Uneven skin tone, pigmentation, and sun damage are among the most common concerns presenting to a dermatologist-led aesthetic clinic. They encompass a wide range of presentations, from discrete sunspots to diffuse discolouration and the complex pattern known as melasma. Accurate identification of the type and driver of pigmentation is essential before any treatment is recommended.
Types of Pigmentation
Sun damage and photoageing produce the most prevalent forms of pigmentation seen in Australian patients. Years of cumulative UV exposure stimulate excess melanin production, resulting in sunspots, age spots, and areas of diffuse discolouration. These changes are most visible on the face, chest, and hands, and tend to deepen and multiply with age and ongoing sun exposure.
Melasma is a distinct form of pigmentation characterised by larger, irregular patches of brown or grey-brown discolouration, typically appearing symmetrically across the cheeks, forehead, and upper lip. In the Australian climate, sun exposure is the primary and most significant driver of melasma. Hormonal fluctuations, including those associated with pregnancy, oral contraception, and perimenopause, are recognised as secondary contributing factors in susceptible individuals. Melasma is a chronic condition that requires ongoing management rather than a single course of treatment.
Post-inflammatory hyperpigmentation occurs following skin inflammation or injury, including acne, dermatitis, or trauma. It is more pronounced and more persistent in patients with medium to darker skin tones.
Treatment Options
Pigmentation is often best addressed through a strategic combination of treatments rather than a single modality. The practitioner will develop a tailored plan based on the type and severity of the pigmentation, the patient’s skin tone, and the presence of any active inflammatory or hormonal drivers.
Enlighten SR pico laser
The Enlighten SR pico laser is a well-established option for a range of pigmentation concerns. The PicoGenesis protocol uses a multi-pass technique to address sunspots, age spots, and uneven tone. Its photoacoustic delivery mechanism makes it suitable for a wider range of skin types than older laser technologies.
Chemical peels
Chemical peels offer an additional modality for pigmentation management, particularly for diffuse sun damage and mild post-inflammatory hyperpigmentation. They are frequently used in combination with laser therapies to extend and maintain improvement.
Excel V+
Excel V+ uses targeted wavelengths to address vascular-related redness and certain forms of superficial pigmentation, and can be used in combination with the pico laser for patients presenting with both concerns.
Clinical skincare
Clinical skincare plays a critical supporting role in pigmentation management. Hydroquinone remains the most evidence-based topical depigmenting agent and is the first consideration for patients with melasma or significant pigmentation. Retinoids, vitamin C, and niacinamide each provide supporting mechanisms for pigmentation reduction, skin renewal, and barrier support. The practitioner will recommend an appropriate skincare programme at consultation.
Your Consultation
At consultation, the drivers of pigmentation will be assessed in clinical order of priority: sun-related changes first, post-inflammatory pigmentation second, and hormonal influences third. Any active contributing factors will be identified before in-clinic treatment is commenced. Realistic expectations will be established, particularly for melasma. There is no obligation to proceed.
