How To Get Rid of Hyperpigmentation


How To Get Rid of Hyperpigmentation
Welcome to this Smazy Academy show with Tonia Ryan and...

Christopher Khorsandi MD, aka Doc Vegas.

Combined we have over 30 years of experience in the medical and skincare industry, and we want to share our best practices, as well as tips that we've learned from seeing thousands of our clients skin transformed. So whether you're a skincare newbie or a skincare connoisseur, this show is for you. In today's episode, we're going to talk about hyperpigmentation, which are all those brown spots that you get on your face.

Fancy word for a horrible, horrible problem. No, it is.

It's no fun.

No, it stinks. It's like, what is hyperpigmentation? Well, I mean, hyperpigmentation very simple. It's like hyper means a lot, and pigmentation is the color in our skins. I mean, very simple concept, right. So, it's brown spots, dark spots, age spots, things that change on our skin. And hyperpigmentation, in general, and what we're going to talk about today is on the face.


So, hyperpigmentation is abnormal pigmentation. It's not supposed to be there. Freckles are normal, and that's okay. And sometimes...

Some people don't like their freckles either.

Yeah, sometimes people don't like the freckles. They'll want to get rid of them. I actually think they're kind of beautiful.

They're cute. Yeah.

It's an interesting kind of variation of skin. There's a lot of beautiful skin types. But dark spots generally are kind of the stigmata of doing bad things to your skin.


Or, in a lot of cases for many women, it's an unfortunate side effect of hormonal changes. Or in the case of melasma, it can be something that's related to pregnancy and can be very common in certain types of skin types. So, brown spots, we can laugh about it, but it's a cross for a lot of people to bear. I mean, it's an issue that has a lot of products in the pipeline and a lot of products currently in the market to treat it. Is anything perfect? Maybe. We'll get into that.


But, what is hyperpigmentation and spaces? Well, hyperpigmentation is the layer of the skin. Unless you're suffering from albinism or if you're an albino in which you don't have the cells, that's the genetic difference.


Each individual has a certain concentration of cells called melanocytes and they're in the layer of our skin that's an intermediate layer beneath the epidermis, in the dermis, and they function to protect our skin. They're actually kind of cool. What melanocytes do is in response to stimulation, they will expand and kind of spread out. And by doing so, they almost form this shield. It's like an amazing evolutionary protection that mother nature, God, has given us. And so oftentimes though, that system becomes dysfunctional in the situation of sun damage. Hormonal changes.

Right. Hormones, yeah.

So, if you've ever seen these really cool videos on like cuttlefish, which are these like little squid like things, or octopuses, you'll see them on the bottom of the ocean, they swim around and all of a sudden they change colors immediately. Those individuals, those creatures have developed a very rapid response, but melanocytic change in the body is a slower sort of response. Now, how do you see a melanocytic change in your body? Well, if you go out on a sunny day without wearing any sunblock, or even if you are wearing sunblock, the stimulation from the UVB and UVA/UVB radiation causes those cells to hypertrophy. They get bigger, they actually spread out. And, in doing so you get darker, this is where the color of a tan comes in.

Now, let's not mistake this with a spray tan. Now, a spray tan is actually completely different.

Right, its completely different.

The way spray tan works is actually pretty safe. Spray tans are great because they may not look great, sometimes you look like a carrot, but sometimes if it's done right, what it is, is, basically the same process that causes an apple to oxidize.


It's an amino acid that's very safe. You put it in the skin and in the exposure to air it turns brown. So it actually kind of creates this brown layer in the top layer of your skin, which is going to flake off and is already dead, the stratum corneum. Okay? That's the science behind that.

Now, melanocytes are actually deeper down and when they're overstimulated, they actually leave spots. You can get an area that has sun damage and you get this melanocytic reaction. When melanocytic reactions get really bad, that's when they turn into melanoma and that's really scary stuff.

Okay. And that's not good at all.

Melanoma is one of the scariest cancers out there. I mean, it's can be so aggressive. It can be so devastating. And one plug for early detection is that, if you catch a skin cancer in its earliest stages, the survival rates close to 99%, it's 98%. It's only if you let things go and, you don't check your skin on a regular basis and you let that weird looking mole go for too long, the longer it's there, the higher the risk and the lower the chance of survival.

Right. So I'll give you my personal experience I've had with my own melasma, which has not been fun at all. After I had my son, I, of course, I lived in Florida and I love the sun. I love the beach, I'm a sun worshiper, but I always use my sunscreen.

You don't move to Florida if you don't like the sun.

I was born in California and I live in Vegas.

Another sunny state. Sunshine. Yeah.

So everywhere I've lived, it's the trifecta of sunshine. Right? So I had my son, of course your hormone levels change.

And this is the basis of melasma.

Right. So even when...

And melasma, for those of you watching us on YouTube, it's called the mask of pregnancy, sometimes.

Pregnancy mask, is what they call it.

Yeah. And so where it lies is pigmentation that forms along the cheek and sometimes around the side of the eyes. And sometimes we see it in the T-zone up here in the forehead and it's really stubborn. Really, really, really stubborn.

Very hard to get rid of. So I got it a little bit on the cheeks, but it was almost like I had a mustache. It was awful. It went like all the way around here. I was even using a sunscreen, so it had nothing to do with not using the sunscreen. And I also, when I would go in the heat itself, I felt like it would flare up.

Well, it's a stress-related sort of change to the skin. And so, stress is kind of what happens with pregnancy and what happens after that baby comes, right?


There's a lot of stress there. Obviously there's a hormonal reaction that sensitizes the melanocytes, these pigment cells in the skin and that occurs in pregnancy. And that's why men don't suffer from melasma generally.

As often, right.

I haven't seen much of it.


Yeah. I mean, it can happen, but it's extraordinarily rare.

So what I did is I started on the Obagi Nu-Derm system.


And that's one of the main product lines that we carry [crosstalk 00:06:42] at Smazy and Smazy Academy.

Combination lines that came out that really kind of addressed this [crosstalk 00:06:47]

It works. It absolutely works. I literally was on it for a few years and it got rid of my melasma. I have zero. When I don't have makeup on you don't see it at all.

It's a victory. It's a victory.

It is a victory.

It takes time. It takes time.

It does take time and you have to stick with it. You have to always use a sunscreen and you have to...

Why the sunscreen? Well, you don't want to go out in the sun and sensitize that skin. So any stress, any free radical stress damage, body stress, sometimes even smoking may exacerbate it.


Any body stress can make the melasma worse. So the thing is, is that it'll come real quick and it takes quite a while for it to go away. And that's just those cells revving down after being irritated. So there's some things that can help, and Obagi created some products and one of them is the hydroquinone base.

Yes, there's the hydroquinone and then they also started, that was in the clear product, but now which requires a prescription because it's 4% hydroquinone, but now they have the Obagi Clear FX, which has alpha-arbutin, which is a skin lightener that you can get over the counter that actually works just as well, I feel. Not as fast, but if you're mixing it with the 2%, hydroquinone, then you can do that.

Well, hydroquinone's you got to be careful with it. It's a medical grade product and there's a reason why it's required to have a prescription for it. Because it can be toxic to the melanocytes. And so, it's really used for kind of corrective, short-term regimens and what they don't want is you going out and putting it on all the time forever and ever, because some people will do that. So it's one of those products that is restricted to a medical license that can prescribe. But the alternative...

Unless you get the 2%. You can use the 2% just over the counter and then mix that with the arbutin, which, people are getting great results with that.

The arbutin's very cool. That's a more modern way of kind of addressing this problem.


I think it's a little bit more gentle, wouldn't you say?

I think it's much more gentle. I would only go with the regular 4% that has RX required, if it's so intense and really extreme.

I mean, you could do the arbutin and the 2%, I think you'll a combination effect with that, but I think that once the melasma is gone, you've really got to protect your skin. When we treat melasma, we use some lasers, it's a wavelength of 19...

Yeah. Tell me about how you would treat it in the practice.

There's a laser called the thulium laser the one that we have as manufactured by Solta, and they made this device called a Clear and Brilliant. Really kind of, I call, lunchtime laser. And you come in, and the thulium laser really is targeted for these pigment cells and the right layer. And one of the things that we would put on, right afterwards, which is a great product after lasers, is a little bit hydroquinone and a little bit of C E Ferulic.

Of course. Yeah.

When we do these treatments it actually, even though it's a technically a non ablative laser where it doesn't leave the skin open and weeping, it's transiently open, which means that the Premea laser, and this is why they called it the Premea, it's a nice play on words, it makes the skin permeable for about a minute and a half. And in that time, once we're done with that treatment, we're able to put our products on, and that's usually C E Ferulic and a little bit of maybe some topical steroid. And then we also put some of the hydroquinone, the 4%.

And so, in our treatment protocols in office, when we're aggressively trying to reduce melasma, we'll work with that. It's been shown that if you use a post anti-inflammatory cream, like a C E Ferulic, after a treatment, it actually decreases the risk of recurrence and it speeds recovery from the treatment. Now, if you're not doing a laser treatment to clear it, the C E Ferulic combination, I think, one of the things I like, and it's a little bit more aggressive, it's a CE Ferulic in combination with another product, as well. And that may be your 4% or [crosstalk 00:10:44]

Or arbutin or you can use the 2%. So it totally depends upon how aggressive you want to go and how extreme your melasma is.

Sure. And some people don't tolerate hydroquinone. I have patients, they'll try it on and it actually causes the opposite effect. It causes hyperpigmentation sometimes.

It can.

So it can really inflame the skin. You've got to be careful, again, that's why it's a prescription based product. The arbutin's much safer, you'd see much less of that.

And we have so many over the counter products that you can try and at Smazy Academy we can help you choose the right product for your skin. We can do different Skypes with you, to where we can actually see what your skin looks like, and then help you pick the best product.

Yeah. At Smazy Academy, we're going to create as a kind of place where you can learn a little bit more and get a little bit deeper into these topics. And have a little bit of a one-on-one coaching to kind of figure out what's the right product for you. I think that, when it comes to melasma, it comes to hyperpigmentation, there's a lot of products out there. Smazy is going to walk you through it.


And not every single thing works for every single patient.

That's the thing. That's why we wanted to create this YouTube channel and Smazy Academy, because there's so information out there that's not geared directly towards your particular skin issues. And we want to be able to dive in one-on-one with you, to make sure that you're getting the right information for your skin.

Sure. This is awesome. So hyperpigmentation, you've got options and we're here for you.

We're here to help you.


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