Depth · Diagnosis · CityLink Mall
Pigmentation is a description, not a diagnosis. At least six distinct conditions produce brown marks on an Asian face, they sit at different depths, and the laser that clears one of them reliably worsens another.
Melanin is manufactured by melanocytes at the base of the epidermis and handed to the keratinocytes above them. Where that transfer is excessive but orderly, and the pigment remains in the epidermis, the result is a sharply defined brown mark that turns over with the epidermis and responds comparatively readily. Where pigment cells sit in the dermis instead, or pigment has fallen into it, the result looks entirely different and behaves entirely differently.
Dermal pigment appears slate grey, blue-grey or muddy rather than brown. This is not a different pigment but a different optical path: light scattering through the overlying tissue shifts the apparent colour of deep melanin toward blue. The practical consequence is that colour is a usable clue to depth, and depth is the strongest single predictor of how a mark will respond and how many sessions it will take.
Fitzpatrick III to V skin carries a baseline melanocyte responsiveness that changes the risk calculation for every treatment. Any inflammatory or thermal insult — acne, eczema, a scratch, a peel, a laser pass with too much energy — can provoke melanin production and leave a mark of its own. This is why the same device that clears a lentigo in one session on fair skin is used more cautiously here, and why the least aggressive approach that works is generally the right one.
There is one more category that is not pigmentation at all. Seborrhoeic keratoses are benign epidermal growths that happen to be pigmented — raised, waxy, sometimes rough to the touch — and they are removed rather than lightened. Treating them as flat pigment with a toning laser accomplishes nothing and delays the correct treatment by months.
Types
Six diagnoses account for most facial pigmentation presenting in Singapore. They differ in onset, distribution, borders, colour and behaviour under sun exposure, and telling them apart is a clinical assessment rather than a device decision.
Pigmentation is what the patient sees. It is not a diagnosis, and treating it as one is how skin gets worse.
The Decision
The diagnosis is made before any device is chosen, because the correct treatment for one entity is the wrong treatment for another. A pigment laser that clears a solar lentigo cleanly will provoke rebound in melasma. A topical depigmenting regimen that works on epidermal pigment will do nothing whatever for Hori's naevus, which sits below its reach. A toning protocol applied to a seborrhoeic keratosis accomplishes nothing at all. Where more than one entity is present on the same face, which is the norm rather than the exception, each is treated on its own terms.
Sequence matters as much as selection. Active inflammation is settled first, because treating pigment on skin that is still producing it is unproductive. Vascular components are addressed before pigment where both are present, since redness misread as brownness leads to the wrong device. And where melasma coexists with anything else, the melasma sets the ceiling on how aggressive the whole plan can be — a face carrying both lentigines and melasma is treated with melasma-appropriate caution, not with lentigo-appropriate energy.
The realistic timeline differs sharply by entity. Epidermal pigment can improve substantially within a few sessions. Dermal pigmentation such as Hori's naevus routinely requires a year or more of spaced treatment, with transient darkening after each session and a genuine risk of post-inflammatory pigment in between — both of which are discussed before the first treatment rather than explained afterwards.
Continue
Atelier Aesthetics · Owned by AYA
1 Raffles Link, #B1-28, CityLink Mall, Singapore 039393 · +65 8023 7170
Book a Consultation