8 minute read
Pesky Pigmentation
Two patients share their journey to peel away their facial pigmentation
Before you get excited about the end of winter and immediately bake your skin in the glorious summer sun,
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consider this. The sun’s ultraviolet light is the number one cause of accelerated ageing! As we will learn from 35-year-old Genta and 40-year-old Julia, taking care of your skin in the summer months with sunscreen and sun avoidance is integral to not only prevent nasty skin cancers, but to avoid premature wrinkles, sagging and pigment irregularities. They both suffer from melasma – a type of skin discolouration or pigmentation that is caused by a mix of hormones and years of poor sun care. Fed up with the way their skin looks, Genta and Julia sought the help of aesthetic practitioner Dr Lori Nigro to see if she could help.
The concerns
Genta and Julia had been suffering from their pigmentation for years, and had tried using numerous creams to help, with no resolve. Genta says, “I’ve had severe pigmentation since my second pregnancy… especially on my forehead. It must be 12 years that I haven’t liked my skin and people constantly ask me why it’s so bad, which is very uncomfortable – I just wanted people to stop feeling sorry for me.” As you will read on p.25, melasma is common in pregnancy and can be badly exacerbated by the sun. Julia has had similar issues, sharing, "I’m a little older now, so I have a few issues with my skin, but pigmentation is what really bothers me. I would say my wrinkles bother me 5/10 but my pigmentation is 20/10! I had been thinking about getting treatment for a while since nothing else had worked.”
The treatment experience
After an in-depth medical consultation, Dr Lori deemed that Genta and Julia could each benefit from a chemical peel treatment because they were looking for a simple, effective and safe treatment without pain. Her treatment of choice for both patients was called the mesoestetic dermamelan protocol. This is a treatment plan that involves preparing the skin at home for two weeks before having an in-clinic chemical peel, followed by an ongoing strict aftercare and maintenance skin regime. A chemical peel is a skin resurfacing procedure where a chemical solution is applied to remove the top layers of the skin. They are commonly used to treat or prevent wrinkles, address skin texture, improve acne and help pigmentation concerns. “This treatment plan was a really novel experience – I haven’t had anything like this before,” says Julia, adding that when she stopped all her usual skincare and started the pre-treatment regime (see pre- and post-treatment box) she noticed her skin started peeling a little bit by the end of the two-week preparation stage. This stage is important because it leads to a quicker and more predictable treatment response, with less shedding and redness, according to Dr Lori. Julia says that she experienced a bit of skin flaking and peeling at this stage, and Genta added that her skin felt a bit tingly at night.
Before After
Pre- and Post-treatment Care Protocol
Pre-chemical peel treatment
Morning
• Brightening Foam: a gentle cleanser with depigmentation action • Ultimate W+ Essence: a serum to initiate normalisation of pigment • Melan 130+ pigment control: a full spectrum sunscreen applied every two hours
Evening
• Brightening Foam • Brightening Peel Booster: a gentle preparatory peel with fruit acids • Ultimate W+ Essence: a serum to initiate normalisation of pigment
Post-chemical peel treatment
Morning
• mesoestetic Melan Recovery Cream: nourishing moisturiser to control dryness • Melan 130+ pigment control: every two hours
Evening
• Dermamelan home maintenance cream: a less concentrated form of the dermamelan mask, with the fully depigmentation stack of active ingredients, used for two to six months after treatment to refine the effect and help reduce pigment After Genta and Julia had each completed the pretreatment protocol, they had their chemical peel treatments with Dr Lori. It was important that they did not have any special occasions booked in for a couple of weeks following the treatment where skin peeling would be a problem. “My skin was cleansed and degreased and then Dr Lori applied the Dermamelan Treatment Mask. This didn’t really feel any different to a normal mask and was completely pain free,” Julia explains. Once the chemical peel was applied during a 45-minute in-clinic appointment, the patients were each instructed to go home and keep the mask on for four hours. The mask contains ingredients to remove the pigmentation and to regulate the cells that caused this pigmentation.
Both Genta and Julia commented that they each had an instant glow to their with improved texture when they washed off their masks. Genta says, “I felt quite beautiful immediately after removing the mask, like my skin was extremely clear! I was really excited – I thought if my skin looks so much better now, and I already have more beautiful skin, how will it look in a couple of months?” Two days after the in-clinic chemical peel treatment, Dr Lori encouraged each patient to start their post-treatment regime. This step is vital because it continues correction and re-establishes normal pigmentation. Sun protection is especially important as new UV overexposure will trigger new pigmentation. A successful corrective treatment needs to be followed up by meticulous prevention of future damage, according to Dr Lori. “This was a process that took time and effort every day and was quite time-consuming, but was bearable to get results,” Julia reflects, adding, “My skin tingled quite a lot when using the aftercare and I sometimes got a sharp tingling for a few seconds when applying it." About 10 days later, both patients started to experience skin peeling and significant dryness, which is to be expected, according to Dr Lori. Genta says, “My skin felt quite irritated, dry
Genta, 35
Before After
Julia, 40
and really itchy at night; I felt I needed to keep re-applying the post-treatment creams for relief. PPE/mask wearing for the pandemic made it more uncomfortable. But I just focused on the results – I focused on positive thoughts; nothing negative, always with a smile and it got better.” Gradually, Genta and Julia started to see improvements in their pigmentation and were instructed to continue their aftercare protocol for six months to maintain the progression of their results.
Radical results
After two months, both Genta and Julia have seen significant improvements in their melasma, skin clarity and texture and are thrilled with the results. Dr Lori confirms that usually the maximal result is achieved within two months of the peel, but measurable improvements continue to be noted up to six months following treatment. Genta says, “I think my results are amazing! When I look at my before picture, I just think my skin has come so far and the results are spectacular – I am so happy! This has changed the way I live and the way that people see me, not always seeing the marks. The most beautiful thing is that I have friends coming up to me saying things like ‘You’ve changed,’ or ‘What have you done?’ and even, “You look amazing, have you had toxin?!” Genta adds that she is delighted that her face no longer looks ‘dirty’, saying, “This has solved a problem I thought I couldn’t fix, and I would absolutely recommend this treatment to anyone with pigmentation concerns.”
For Julia, the real bonus is not having to feel like she has to wear makeup constantly. “I feel fantastic – 10 out of 10!” she says, adding, “My skin is very clear, my complexion looks healthier, and my dark spots are gone, which I never thought would happen! I think the problem has gone from 20/10 to 1/10. My husband has really noticed the difference, and my seven-year-old son told me he loves my skin!”
According to Julia, the whole treatment process has made her more aware of the importance of taking care of your skin. “I didn’t use sunscreen before and sometimes I wouldn’t even clean my face before I went to bed! Now I have this daily routine, I am much more careful about taking care of my skin as it’s had such an impact on my dayto-day life. I really think this treatment has been life changing!”
According to Dr Lori, the results should last longterm, and if Genta and Julia maintain their aftercare routines, they could expect a life-long improvement. Strict sun protection, with full spectrum sunscreen and clothing, should significantly slow ongoing photoageing, but trigger events such as pregnancy, or skin injury, may lead to further (treatable) hyperpigmentation.
Practitioner perspective
Chronic facial pigmentation has a severe impact on patients’ quality of life. I often hear people say they are asked ‘why they have a moustache’ when the upper lip is affected or told ‘your face looks dirty,’ by well-meaning observers. Treating pigmentation, specifically melasma, can be difficult and it’s important patients are compliant to the prescribed protocol for successful results. Genta and Julia had excellent compliance and enthusiasm, allowing them to have a fantastic clearance of their pigmentation and improvement in skin luminosity following the chemical peel. Sun protection is crucial for preventing pigmentation and maintaining the treatment results. Once pigment producing cells (called melanocytes) are damaged by the sun, pigment production (called melanogenesis) becomes unbalanced, and pigmentation becomes visible on the surface of the skin. Over a patient’s lifetime, the damage becomes cumulative. Sun damage + melasma + inflammation + chronological ageing = ever worsening pigmentation. A treatment such as a chemical peel, along with a carefully constructed pre-and post-procedure protocol can allow patients of all skin colours to go makeup free and feel confident again in a short time frame. In my clinic, this treatment costs from £1,200.
Dr Lori Nigro,
aesthetic practitioner, 10 Harley St in London, Desenzano & Johannesburg
