Plastic Surgery Trends
Control of Facial Pigmentation Part 2
By Dr. Kenneth Dickie
Feb 10, 2008 - 4:08:21 PM

Further to my article written last time depending upon the cause of your facial pigmentation, there are several treatment options.   Some consist only of cream or changes of your skin care routine or sunbathing habits. Substituting or changing brands of hormonal supplements of birth control pills may also resolve abnormal melanin production.


For standard non-hormone induced hyperpigmentation, hydroquinone usually reduces or removes hypergigmentation very effectively.   For the person who does not wish to have expensive or invasive procedures or only has slight hyperpigmentation, hydroquinone can be a good option.   However, these products may not be suitable for your needs and they will also take longer than others treatment options.   Hydroquinone is a melanin blocker. You may have heard it called “skin bleach” but in actuality, it prohibits new melanin production as your body goes through natural or chemical-assisted exfoliation.   These products can be obtained over the counter in weak strengths or by prescription for stronger concentrations. Formulations of 4% hydroquinone used to be thought to be the best, as irritation would erupt at higher strengths.   This has been proven although strengths up to 10% are routinely formulated for patients.   However it must be noted that higher strengths of hydroquinone have caused hydroquinone-induced ochronosis (black speckling in the dermis) in patients with darker skins.   Hydroquinone has been banned in parts of Europe and parts of Asia due to the belief that higher concentrations may be carcinogenic. Hydroquinone is used by itself or it can be mixed with other agents such as kojic acid or azeliac acid. These agents are meant to accentuate the effect of hydroquinone.   They may be formulated by a pharmacist to deal with more difficult pigmentation abnormalities


Hydroxy Acid “Peels


The “peels” one can get at an esthetician/aesthetician/facialist office can be considered rather mild to slightly invasive.   Alternatively, you may visit a plastic surgeons office where there are strengths that are much more penetrating.   These aren’t exactly “peels” per se, but cause a reaction in your skin that makes you peel a few days later on your own.   They increase cell turnover rate and thicken the dermis as well as correct hypergigmentation or texture problems.   Of course the amount of improvements depends on the strength or number of treatments you have.



Alpha Hydroxy Acids (AHA) :   Water soluble, these products such as 8% Glycolic acid cream can help remove hyperpigmentations and help with photo damage, thickening of the dermal collagen and increase cellular turnover.  


BetaHydroxy Acids (BHA) :   (Salicylic Acids are most common); lipid (fat) soluble.   It is an exfoliant, and anti-inflammatory (acetylsalicylic acid- aspirin family), a comedolytic (de-clogging agent for pores).   They are not particularly known for removing hypergigmentations but does increase the rate of exfoliation which increases the chance of removal as long as a melanin blocking agent is used in person who are prone to re-pigmentation of the treatment area.


Post Inflammatory Hyperpigmentation (PIH):   A common consequence of dermal inflammation (either from acne or ingrown hairs) is post inflammatory hyperpigmentation.   Excess melanin is produced in response to the inflammatory reaction, and often remains long after the inflammation has resolved.   Control of PHI requires a two step approach; the first is controlling the cause of inflammation (eg: acne).   The second is to remove excess melanin and control its production once the inflammation has been resolved.   There are very effective programs to deal with PIH, therefore one need to accept that irregular pigmentation is simply a fact of life.


Control of facial pigmentation requires a commitment to a skin maintenance program.   With the combined use of Vitamin A, Hydroquinone and other agent to control your skins melanin production, restoration of a healthy, even complexion is possible.   In addition, programs such as the Obagi skin care program can assist your skin in reversing pre-cancerous and pathological lesions on the skin which are often a consequence of aging.  


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