling, sometimes paired with radiofrequency or platelet-rich plasma (PRP), can help reduce pigmentation and improve overall skin tone. This technique creates microchannels in the skin to trigger collagen production and accelerate cell turnover. When combined with brightening serums or growth factors, it enhances pigment dispersion and rejuvenates the skin’s appearance.

Similarly, non-ablative fractional resurfacing offers improvement with limited downtime, making it suitable for patients seeking gradual yet long-lasting results.