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I am excited to feature a guest post by Ellen Bishop.  Ellen is a board certified Family Nurse Practitioner owner of reFresh Aesthetics in Boston, Mass.  She received her Masters of Science from Regis College and is full time faculty at Boston College in the Connell School of Nursing. She has many years of practice experience, including several years on a surgical floor at Massachusetts General Hospital.


These now bothersome dark patches once carried a cute name in our youth, freckles.  But, as we have gotten older, our past and current transgressions in the sun, develop into larger areas of pigmentation and carry a new title, “Age spots” or even worse,  “liver spots”.  Their scientific name is much nicer, however, solar lentigines.  Whatever you call them, one universal truth remains, we all want to get rid of them.  Over the counter products are ineffective. So what really works?

 There are several options available, however, you can not begin treatment until you commit to a regimen of daily sun protection, SPF 15 minimum. 

One state of the art option is Laser Resurfacing.  The laser works by removing the surface layers of the epidermis or dermis, depending on the severity and depth of the pigment.  Therapy may consist of several treatments, and can be quite expensive.  Laser therapy is a safe and proven method, however with any more invasive treatment, it does carry the highest amount of risks, including hyper or hypopigmentation, redness and swelling, and in rare cases it may worsen acne.

Microdermabrasion is a procedure that mechanically removes surface layers of the epidermis and resurfaces the skin.  There are typically three microdermabrasion handpiece systems; crystal, diamond-tip and plastic disposable-tip microdermabrasion.  The speed of movement and the number of passes will determine the depth of treatment.  Immediately after microdermabrasion the skin may be red and tender and it is advised not to apply any irritating products to the skin.    Typical cell regeneration occurs over a 30 day period and because microdermabrasion manually exfoliates the dead top layer of the skin, it is necessary that multiple treatments are performed, typically every two to four weeks.  This procedure induces collagen remodeling, the new, healthy skin will usually have a smoother, brighter looking appearance.  There is little to no downtime with this procedure with minor risks include redness and swelling, slight bleeding, development of milia and, very rarely, infection.

Another option is Chemical Peeling.  Chemical Peeling involves the application of one or more chemicals to cause the top layer of skin to peel off and encourages collagen remodeling and the growth of new smoother, healthier, more hydrated skin.  Peels are performed in various strengths.  The strongest peels (ex. trichloracetic acid or TCA) have the most dramatic effects but also result in longer healing time, typically 7-10 days.  Risks to chemical peels include redness, hyper or hypopigmentation, and very rarely scarring and/or infection.

My personal preference is to start a client with a chemical peel as most folks have good results and it is often less costly than the other methods I use Image Skincare products exclusively in my practice.  I have tried many other lines without satisfaction.  My own skin has responded amazingly since starting with Image and my clients have had similar results. Depending on the severity of the pigment correction desired, I will use either a Lactic/Kojic Acid or a physician-strength TCA peel.  The results will vary from client to client but I have yet to have an unhappy client with these peels. 

As an avid golfer, I have developed a fair amount of sun damage and pigmentation on my hands.  I’ve been using Image’s Total Rejuvenating Hand Creme  for the last few months and have started to notice the spots on my hands lightening.  What is unique about this hand creme is that it contains both botanical skin lighteners to treat existing spots, and an SPF of 15 to prevent future pigmentation.

This is not to say that the other methods are not effective, they certainly can be.  This is just my preference and have thus far had success with it on my patients.

The bottom line is a very good skincare regimen and sunscreen.  The best treatment for age spots is prevention!