Laser Correction for Pigmented Lesions

What is a Pigmented Lesion?

A benign pigmented lesion is caused by an abnormal production of melanin which makes it visible on the skins surface.  Solar lentigines, benign melanocytic Nevi and Seborrheic Keratoses are the most common lesions treated with our Alexandrite laser and they can typically be treated in 1-3 sessions of laser therapy, with minimal discomfort and downtime.

The Alexandrite laser pigmentation treatment is suitable for epidermal (outer layers of skin) benign lesions.  Potential skin cancers should be ruled out before treatment.  Suspected cancerous skin lesions should be pre-screened by your family doctor (often via skin biopsy) and then a referral to a plastic surgeon or dermatologist may be required.

How are benign lesions treated with laser therapy?

Laser treatment with the Alexandrite GentleLASE laser provides reduction in the appearance of superficial (epidermal) benign lesions. The concentrated beam of light is absorbed by the melanin – or pigment – within the lesion, causing the cells to increase in temperature which damages the cells so that the body naturally removes them. The pigment will appear to darken as the pigmented cells are lifted to the surface, which indicates that the lesion has responded well to the treatment. In some cases, a very light scab or micro-crust may form which is naturally shed from the skin after a week or two, and the pigmentation underneath will be significantly reduced and often can be almost completely eliminated.

Is this treatment right for my skin type?

Because this specific laser treatment targets the pigment of the skin, it is only recommended to be performed on skin types I-III on the Fitzpatrick scale. The Fitzpatrick scale is numerically based from I-VI, with I being the lightest colour skin type and VI the darkest.

Azure’s Alexandrite Laser Pigmented Lesion treatment provides the most benefit to patients with superficial (epidermis – outer layers of skin) benign pigmented lesions.  The ideal candidate for this treatment has a lighter skin type with darker brown superficial and benign (non-cancerous) lesions.

For general reddish pigmentation, including Rosacea, Ruddy skin, frequent flushing, red bumps and thread veins, Intense Pulse Light (IPL) treatments generally provide improvement in skin colour, tone and overall skin rejuvenation benefits.

For pre-cancerous lesions (Actinic Keratosis), PhotoDynamic therapy (combining Levulan topical drug and IPL) is usually recommended.

For deeper benign pigmentation, lighter / different colour lesions or darker skin types, the newest Q-switched laser technology may provide good results; however, at this point in time, this new and very expensive technology is not available in Northern BC.

For darker skin types, other treatments such as Clear + Brilliant are available to help reduce pigmentation and even out skin tone. Read our blog post on Clear + Brilliant HERE.

How many treatments will I need?

Everyone’s skin is different and 100% clearance may not always be achieved.  The course of treatment may require a number of treatments, occurring typically at four-week intervals.  The actual treatment time and number of treatments will be dependent on the condition being treated, the size of the area being treated and the skin’s reaction to the laser treatment. Many clients see a significant result after the first treatment but may have to return for up to three treatments (typically) to achieve their desired results.

What should I do prior to treatment?

Before treatment can begin, a laser technician will see you in a personalized and private consultation to make sure this treatment is right for you. Consultations may be completed in advance or, sometimes, on the same day as the first treatment at the discretion of your laser technician. Photographs will also be taken with AZURE’s high-quality facial scanner in colour as well as under UV light in order to better see where the lesions are and how well they have reacted to treatment.  Body photos are taken for lesions off of the face.

  • If you have a history of HSV (cold sores or herpes outbreaks) close to the area being treated, it is recommended that you take antiviral medication before the treatment.
  • Avoid self-tanners one week before treatment and unprotected sun exposure 4 – 6 weeks prior to treatment.  Use quality SPF 30+ daily on sun-exposed skin that is to be treated. TAN SKIN CANNOT BE TREATED due to possibility of hypopigmentation (white spots)!
  • If you have a history of hyperpigmentation, you may be prescribed topical agents to apply 4 weeks prior to treatment to prevent any hyperpigmentation.
  • You will need to discontinue any medications that may cause light hypersensitivity for a week before each treatment, such as antibiotics (minocycline, tetracycline, doxycycline) or Vitamin A compounds (Retin-A/Renova).
  • You may be asked to avoid taking aspirin, ibuprofen, or Aleve one week prior to treatment unless medically indicated as these medications can promote bruising.
  • You will be required to discontinue oral isotretinoin (accutane) for 6 months prior to treatment.
  • Laser treatments should be avoided if you are pregnant, have a history of seizures, healing problems or keloid formation, severe dermatitis or eczema (within the treatment area), active infections or open wounds in treated area, have a significant systemic illness, have a history of skin cancer or suspicious lesions, are hypersensitive to sunlight, take anticoagulants or medication that alters wound healing, have received gold therapy, or are experiencing cold sores / herpes outbreaks.
  • Laser treatments are safe for clients on oral contraceptives (birth control pill) or who are using hormone eluting IUD’s.

What can I expect at my first treatment?

At your laser pigment treatment appointment, your laser technician will bring you into the treatment room, where the specific spots of concern will be treated with the Alexandrite GentleLASE Laser. All personnel in the treatment room, including both technicians and clients, will wear protective eyewear to prevent the possibility of eye damage from the intense laser beam.

Test spots at several lower energy levels are typically completed in an inconspicuous site, when skin reaction may be a concern.  Your technician will need to determine a balance between lower energy settings to protect adjacent skin, and higher energy settings to get the most effective treatment level for the pigmented lesion(s).

Cooling is not used during treatment; however, cooling may be used pre-treatment and immediately post-treatment (patient directed chiller cooling) for additional patient comfort.

Your technician will use the laser handpiece to emit laser pulses directed at the area being treated, and the pigmentation in the lesion will absorb this energy.  Pulses are delivered in a linear fashion with no overlap between pulses (single pulse per spot).

You may hear a “Snap” during treatment.  The darker the lesion, the louder the “Snap”.  It is not uncommon to see a “Frosting” of the lesion.  Within 5–10 minutes of treatment the lesion will darken.  Erythematous flare, edema and hyperpigmentation will be evident around the treated pigmented lesions, but there should be no bruising. The pigmented lesion will typically form a micro crust.  Erythema and edema may be evident for several hours.

Aquaphor, aloe, bacitracin or even Vaseline is typically applied to keep the area moist until the crust falls off. The skin underneath will be pink, and there is a gradual return to normal skin color over time when the skin sheds the pigmentation in the next week or two. Treatment times can vary from 15 minutes to an hour, depending on the size and quantity of lesions being treated.

Does it hurt?

Laser energy settings for pigment correction are typically similar to those used for laser hair removal, and the sensation will be similar.  However, for optimal results, skin cooling is not used with the laser pigment treatment pulses.  Pre-cooling can be done for sensitive skin, and we typically provide patient directed Zimmer air cooling for treated areas immediately after the laser pulses for increased patient comfort.

Everyone has a different pain threshold, but generally clients often say it is slightly “spicy” or feels similar to the snap of a rubber band. Slight redness or localized swelling can occasionally occur, but this usually subsides within the first 24 hours of treatment.

Most clients do not require an anesthetic cream; however, topical freezing cream (such as Emla) can be purchased at a pharmacy and applied before the appointment to make treatment more comfortable. Be aware that using anesthetic cream is only safe on small areas and in small quantities.

What can I expect following my treatment?

Immediately following treatment, your laser technician will apply an aloe-based gel, or equivalent, to sooth and moisturize the skin.  Local swelling and redness may result from the treatment, but should not last longer than 48 hours.  Treated lesions will likely crust, then slough over the course of several days/weeks. Patients should not scratch or pick at crusts.

Laser treated skin is sensitized to sunlight.  Patients should use daily a broad-spectrum (UVA/UVB) sunscreen SPF 30 or greater before, during, and after the course of treatment.  Post-care with a sunscreen of at least 30 SPF is required to ensure the treated area stays protected and heals properly.

Avoidance of direct and indirect sun exposure for at least 2 weeks after the laser treatment is advisable.  Sun exposure after treatment may contribute to hyperpigmentation or other undesirable skin responses in the treated area.

Simple daily cleansing with a gentle, antibacterial cleanser and application of your sunscreen will aid the healing process. If the lesion crusts over or develops a scab, a moisturizing ointment may be used to keep the area hydrated until the crust falls off.

Side effects are very rare for this treatment but may include discomfort, bruising, swelling, scabs, hyper-pigmentation or hypo-pigmentation, scarring or lesion recurrence.

Choosing a Clinic for Laser Pigment Treatments:

When selecting a provider for laser treatments, give your decision the same level of care and scrutiny that you would for a medical procedure.  Even though it is non-surgical, laser pigment treatment is still a complex procedure that requires specific training, knowledge and skill to ensure safe treatment and effective results.  You’ll want to choose a provider with extensive experience and access to a well-trained physician for any potential questions or complications.  Typically, a plastic surgeon or dermatologist practice has the requisite training and experience for the best outcomes.  A reputable and experienced Laser provider who has access to other skin treatments will know what Lasers can do for your skin and what they can’t.  Each person is unique; therefore, at your initial consultation, your provider should address your concerns in a comprehensive, integrative manner.

Note that Azure Advanced Aesthetics is a physician owned and directed facility; therefore, all of our laser equipment is Health Canada approved, CSA approved, and registered with the College of Physicians and Surgeons of British Columbia to ensure the utmost in patient safety.