PigmentationWhat it is, and what we can do about it.

Why the type matters more than the treatment

Pigmentation is one of the few skin concerns where getting the diagnosis wrong does not just waste money, it can actively make things worse. Two brown patches on two cheeks can look almost identical and need opposite approaches. So before anything else, this page is about telling them apart.

All pigmentation comes down to melanin, the pigment made by melanocytes in the base of the epidermis. Melanin exists to absorb ultraviolet radiation and protect the cells beneath. The problem is not that your skin makes melanin, it is that it makes it unevenly, in the wrong places, or in response to things that should not provoke it.

The main types

Solar lentigines (sun spots or age spots) are discrete, flat, well-defined brown marks that appear on the areas that get the most sun: the cheeks, the backs of the hands, the chest and shoulders. They are the result of cumulative ultraviolet exposure, they sit relatively superficially, and they generally respond well to light-based treatment.

Post-inflammatory hyperpigmentation is the flat brown or grey mark left behind after the skin has been inflamed. Acne is the most common cause, but eczema, a burn, a scratch, waxing or an over-aggressive treatment can all do it. It fades on its own, but slowly, and it can be accelerated. It is much more common and more persistent in richer skin tones.

Melasma is a symmetrical, patchy pigmentation typically across the cheeks, forehead and upper lip that is influenced by hormones and by heat as well as ultraviolet light. It behaves differently from everything else here and can be worsened by exactly the treatments that clear sun spots. We give it its own page for that reason.

Freckles (ephelides) are genetically determined, darken with sun exposure and fade in winter. They are entirely benign, and treating them is a personal preference rather than a clinical need.

What actually drives it

Ultraviolet exposure is the dominant factor for most people, and it accumulates from ordinary daily life rather than from beach holidays. Visible light and infrared heat also contribute, particularly for deeper pigment. Inflammation of any kind can trigger pigment deposition, which is why picking at a spot reliably leaves a mark that outlasts the spot by months. Hormonal change is a major driver for some people, and certain medications increase how reactive your skin is to light.

How we assess and treat it

The assessment comes first: what type of pigmentation this is, how deep it sits, what your skin type is, what your history of pigment response looks like, and whether anything about a specific lesion needs medical review before we touch it. That last check is not optional.

BBL broadband light is our primary tool for sun-induced pigmentation. The light is absorbed by melanin in the pigmented areas, which are then cleared by the skin over the following days.

Medical-grade peels work by accelerating turnover of pigmented cells and, depending on the formulation, by interrupting melanin production. They are useful across several pigmentation types and are often the safer first choice in richly pigmented skin.

Microneedling improves overall tone and, importantly, helps deliver topical actives more effectively.

CO2 laser resurfacing is the most intensive option and is reserved for cases where pigmentation sits alongside significant texture and sun damage.

Hollywood Carbon Peel suits congested, uneven skin where tone and texture are both concerns.

Whichever route we take, the maintenance conversation is part of the treatment rather than an afterthought. Pigment-prone skin that is not protected daily will simply repigment, and we would rather be honest about that before you spend anything.