Dr. Joseph Hkeik
Spotted, blotchy, uneven skin tone – these are all bi-products of the changes in your pigmentation. Fighting biology is no mean feat. We spoke with Rescu Expert, Cosmetic Physician Dr. Joseph Hkeik about ways to tame pigmentation changes and enhance your appearance.
What causes changes in skin pigmentation?
Pigmentation is the colour of your skin. The process of pigmentation is also responsible for giving your body a summer tan.
Some cells make too much tan unnecessarily, this can result in hyper-pigmentation. Changes to your pigmentation can be caused by different hormonal changes in the body, such as after menopause and with the oral contraceptive pill.
Can you explain what melasma is?
Melasma occurs when the pigmentation forms a butterfly pattern or mask. It’s usually symmetrical and is hormonally stimulated, another name for it is Chloasma.
This type of pigmentation problem is hard to treat because, although you can fix the outside, if there is a body imbalance again, that Melasma can come back with vengeance.
I’ve seen many cases where we’ve treated, corrected everything, then the pigment is triggered again and when patients come back, and it’s almost like we haven’t really started.
So it’s a tricky one. You need to invest time, energy and money into treatment, knowing that it can return. However, you shouldn’t stop treating it completely, because your skin can become quite dark and stubborn, even with future treatment.
Are there anyways to improve pigmentation with a daily skincare routine?
Always use skin lighteners on your skin as part of your skincare routine.
Your night cream should have something to block the hyperactive Melanocyte from making too much pigment. There are a few products on the market that do this. Usually we’ll prescribe ‘Simply Brilliant’ from Cosmetix, or the Brightening Serum from Ultraceuticals MD. Use these as part of a daily care routine at nighttime and then try to suppress it as much as possible.
Is there anything that can be incorporated during the day?
Many patients use an antioxidant in the morning as well, and use sunscreen every single day. Protecting the patient’s skin is important. Often the melasma or the pigmentation has darkened because they’ve been in the sun, or on holidays. I say to people that if you’re sitting within two metres of a window, you ought to be wearing sunscreen.
If doesn’t even matter if you’re not going outside. If you’re working all day, facing a glass window, turn your chair around to face the opposite direction. Especially in Australia, sunscreen should become part of every person’s daily routine.
In the morning, cleanse, moisturise, and sunscreen. If you wear foundation, choose a healthy mineral foundation, this also gives extra cover of protection for the melasma.
Make-up application and melasma treatment often go hand-in-hand. Many patients actually want to cover the melasma, so mineral foundation is ideal.
Why should mineral foundation be used?
You don’t want to have anything chemical on the skin to irritate it and cause inflammation. Inflammation is going to add to the pigmentation, you should also be aware that hyperpigmentation, can occur after peels, laser, microdermabrasion and waxing.
If your skin isn’t prepared, these treatments can cause a lot of inflammation. If you’re using an over the counter make-up that has certain ingredients which are going to inflame your skin on a regular basis, you’re causing inflammation for a longer period of time. This can trigger your pigmentation; any skin type that is Fitzpatrick 3 and above is at higher risk.
What is the Fitzpatrick scale?
Fitzpatrick is a classification of skin type. Fair skins, accompanied with blonde hair, blue-eyes, are classified as Fitzpatrick 1. They will never tan, only burn in the sun. A Fitzpatrick 6 is a dark skin tone, such as African American, accompanied by brown eyes and black hair and will not burn in the sun.
Lebanese, Mediterranean, Greek and Italian regions are usually about a Fitzpatrick 3 on the scale. Asian skins are usually a 3-4, and Indian skins usually register as a 5.
Why is the Fitzpatrick scale important when dealing with pigmentation?
These skin types directly determine the best treatment plan for the patient.
It’s not to do with the colour of your skin, but more to do with your genetics. You may be Lebanese with blonde hair and green eyes, and you might assume he is a two, but both his parents are Lebanese, his grandparents are Lebanese, so really, he is Fitzpatrick III.
If we don’t prepare these skin types, they may suffer pigmentation as a result of the treatment.
What preparatory steps do you recommend before commencing treatment to combat pigmentation?
For most patients, I would prepare their skin with a brightening serum, two or three weeks ahead of time. That way you’re suppressing the cells that could react post treatment.
If we don’t prepare properly, these cells over produce pigment to protect the skin because that’s their response to trauma. They say, “Let’s protect the skin from any trauma.”
You talked about some preventative treatments like melanocyte blockers, sunscreen. What are some of the other things you can do?
Any skin type can receive laser. It’s not true that you can’t treat because of a skin type; you have to prepare the skin to tolerate the laser. We begin with baby steps. You can also do a chemical peel, such as a lactic acid (derived from milk) peel. This is a gentle peel, to gently remove the top layer of the skin’s surface.
Because a lot of the melasma has a superficial component, if you regularly peel off the top layer of your skin, gently, you will reveal a newer layer that is not as pigmented.
Laser treatment is also an option.
Can you explain more about how laser works?
‘Permea’ laser is a good solution because we only treat small columns of skin, superficially. It’s similar to doing IPL(intense pulsed light), but in dots and pixels. You’re not taking the full surface. This way you’re not causing too much heat, nor too much inflammation, but you’re removing these columns very gently.
So you’re almost breaking it up?
Yes that’s exactly what you’re doing. With ‘Permea’, we’re creating tiny cross channels on the top layer of the skin, but it doesn’t go too deep. As a result, there’s not too much inflammation in the deeper layers that could create more of a reaction.
Essentially, you’re creating these micro-channels, and then you can add serum.
After laser, you have a window of opportunity of six to twelve hours after the treatment where you can actually penetrate serums into the skin’s micro-channels, enabling cause and effects, and hopefully lighten the skin.
Would needling work?
Needling can work. But again, you have to be careful. Needling is almost like ‘Permea’ really. You’re creating micro-channels but without heat.
I’ve treated a patient of Indian background, with melasma, using both methods (In those days I only had the ‘Fraxel’ laser, not ‘Permea’.) We did a gentle Fraxel laser treatment, and then I treated him again two weeks later and with needling. Because needling doesn’t have heat, there’s less inflammation, so you can layer these treatments.
And what about light therapy? Does that help pigmentation?
Absolutely. Especially something like Omnilux. The infrared light can aid healing. This helps reduce inflammation and if you reduce the inflammation, it’s helpful.
And you were talking about oral supplementation of antioxidants? Is that the some principle again? Reduce inflammation?
Antioxidants are going to help the skin tolerate the sun a little better, so you’re not going to get as much Ultra Violet B or Ultra Violet A damage; thus reducing the amount of trauma when in the sun.
Hopefully, because you have less trauma to the skin, you have less inflammation, leading to less pigmentation.