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Hyperpigmentation Treatment for Face – Different Treatment Options

The presence of various forms of hyperpigmentation is a common concern for patients of all skin types. Any treatment strategy must begin with an accurate diagnosis of the underlying cause of hyperpigmentation. I’ll go over some of the most common causes of hyperpigmentation in my practice, as well as how I tailor treatment plans to different skin types.

Common Causes of Hyperpigmentation

Cosmetic procedures performed elsewhere such as overly aggressive laser treatments, or laser treatments applied to unsuitable skin types are common causes of hyperpigmentation I treat in my practice. Often, the practitioner could have avoided these situations if certain guiding principles had been followed. For example, I restrict the use of certain lasers and other devices on patients whose skin type is predisposed to hyperpigmentation.

woman with hyperpigmentation on face from laser

I frequently see patients who were assured by their aesthetician, or other type of practitioner that the laser they were having was safe for all skin types. Unfortunately, their skin reacted in an unexpected way, which their practitioner was not expecting. This type of scenario is becoming more common with growing the number of unsupervised aesthetic procedures performed by non-physicians.

In terms of terminology, hyperpigmentation refers to skin darkening, whereas hypopigmentation refers to pigment loss in the skin. Hyperpigmentation is caused by an increase in the skin pigment melanin.


Melanin is the natural pigment in your skin that determines skin color. Melanin production in the skin is frequently triggered by external stimuli. A sun tan, for example, is an adaptive response to the sun’s ultraviolet light. More melanin in the skin protects it from UV light absorption. In people with lighter skin, in addition to a sun tan, clusters of pigment within the skin can accumulate and last long after the tan fades.

Solar Lentigos or Dyschromias

Pigment clusters are known as solar lentigos (sun spots, or age spots) or solar dyschromias (freckles). There are several approaches to solar lentigos, and dyschromias. In general, my approach to this type of hyperpigmentation is to provide the most effective treatment with the least amount of downtime and risk of complications. My strategy is to use a non-ablative laser, such as a Q-switched laser, to disrupt the pigment into smaller particles.
solar lentigo before and after laser treatment for Wrinkles
before and after solar lentigo and laser treatment for wrinkles
This method is similar to how we treat tattoos, in which the tattoo pigment is disrupted into smaller particles. The smaller pigment particles are metabolized by your body in both of these scenarios.

Post-Inflammatory Hyperpigmentation

Post-inflammatory hyperpigmentation, or PIH, is another common cause of hyperpigmentation. PIH causes skin darkening due to increased melanin production caused by inflammation. Post-inflammatory hyperpigmentation can be caused by various types of acne, insect and animal bites, or even scratching the skin.
woman with post acne hyperpigmentation treatment

Post-inflammatory hyperpigmentation has increased as a result of cosmetic treatments such as laser, radiofrequency, microneedling, and chemical peels. Although PIH can occur after aesthetic procedures performed in a medical setting, many people experience hyperpigmentation as a result of their own at-home aesthetic treatments. Instruments such as dermarollers, and medical-grade chemicals for chemical peeling, for example, are readily available over-the-counter for at-home use.

It is not uncommon to see the effects of overly aggressive dermaroller application, or skin infection caused by suboptimal sterility practices at home. Post-inflammatory hyperpigmentation can occur if your skin is overly traumatized or infected with a dermaroller, necessitating additional treatment.

Hyperpigmentation Treatment for Dark Skin

People with darker skin are often unaware that they are more prone to hyperpigmentation as a result of using dermarollers and chemical peels. For people with darker skin, I begin by educating them on the importance of using less inflammatory inducing strategies, and being cautious of anything too aggressive. For example, I recommend Hydrafacial as hyperpigmentation treatment caused by blemishes after acne or ingrown hairs.
hydrafacial for skin rejuvenation and hyperpigmentation treatment
Hydrafacial is similar to microdermabrasion, except that instead of crystals the device uses water to remove the top layers of skin more gently. Simultaneously, active ingredients such as glycolic acid can be used to aid in the resolution of hyperpigmentation. To reduce pigmentation in darker skin types, treatment can be done gently and gradually over several sessions.

Hyperpigmentation Treatment for Under Eyes

The under eye area, also known as dark under eye circles, is a common source of concern with hyperpigmentation. My approach in this area, where the eyelid skin is very thin at approximately 1/2 millimeter in thickness, is to optimize skin quality with minimal trauma. I’ve been using platelet-rich plasma (PRP) for over 15 years to help people of all ages and skin types improve the area under their eyes.

lower eyelid surgery with fractional laser and PRP under eyes before and after
lower blepharoplasty with fractional laser and PRP under eyes before and after

PRP is made up of wound healing and growth factors found in blood, which are responsible for healing after an injury such as a cut. When these wound healing and growth factors are concentrated and applied to a specific area, blood supply and collagen production increase, resulting in better skin quality and the appearance of lighter dark circles.

Depending on the patient’s skin type, I also perform laser treatments such as a long-pulsed erbium laser, also known as a “smooth eye” treatment. In my practice, the smooth eye long pulsed erbium laser is very popular because it has no downtime when compared to fractional or ablative Erbium and CO2 laser treatment.

Upper and lower eyelid surgery with PRP and laser treatment for dark circles under eyes
upper and lower blepharoplasty before and after performed in Prasad Cosmetic Surgery Manhattan office

When there is significant wrinkling in addition to hyperpigmentation, I frequently use fractional erbium and CO2 laser. Using the same principles that I use to improve eyelid skin, I also use PRP in other areas of the face and neck to help patients with hyperpigmentation improve the quality of their skin. Since hyperpigmentation is frequently associated with inflammation or injury, it stands to reason that improving collagen and blood supply to the skin can aid in the resolution of hyperpigmentation.

The preparation of PRP begins with a simple blood draw, similar to that of a routine lab test. I tailor different strategies to each patient’s unique situation in order to deliver PRP. For example, I inject PRP just beneath the delicate skin beneath the eyes.

platelet rich plasma growth factors
I also use a unique device to create microchannels in the skin without bleeding, which we call Skin Boosting. I frequently combine laser and other thermal energy device treatments with PRP to create a synergy between the stimulatory effect of the energy delivery, and the optimal healing process amplified by PRP. This frequently means that I can limit the laser device’s aggressiveness and reduce the risk of complications caused by higher energy delivery. I’ve also discovered that PRP placed strategically beneath the skin can produce a glowing effect due to increased circulation and benefit the fatty cell layer just beneath the skin.

Best Treatment for Pigmentation on Face

It’s understandable that people who suffer from hyperpigmentation wish they could simply take an eraser and erase the hyperpigmentation in one sitting. Although I can use more aggressive modalities for certain skin types, such as a fully ablative Erbium or CO2 laser, I have found that being strategic and minimizing risk and downtime is better for many people in the long run.

before and after prp treatment for acne scars - female right cheek
before and after prp treatment for acne scars - female right cheek

Being patient is especially important for people with darker skin to avoid making a bad situation worse. The key to long-term satisfaction for my patients who I treat for hyperpigmentation is a proper diagnosis and a detailed treatment plan that includes observing the outcomes as treatment progresses and making adjustments accordingly.

Hyperpigmentation Treatment for Face - NYC and Long Island, New York

Dr Amiya Prasad is a Board-certified cosmetic surgeon, and a Fellowship-trained oculofacial plastic and reconstructive surgeon. He’s been in practice in Manhattan, New York City and Garden City, Long Island for over 25 years. To schedule an appointment, fill out the form below, or you may call any of our offices at (212) 265-8877 Manhattan, New York City or Garden City, Long Island at (516) 742-4636; or Vienna, Virginia at (703) 356-1336.

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