Brown Spots

Brown spots on skin have many names such as age spots, liver spots, sunspots, skin discolorations, hyperpigmentation, melasma or freckles. While these spots are harmless, many people think they are unsightly. These spots usually start to appear after age 50 and grow larger as a person ages. Brown spots most frequently appear on the face, the scalp and the hands. The main cause of the brown spots is too much exposure to the sun. Prevention is accomplished with sunscreen, sunblock, and prevention of sun exposure. There are several ways to treat brown spots to reduce their appearance or to remove them.



Topical hydroquinone is considered by many dermatologists to be a safe, similarly effective, and less expensive option than lasers or deep peel treatments. Topical hydroquinone comes in 2%, over the counter to 4% or higher concentrations available from a physician or by prescription. Hydroquinone can be used alone or in combination with tretinoin cream. Research has shown hydroquinone and tretinoin to be powerful tools against sun or hormone induced melasma or postinflammatory hyperpigmentation.


Topical retinoids have been shown to reverse some of the changes due to photo-aging, i.e. sun damage. If used long term, they may reduce some fine wrinkles, freckles, whiteheads and blackheads, and solar keratoses. They may also be used along with bleaching creams to reduce pigmentation in melasma.

Topical retinoids can be applied to any area but are most often used on the face, the neck and the back of hands. They work by laying down a new layer of collagen in the skin and increasing cell turnover. This pushes the damaged collagen down, and allows newer healthier skin cells to be brought up to the surface.

Retinoids can irritate the skin, especially when they are first used. This is more likely in those with sensitive skin, resulting in stinging. Excessive use results in redness and peeling in treated areas. They may cause or aggravate eczema or atopic dermatitis. The side effects can often be managed with emollients, and less frequent applications.

Chemical Peels

A chemicalpeel is a technique used to improve and smooth the texture of skin using a chemical solution that causes the outer layers of skin to peel. The regenerated skin is usually smoother, less wrinkled, and less pigmented than the old skin. The most common uses of chemical peels are to aid in the reduction ofwrinkles, reduce unevenpigmentation and brown spots, aid in the control of acne and improve texture of skin.

ALPHA HYDROXY ACIDS (AHAs) are naturally occurring organic carboxylic acids such as glycolic acid, a natural constituent of sugar cane juice, and lactic acid, found in sour milk and tomato juice. This is the mildest of the peel formulas and produces light peels for treatment of fine wrinkles, areas of dryness, uneven pigmentation and acne. Alpha hydroxy acids can also be mixed with a facial wash or cream in lesser concentrations as part of a daily skin-care regimen to improve the skin's texture.

BETA HYDROXY ACID: It is becoming common for beta hydroxy acid (BHA) peels to be used instead of alpha hydroxy acid (AHA) peels due to BHA's ability to get deeper into the pore than AHA. Studies show that BHA peels control oil, as well as acne and removes dead skin cells to a certain extent better than AHAs due to AHAs only working on the surface of the skin.

JESSNER’S PEEL: Jessner's peel solution is 14% salicylic acid, combined with lactic acid, and resorcinol in an ethanol base. It is thought to break intracellular bridges between keratinocytes. It is very difficult to "overpeel" the skin due to the mild percentages associated with the acid combination.

RETINOIC ACID PEEL: Retinoic acid is derived from retinoids; which is denatured vitamin A. It is chemically similar to Retin-A. This is a deeper peel than the Beta Acid peel and is used to reduce the appearance of scars as well as wrinkles and pigmentation problems. It is usually performed in conjunction with another peel which is done first in order to open up the skin so the retinoic can penetrate on a deeper level.

TRICHLOROACETIC ACID PEEL (TCA) is used as an intermediate to deep peeling agent in concentrations ranging from 20-50%. Depth of penetration is increased as concentration increases, with 50% TCA penetrating into the reticular or upper dermis. Concentrations higher than 35% are not recommended because of the high risk of scarring.

Skin Medica Line Of Peels

ILLUMINIZE PEEL™ is non-invasive very superficial chemical peel utilizing a novel approach to chemical peeling with a newer generation of alpha-hy`droxy acids (mandelic acid and malic acid) in combination with phytic acid and commonly used peeling agents (salicylic acid and resorcinol) to maximize skin rejuvenating effects with low irritation. Illuminize peels increase skin glow and radiance, tighten the skin and restore a more youthful appearance, improve clarity, color and skin texture. Patients achieve enhancement of skin appearance with minimal downtime and discomfort. These peels are appropriate for first-time chemical peel patients or patients looking for a gentle, very superficial peel. They may be performed on Skin types I- VI with little or no visible peeling.

VITALIZE PEEL™ helps fight the effects of time, sun damage, and environmental assaults. This powerful yet non-damaging peel can take years off aging skin. Vitalize peels address various skin conditions, such as pigmentation abnormalities, post-inflammatory hyperpigmentation, melasma, and photodamage, and achieve visible improvement after one treatment. Significant results may be seen after a series of treatments. They may be performed on Skin types I- VI with little or no or down time. Vitalize peels combined with Retinoic acid creates more exfoliation than other chemical peels and is well tolerated.

REJUVENIZE PEEL™ are an advanced formulation of peeling agents, with a built-in anti-irritant and penetration enhancer that provides controlled exfoliation of the uppermost damaged layers of the skin to reveal fresher and healthier skin. It provides predictable results with minimal down time and is effective for use on skin with sun damage, melasma, pigmentary changes and acne scarring. Recommended for Skin types I-VI and can be used on skin types V-VI after the patient has established tolerability to Vitalize Peel, or with physician consent.

A novel synthetic surfactant, Isoceteth-20, creates more uniform peeling while controlling penetration of salicylic acid, and therefore reduces skin irritation associated with the stronger chemical peels without diminishing peeling effect.

ENERPEEL EL is a gel-based skin remodelling solution that is especially designed for these sensitive areas, allows you to achieve similar results as you would with a high strength acid, thus limiting and controlling any irritation and reddening of these sensitive areas and receiving a significant increase in skin firmness around eyes and lips, decreasing fine lines and wrinkles. You also have a noticeable reduction in moderate hyperpigmentation and dark circles around eyes.

NEOCUTIS NEO-PEEL with MELAPLEX® technology combines glycolic acid with skin brightening agents to target the signs of photoaging. Lines and wrinkles, Uneven tone and texture, Brown spots and skin discolorations.

MELAPLEX® is a proprietary skin brightening complex consisting of four ingredients to address unwanted skin discolorations from a new perspective. MELAPLEX® targets an enzyme important in melanin pigment production, works to block transfer of the melanosome into keratinocytes, and helps minimize sun induced melanin formation. By addressing pigment formation at multiple steps, MELAPLEX® helps reduce the appearance of skin discolorations and visibly brightens skin tone.

Liquid Nitrogen Treatment

Also called cryosurgery, is the localized freezing of the skin for controlled removal of unwanted growths or discolorations.

During the treatment there is a small stinging sensation which is temporary. After the procedure, the spot will be red and swollen for a few days; the brown spot will get darker brown and eventually will flake off after approximately 1-2 weeks. Sometimes more than one treatment is needed to fully remove the spot. Repeat treatments can be done at monthly intervals or as needed.

GentleMax Laser

Brown spots and patches such as sun damage and melasma as well as freckles, liver or age spots, moles and even some types of birthmarks may be treated with the GentleMax laser resulting in a more gentle and natural lightening of brown spots.

During the treatment you will feel a warm to hot stinging sensation. It is normal for the treated area to feel warm and stingy or sensitive for approximately one hour after the procedure. The brown spots will darken slightly and, over the next 5 to 7 days, lightly scab and peel. Treatment on areas other than the face may take slightly longer to heal. Makeup can be applied immediately after treatment and during the healing phase.

Often improvement is seen after just one treatment, but more than one treatment may be required to more completely remove brown spots, particularly melasma. Brown spots will likely recur or you will get new ones, thus repeat treatments are required to maintain the results achieved. Repeat treatment may be required as soon as 4 months after your last treatment or just once yearly. A good skin care regimen that includes a broad spectrum sunblock such as zinc (which blocks UVA) and sun avoidance will help keep your skin looking its best.

Brown, blotchy spots will be lightened to reveal a more even skin tone. Not every single brown spot will be removed completely, but all will be lighter giving your skin an enhanced appearance. Most patients also notice a slightly improved skin texture. Skin texture improvements are increased with more than one treatment.

CO2RE Fractional CO2 System

CO2RE is the versatile fractional CO2 system that enables your physician to precisely target and effectively treat the skin’s surface, middle and deep dermal levels, plus perform traditional CO2 resurfacing and laser excision of lesions. This treatment is lighter, faster, and a more versatile solution for skin resurfacing, traditional ablation and minor dermal excisions. CO2RE has the ability to treat both superficial and deep skin layers simultaneously with precision-control over the intensity, pattern and depth of ablation. Experience dramatic improvement in skin tone & texture, sun-damaged skin and age spots.

How do I know if CO2RE treatments are right for me?
Ideal candidates for CO2RE are in their 30’s or older with skin damaged by exposure to the sun, age spots, fine lines, discoloration, rough texture and other skin imperfections. It is ideal for anyone seeking younger looking skin without the long downtime associated with conventional resurfacing procedures.

What is the CO2RE procedure like?
You can expect some moderate discomfort during the treatment, but the anesthetic applied prior to the procedure typically makes any discomfort tolerable. For more aggressive, higher powered treatments, your practitioner may recommend a subcutaneous anesthetic, oral pain relievers and/or sedatives during the treatment session. Over-the-counter pain relievers may be taken in the days after the procedure to alleviate any residual discomfort.

Is CO2RE safe?
Yes. You should speak with your practitioner about your complete medical and skin history to minimize the potential for any negative reactions.

How many CO2RE treatments will I need?
Generally you will see the difference you want after only one treatment and maximum results with three treatments. In the days after the treatment your skin will gradually look softer and smoother. The age spots and uneven textures will start to show immediate improvement.

How long will the results last?
The durability of CO2RE results approaches that of surgical procedures. However, there are a number of variables that will determine how long you can expect the results to last, including your health, age and how you care for your skin after treatment.

What can I expect after my procedure?
Immediately following the procedure you can expect a sensation similar to a sunburn, lasting several hours. You can expect peeling of dead skin from the treatment area. This is a natural exfoliation process that may last 7-10 days.

Do I need to take any special precautions after treatment?
Your practitioner may recommend a short course of antibiotics to minimize any risk of infection. Use of a moisturizer and sunscreen is recommended during the healing process and for the weeks and months following treatment.

Are CO2RE treatments covered by insurance?
Most insurance companies do not offer reimbursement for cosmetic and aesthetic procedures. Please consult your insurance carrier for more details.

How much do treatments cost?
Cost depends on the area being treated, the condition being treated, and the aggressiveness of the treatments themselves. Speak with your doctor to create a treatment plan to meet your personal needs.



IPL is a medical device using multiple wavelengths of light to treat sun-induced changes on the face, including brown pigmentation, age spots and broken blood vessels. IPL is also used to treat the facial changes of rosacea, including redness and broken blood vessels. IPL may be used for these changes on the hands, neck and chest as well. It is safe, non-invasive and is tailored to the individual patient’s skin generally requiring multiple treatments.


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