A Top Plastic Surgeon on Dark Spots (and How to Handle Them)

Written by: the Editors of goop


Updated on: March 12, 2020


“I joke that I hyperpigment if I even look at my skin the wrong way,” says Dr. Chaneve Jeanniton, a New York oculofacial plastic surgeon who personally struggles with melasma and postinflammatory hyperpigmentation, the lingering dark spots that result from an overproduction of melanin. “Dealing with hyperpigmentation is a marathon—not a sprint,” says Jeanniton. “You can’t fix it in a one-and-done fashion.” Her approach combines in-office treatments with support at home in the form of gentle cleansers, glycolic acid, and other active ingredients, along with the essential: daily sunscreen.

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Any skin tone can suffer hyperpigmentation, but skin of color has a higher risk, points out Jeanniton, who knows the challenges firsthand—but you wouldn’t know it from her glowy, even skin. “Back when I was a resident, I treated myself to a facial after wrapping up my annual exams—and ended up with dark blemishes after the extractions went wrong,” she says. “That was my intro to learning about active ingredients. I started a series of chemical peels to get my skin back.” Sunscreen is key for prevention and maintenance, she continues. “But it’s the combination of in-office and maintenance that gives you long-term results,” she adds.

Inside Jeanniton’s airy, renovated brownstone office on Brooklyn’s Prospect Park West, she treats all manner of dermatologic issues, but she specializes in oculofacial plastic surgery: nuanced refinements around the eyes. She’s also a pro at addressing hyperpigmentation concerns because it’s something she suffers from herself. The treatments—in-office chemical peels, microneedling, laser resurfacing—are essentially the same (more on that later) no matter what type of hyperpigmentation a patient has. “Depending on your skin, it can show up as photoaging—skin damage caused by the sun,” she says. “The upper layer of the skin protects itself from the sun’s ultraviolet rays by producing more melanin. This can leave you with uneven skin darkening that turns into solar lentigines, also called age spots or liver spots.”

Another variety, postinflammatory hyperpigmentation, involves lingering red or brown spots after an acne breakout or inflammation has healed. The more inflamed the breakout (like cystic acne, pustules, or red bumps), the darker the spot, she says. The darker the spot, the longer it typically takes to heal. It can also show up as melasma—symmetric, blotchy, hyperpigmented patches on the face, usually at the cheeks, bridge of the nose, forehead, chin, and upper lip, she says. “Melasma is one of the harder types to correct because it can affect the deep dermal layers,” says Jeanniton. “It affects women predominantly, because it’s tied to levels of estrogen and progesterone.” UV exposure and genetic predisposition seem to be the main factors in melasma, she adds, along with pregnancy, oral contraceptives, endocrine disorders, and hormonal treatments.

An At-Home Routine

Keeping skin looking healthy and doing your best to prevent hyperpigmentation (and keeping it from coming back) is a daily endeavor, Jeanniton says.

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    Daily Sunscreen

    “You can’t improve the skin if there’s continued UV exposure,” says Jeanniton. So wear sunscreen every day, she says, regardless of season or weather: “It’s the best way to prolong the benefits of in-office treatments that target hyperpigmentation.”

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    Incorporate Active Ingredients

    Jeanniton says that topical skin care is an effective adjunct to a hyperpigmentation-fighting routine. It primes skin to optimize the benefits of in-office and prescription treatments. Ingredients she likes include retinoic acid, arbutin, kojic acid, niacinamide, and azelaic acid.

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    Chemical Exfoliation

    “If you’re scrubbing your face with something that has rough, irregular edges, you can create microtears on your skin,” says Jeanniton. “Intense physical exfoliants can cause hyperpigmentation by inducing trauma and inflammation, with a higher risk for those with darker skin tones. So I prefer chemical exfoliation.” Glycolic acid is one of her favorite exfoliants for face: “It’s effective and well-tolerated when used correctly, and using it gives my patients brighter, more even skin over time.” If you’re sticking with a consistent skin-care regimen with clinical and prescription active ingredients and in-office treatments, six months is a realistic timeline to see a real improvement in your hyperpigmentation, Jeanniton says.

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    Thorough Cleansing

    “Given that environmental pollution can exacerbate melasma, make sure you properly cleanse your skin every night without stripping it,” says Jeanniton. She recommends gentle daily cleansers, like the calming rose-hip-infused one from her skin-care line epi.logic. The foaming option from Ursa Major, with its added alpha hydroxy acids, will keep skin clean as well as nourished.

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In-Office Options

The treatment approaches for hyperpigmentation—no matter what kind—are similar, Jeanniton says: stopping or preventing steps of the pigment-production process, breaking down deposited pigment, exfoliating to enhance turnover, and decreasing inflammation. There are a few differences, though. “In some cases, cryotherapy—freezing—is effective at removing solar lentigines, which are age and liver spots from sun damage. Lower-energy fractionated lasers can be particularly helpful in improving melasma, sun damage, and skin texture,” she says. “With the latter, you need to get treatments on a monthly basis for at least three months. We had one darker-skinned patient who signed up for a series of three treatments and finally saw the change she had been hoping for. She now skips foundation because she doesn’t have anything to cover up anymore.”

Not all in-office dark-spot-lightening treatments work for every skin tone, however. “Intense pulsed light is best for lighter skin tones,” says Jeanniton. “It’s an ideal treatment when there’s more contrast between the base skin color and the target blemish, meaning dark spots on fair skin are easier to treat. In darker-skinned patients, the skin surrounding the problem area absorbs some of the light, resulting in injury to the surrounding skin, which can then prompt postinflammatory hyperpigmentation.”

What not to use: a prescription drug called hydroquinone, which is a prescription depigmenting agent used to lighten dark spots. It can cause irritation, sun sensitivity, and in some cases, bluish-black or brown-grey hyperpigmentation on the surface of the skin (especially in darker skin), but the real risk is its potential toxicity. “While there are no reported cases of cancer from topical use in humans, there was evidence of carcinogenic activity in rodents who were orally exposed to hydroquinone,” says Jeanniton. (It’s banned in the EU, Japan, and Australia, but not here.)

Jeanniton recommends that anyone looking to treat hyperpigmentation get background on the provider’s experience. “Be specific with your questions,” she says. “Has the doctor treated this problem in patients with similar skin tones to yours? What preventive measures are being taken to minimize complications?” Jeanniton points out that whenever a laser is used on skin of color, it’s incredibly important to minimize redness and inflammation—any form of irritation can transform into hyperpigmentation and dark spots. This is where she brings in more conservative, common-sense parameters rather than the standard measures recommended by laser manufacturers. And, she adds, you should get a sense of the complication rate and protocols in case something unexpected does happen.