So what is it that will get rid of age spots on a permanent basis? Put simply, you need professionally overseen laser work, intense pulsed light, cryotherapy or a chemical peel of the right sort to deal with solar lentigines in a manner that is effective. But do not be under any illusion that nothing will ever reappear; UV rays are apt to rouse pigment cells once more. The aim should be a lasting clearance and some discipline when it comes to sun protection.
I am Finnian Ross and I write this from the vicinity of Fremantle in Western Australia where the sun has a way of turning a pleasant picnic into something like a billy on a campfire. Here I set out the ins and outs of age spot removal, what one can realistically expect and the practicalities that apply once you have been and gone from the clinic.
The Nature of Age Spots
For the most part they are flat brown marks put there by years of sun exposure. A doctor will refer to them as solar lentigines. You may hear them called liver spots but do not let the common name fool you, they have no connection with the liver.
They are found on the face, the upper chest, shoulders, forearms and the back of the hands. They are made up of an excess of melanin. While age is a factor, it is not the whole of it; time at the beach or on a boat, outdoor labour and the odd sunburn will see them make an earlier appearance.
Make a Diagnosis
A solar lentigo is normally flat and of an even colour with distinct borders. If a mark is irregular, very dark, crusting or bleeds, it could be a skin cancer or other matter entirely.
Before you consider cosmetic measures for an odd looking spot, put in for an assessment with a dermatologist or other qualified practitioner. To put a laser or peel to an undiagnosed lesion is to risk putting off a proper diagnosis. That is a poor trade for a better complexion.
Treatments With Staying Power
To remove an age spot for good one has to do away with the pigmented cells. The more robust choices are medical-grade peels, cryotherapy, IPL or BBL and laser treatment.
How well a treatment works is a matter of the device settings, the diagnosis, your skin type and what you do in the wake of the procedure. It might leave a spot clear for years but it will not inoculate the rest of the skin against UV.
| Treatment | Typical role | Downtime and the like |
|---|---|---|
| Picosecond / Q-switched laser | Concentrated brown pigment is the target | Some redness, crusting or temporary darkening is not uncommon; done in a specialist or medical clinic |
| IPL or BBL | Evening out tone and dealing with scattered sun damage | You will likely need to come back for a number of sessions; wrong settings and you can have burns or altered pigment |
| Ablative laser resurfacing | Broader damage is treated by removing layers of skin | Not for everyone, it involves more risk and downtime |
| Cryotherapy | Liquid nitrogen to freeze off a lesion | Good for an isolated mark and quick, though you may be left with a blister or a patch of discolouration |
| Chemical peel | Pigmented surface is shed | Professional opinion is key here, especially with darker skin; strength of the peel can vary |
| Prescription creams | Will slowly cut down on pigment | Hardly permanent and slower; can cause irritation and a rebound of pigment |
No two people are alike so there is no best dark spot remover to go round. The dermatologist will look at the mark and take into account scarring risk, medication and skin tone before making a recommendation.
Going in for Laser
When you have a couple of defined marks, laser is the fastest way to an improvement. Pico and Q-switched systems put energy into the pigment to break it up and let the body dispose of it. One might opt for a Q-switched Nd:YAG for instance. Picosecond units have very short pulses. What is best will hinge on the operator and whether the mark is truly a solar lentigo.
In practice
In practice it is said to feel like an elastic band snapping. The clinic will put on some topical anaesthetic or cooling. Afterward small crusts form and the spot may darken prior to fading.
Leave the crusts alone. Heed the wound-care advice and put off any skincare that might irritate until the barrier is sound. Freshly treated skin will smart at the wind or saltwater from a stroll on the coast, so plan your recovery accordingly rather than as if you have just come across a long weekend.
The Case for Ablative Lasers
This is a more involved procedure for texture, fine lines and wider sun damage as well as pigmentation, as it takes away controlled amounts of skin. There is also a higher risk of infection, scarring or post-inflammatory hyperpigmentation and redness that lingers. A solitary brown mark does not make this the automatic choice. One should enquire as to the qualifications of the practitioner, what is entailed by way of aftercare and sun restrictions, the downtime one can expect and the protocol should pigmentation reappear.
IPL And BBL For Widespread Damage
By means of broad bands of light as opposed to a single laser wavelength, IPL and BBL are capable of dealing with uneven redness, sun spots and freckles on the face, hands, chest or neck. The appeal of these modalities is that an appointment will see several areas attended to. Do not be surprised if a course is called for and results are not uniform; the flashes have a hot, sharp quality and the spots treated will in time darken and slough off.
Then again, IPL is not for all tanning histories or skin tones. A recent tan puts one at risk of burns and odd patches of colour. Put the practitioner in the picture on any use of self-tanners or medication, and any scarring from injury that has left its mark.
Freezing Peels And Skin Polishing
With cryotherapy a spot is frozen using liquid nitrogen. It is a fast procedure for a lesion or two but there can be some swelling, blistering, a change in colour or temporary soreness. Chemical peels will loosen or get rid of damaged cells on the surface with acids; microdermabrasion is a more physical polishing of the outermost layer. They might take away some of the dullness and uneven tone yet it would be disingenuous to present either as a permanent fix.
Choosing A Safer Option
While microdermabrasion is the milder of the two, it will not get at pigment residing deeper in the skin. A more vigorous peel risks post-inflammatory hyperpigmentation if the skin is predisposed to it or aftercare is wanting.
Find out who is doing the work, what device or acid is involved and how the clinic defines a complication. Get a sense of how many sessions are to be had. Make sure to put photographs on record before you start so you can measure your progress; memory is apt to be a drama queen.
Prescription Creams And Home Care
There are prescriptions for hydroquinone, tretinoin and retinoids which will put the brakes on melanin and promote cell turnover for a more even complexion. They are no match for a procedure when it comes to expediting the removal of a solar lentigo though, and they do their work in their own time.
Vitamin C, niacinamide and alpha arbutin are over-the-counter ways to a brighter look and are fine for mild hyperpigmentation or prevention. But be sceptical of any household product that is said to put an end to age spots for good.
Leave the lemon juice, bleach and undiluted essential oils alone. “Natural” carries no medical weight and such things can burn or irritate the skin, complicate pigmentation and render a later diagnosis difficult.
How Quickly Results Usually Appear
Those in a hurry to be done with age spots will be disappointed to find clear skin is not something that happens overnight. With laser, IPL or cryotherapy the pigment will often go darker before it recedes with healing. An isolated mark might be put right with a procedure but more extensive damage calls for a number of them. As for creams, weeks or months of regular application is the norm. A good clinician will set a realistic schedule and not sell you a miracle for your lunch hour.
Practical Clinic Planning
Factor in time for the consultation, consent, photography and the like. If you are having work done around the eyes or your vision is compromised by protective eyewear or swelling, put transport in place. It is unwise to book in on the eve of a road trip, a day at the beach or an outdoor function.
In Australia one should verify the accessibility, parking and public transport options, as well as after-hours contact, before parting with a deposit. Ask for a quote in Australian dollars as prices are all over the place depending on the clinic, the device and the scope of the treatment. Do not count on Medicare for anything cosmetic.
Can New Pigment Come Back
It can. What the treatment does is reduce or eliminate what is there, it does not undo years of UV exposure. So a spot may come back or new ones will make an appearance.
Patients have a habit of making up their minds in the first week. The skin is liable to be flaky, red or uneven as it heals. Or they will put themselves back in the elements unprotected once the old mark has gone.
How To Prevent A Repeat
The longevity of the result is down to sun protection. Put on a broad-spectrum sunscreen of 30 SPF or higher on any exposed skin and remember to reapply if you are swimming or perspiring. In a lab setting an SPF 30 will block some 96.7% of tested UVB. Out in the world, where people do not put on enough or cover every inch, the protection is less. The figure on the bottle is no force field.
- When the UV is running high, put on a wide brimmed hat and sunglasses, cover up with protective clothing and make for the shade.
- Be sure to reapply your sunscreen once you have been in the water or have had a good sweat or towelled off. Do not neglect the hands, ears and neck or the part in one’s hair.
- It is wise to keep an eye on any area you have treated; should a mark begin to bleed, crust, alter in some way or will not heal, have it assessed by a skin specialist.
One need only read the sun and solar UV guidance from the Australian Radiation Protection and Nuclear Safety Agency to be apprised of the safety advice Australia puts forward. In Fremantle or the Top End or the Pilbara, bright weather has a way of making you lose track of your UV exposure so this is relevant wherever you are.
Who Should Consider Treatment
An adult with diagnosed solar lentigines may find professional treatment preferable if the marks are an isolated, clearly defined nuisance and he or she would like to see results more quickly than skincare can offer.
But do not put cosmetic treatment on the agenda if there is an active infection, a recent tan, a lesion of unexplained change or a propensity for scarring; let a clinician who is qualified to do so have a look at you first. Those on photosensitising drugs or with strong actives in their skincare regimen should make that known ahead of time.
Frequently Asked Questions
Will anything truly do away with age spots?
Laser, IPL, BBL, cryotherapy and the right chemical peel will remove or all but fade confirmed solar lentigines. Do not expect it to be permanent as UV will bring about new pigmentation.
Is there a household remedy for brown age spots?
Nothing in the house has been shown to safely and permanently get rid of them. Lemon juice, vinegar, bicarbonate of soda or bleach are apt to burn or irritate. Get a diagnosis and use sunscreen.
So what is the number-one remover for dark spots?
There is no such thing as a universal product. A cream is no match for a laser or cryotherapy when it comes to an isolated spot. If you want something reliable to prevent and slowly improve matters, stick to a medically sound routine and your sunscreen rather than looking for a miracle in a bottle.
For a quick fix on brown age spots?
Make an appointment for a skin cancer assessment to start with. Provided they are solar lentigines a dermatologist or other practitioner might put you down for laser, IPL, BBL or cryotherapy. Leave the picking and scrubbing at home.
Are age spots an indication of liver trouble?
Not at all. “Liver spots” is just a moniker for solar lentigines. But any mark that is bleeding or changing is worthy of medical attention.
The sensible long-term view
To have age spots removed for good the answer is professional intervention of the laser, IPL, BBL or cryotherapy variety, or selected peels, with some prescription creams and niacinamide or vitamin C to aid in gradual improvement. And then you must be serious about sun protection. You cannot realistically expect to never have another brown spot. But with a proper diagnosis, aftercare and a hat that has not been blown inside out, you have the best of it.
