Pigmentation: what can be done?

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If you suffer from pigmentation, you will be well familiar with the look of panic or dejection on your doctor or skincare therapist’s face when you tell them that it is a concern of yours.  While not all pigmentation was created equal, it is well known in “skin circles” that pigmentation is likely to be difficult if not impossible to completely remove, and that it requires a much stronger commitment from the patient than other skin concerns might.  Having said that, it IS possible to lighten most kinds of pigmentation, but it usually requires a multimodal approach, using several different treatments or products.   At Cape Aesthetics we offer a broad selection of treatment options that can be combined in different ways to do just that.


Pigmentation can be caused by a number of different factors: the sun (sun spots), hormones (melasma or chloasma), trauma to the skin (post-inflammatory hyperpigmentation) and even genetics (freckles and beauty spots).  While sun exposure and skin trauma can be limited or avoided as far as possible, there isn’t as much we can do about our genes and our hormones.  While freckles often look very cute, we have yet to meet a person who loves their hormonal pigmentation.

Hormonal pigmentation is probably one of the most difficult kinds of pigmentation to treat, since we end up treating the symptom (the pigment) rather than the cause: hormones.  Unfortunately, women’s hormones are almost never “stable”.  We are seemingly constantly either going through puberty or menopause, starting hormonal contraception or coming off it, falling pregnant or breast feeding, and these processes involve complex hormonal changes that affect our whole body, including our skin.  Trying to regulate our hormones to avoid or treat pigmentation is unfortunately not an option, but it does make sense that part of the treatment of hormonal pigmentation should be systemic rather than only topical.  For this reason, the treatment of hormonal pigmentation often includes oral or IV antioxidant supplementation to treat the problem from the inside rather than just from the outside.

Home care

The first step towards taking control of your pigmentation is to make sure you are using homecare that is working to combat the pigmentation 24/7.  The most important product in your homecare is ALWAYS sunscreen, no matter what your skin concern is, even if you don’t have any.  If you suffer from pigmentation an SPF 50 is a must every single day, rain or shine.  Your other skincare products should focus on blocking tyrosinase and suppressing your over-active melanocytes.  There are many ingredients that do this to varying degrees, and your skincare therapist should be able to help you select one that is suitable for your skin.

Chemical Peels

Next, because your melanocytes or pigment producing cells live in the basal layer of your epidermis, epidermal peels can help to lift pigment up through the layers of your epidermis, and eventually allow it to slough off.  Peels will improve the appearance of pigmentation, but may not necessarily be preventing more from occurring, so while they are good treatments they aren’t usually very effective alone.  For this reason, we choose to interrupt our peeling programmes with more aggressive treatments that prevent the formation of further pigmentation.

Fractionated Treatments

The ideal treatment to use in combination with peels is usually one that gives the melanocyte a little physical fright, jolting it hard enough to make it reset itself and “restore factory settings”.  This hopefully means that the melanocyte will produce the pigment you were born with, and not excess pigment.  Fractionated treatments are the ideal treatments for this effect – by causing an injury to your skin they activate a cascade of events that include this “jolt” which will help to break patches of pigmentation up so that they are easier to treat.  Treatments like Dermapen or Venus Viva fractionated radiofrequency are both effective and cost-effective at producing this reaction, and can be repeated monthly (usually bunny-hopped with peels) until the desired effect is achieved.  They also have the additional benefit of treating dermal pigmentation, which is pigmentation that has crossed the barrier from the epidermis into the dermis, and now lies deeper making it more difficult to “cure”.  These treatments will leave the patient red for up to 2 days, and with very dry, possibly flakey skin for up to a week.


For patients with more stubborn pigmentation, or who are impatient, we start to introduce injectable options.  These come in 2 major forms that can be altered slightly by the doctor performing the treatment: PRP and Redermalization.  PRP stands for Platelet Rich Plasma, and is what many people know as “The Vampire Facial”.  This treatment involves collecting blood from the patient, spinning it in a centrifuge to separate the blood into distinct layers of red blood cells, white blood cells and platelet rich plasma, and platelet poor plasma.  The red blood cells are then discarded, and the platelet rich plasma and white blood cells are injected or needled (or both) into the skin where stem cells, growth factors and white blood cells work to clear the pigment deposits and improve skin health.  Redermalization involves a mixture of free hyaluronic acid and succinic acid being injected into the dermal layer of the skin to dilute pigment and make it easier to clear.  Both treatments will leave the patient with redness and little bumps across the treated areas that will slowly dissipate.

Tackling pigmentation always requires a strong commitment from both the treating doctor or therapist AND the patient.  Results take time, and maintenance ongoing.  However, using combinations of treatments to treat the excess pigment at all stages of it’s development and appearance on the skin does produce good results, and we have had great success in treating all kinds of pigmentary issues provided our patients are as committed to the process as we are!

If you would like to find out more, or would like to start your journey to lightening your pigmentation today, give us a call to make an appointment on (021) 6833048 ext 1.


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