Age spots, liver spots, or brown spots usually first appear on the face and are the result of genetic susceptibility as well as sun exposure. Contrary to common belief they have nothing to do with age or the liver although one may get more as they get older. In addition to the face, they often can occur on the chest, arms and any sun-exposed areas.

Brown spots or age spots do not respond to creams. They can safely and effectively be removed by a variety of laser treatments. The most effective treatment for brown spots on the face is the use of Q-switched lasers such as the Q-switched Alexandrite laser or the Q switched Nd-YAG laser. Often, one treatment is enough to eradicate brown spots safely and effectively anywhere on the body. Rarely a second touch up treatment will be necessary. Freckles on the face, chest, and back can also be effectively treated with the Q-switched Alexandrite of Nd:YAG lasers.

Intense pulsed light sources (IPL) or photofacials can also be used in treatment of brown spots or age spots. However, treatment with this modality often requires at least three to five sessions. This modality is not as effective as lasers.

Fractional Resurfacing with the Fraxel laser is also an effective treatment for brown spots for those individuals who additionally seek improvement in fine and moderate wrinkles, texture, pores, acne scars, and other skin imperfections.

Causes of Aging Skin

Research shows that there are, in fact, two distinct types of aging. Aging caused by the genes we inherit is called intrinsic (internal) aging. The other type of aging is known as extrinsic (external) aging and is caused by environmental factors, such as exposure to the sun’s rays.

Intrinsic Aging

Intrinsic aging, also known as the natural aging process, is a continuous process that normally begins in our mid-20s. Within the skin, collagen production slows, and elastin, the substance that enables skin to snap back into place, has a bit less spring. Dead skin cells do not shed as quickly and turnover of new skin cells may decrease slightly. While these changes usually begin in our 20s, the signs of intrinsic aging are typically not visible for decades. The signs of intrinsic aging are:

  • Fine wrinkles
  • Thin and transparent skin
  • Loss of underlying fat, leading to hollowed cheeks and eye sockets as well as noticeable loss of firmness on the hands and neck
  • Bones shrink away from the skin due to bone loss, which causes sagging skin
  • Dry skin that may itch
  • Inability to sweat sufficiently to cool the skin
  • Graying hair that eventually turns white
  • Hair loss
  • Unwanted hair
  • Nail plate thins, the half moons disappear, and ridges develop

Genes control how quickly the normal aging process unfolds. Some notice those first gray hairs in their 20s; others do not see graying until their 40s. People with Werner’s syndrome, a rare inherited condition that rapidly accelerates the normal aging process, usually appear elderly in their 30s. Their hair can gray and thin considerably in their teens. Cataracts may appear in their 20s. The average life expectancy for people with Werner’s syndrome is 46 years of age.

Extrinsic Aging

A number of extrinsic, or external, factors often act together with the normal aging process to prematurely age our skin. Most premature aging is caused by sun exposure. Other external factors that prematurely age our skin are repetitive facial expressions, gravity, sleeping positions, and smoking.

The Sun. Without protection from the sun’s rays, just a few minutes of exposure each day over the years can cause noticeable changes to the skin. Freckles, age spots, spider veins on the face, rough and leathery skin, fine wrinkles that disappear when stretched, loose skin, a blotchy complexion, actinic keratoses (thick wart-like, rough, reddish patches of skin), and skin cancer can all be traced to sun exposure.

“Photoaging” is the term dermatologists use to describe this type of aging caused by exposure to the sun’s rays. The amount of photoaging that develops depends on: 1) a person’s skin color and 2) their history of long-term or intense sun exposure. People with fair skin who have a history of sun exposure develop more signs of photoaging than those with dark skin. In the darkest skin, the signs of photoaging are usually limited to fine wrinkles and a mottled complexion.

Photoaging occurs over a period of years. With repeated exposure to the sun, the skin loses the ability to repair itself, and the damage accumulates. Scientific studies have shown that repeated ultraviolet (UV) exposure breaks down collagen and impairs the synthesis of new collagen. The sun also attacks our elastin. Sun-weakened skin ceases to spring back much earlier than skin protected from UV rays. Skin also becomes loose, wrinkled, and leathery much earlier with unprotected exposure to sunlight.

Sun Spot Laser Removal in NYC

Sun Spots, or Brown Spots, like their name implies, is a condition developed by overexposure to the sun. The darkened patches of skin can appear in a variety of shades depending on a patient’s skin type, age and amount of exposure. Also called actinic keratoses, liver spots or age spots can be mildly treated with strong topical medicine made with hydroquinone that works to bleach the spots and even out skin tone.

Lasers have been proven to most effectively treat sunspots. Unfortunately, they cannot be completely erased, but laser treatment can stimulate new melanin production that will exfoliate the out layers of the skin, bringing sunspots to the surface where the skin can naturally shed the old skin.

Lasers available to treat sunspots:

Q-Switched Alexandrite Laser– When the laser is shone on an area of skin, the irregular pigment absorbs the laser light. During absorption, the pigment is broken down and then shed by the body’s natural process.

Q-Switched Ruby Laser– Uses a wavelength with a similar technique to absorb the melanin. The laser is highly selective in targeting the pigmented cells that cause a discolored appearance. Fading has been clinically proven and tested as a safe and effective procedure for removing sunspots.

Nd:YAG Laser– Another Q-switched laser that’s known for its efficacy in removing sunspots. After the laser has been placed over the discolored skin and treatment is complete, the pigment will develop a white color and leave behind a small scab. After the skin continues its natural healing process and the scabs fall off, a slight red discoloration will remain but slowly fade and new skin with matching pigmentation to the rest of the undamaged face will take its place.

What Is Sun Damage?

Uneven pigmentation can result from the damaging effects of too much sun exposure. The skin increases the production of melanin, which creates a darker tone, which is why skin looks a darker brown shade from sun tanning. Melanin protects the deeper layers of the skin from sun damage, the darker the skin appears, the more protection it has against the sun.

The sun can also cause a permanent stretching or dilation of small blood vessels, which creates an uneven, reddish appearance.

Solar lentigines, more commonly known as age or liver spots, are flat spots of increased pigmentation that can appear as tan, brown, black or even gray. Spots usually appear in areas that are most exposed to the sun such as the face, hands, arms, and upper back.

Size varies depending on the level of sun exposure. This is typically found on older adults but can occur in younger people that spend an excessive amount of time in the sun.

Solar elastosis occurs when ultraviolet rays from the sun break down the skin’s connective tissue, collagen and elastin fibers within the dermis. The weakening of the skin’s dermis causes the skin to lose flexibility, leaving vertical creases deep wrinkles and loose sagging skin.

Solar keratoses also referred to as actinic, appear as rough, scaly raise patches found along the face, ears, lower arms, and hands. They range in color from pink, dark pink, light brown, or brown on fair-skinned people from overexposure of the sun. It is important to note, that although any skin damage will increase the chance of skin cancer, solar keratoses if left untreated can progress to a type of skin cancer known a squamous cell carcinoma.

Labial lentigo is a dark brown lesion that appears usually as a single spot on the lower lip after repeated sun exposure, however, it can appear anywhere along the lip’s surface.

Melasma occurs from a combination of overexposure to the sun and an increase in the female hormones, estrogen, and progesterone and typically appear on the cheeks, forehead, nose, and chin. Women with a darker skin complexion or those who take oral contraceptives, hormone therapy, or are pregnant are most susceptible to melasma.

Poikiloderma appears as irregular reddish-brown pigmentation characteristically underneath the chin, down the neck, over the collarbone and chest from too much sun exposure.

Lentigo maligna is a growth that appears most commonly along the face, hands or legs from overexposure to the sun. With increased sun exposure, the dark flat spot that develops will slowly darken and enlarge along the skin and may eventually develop into melanoma, a type of skin cancer that begins on the uppermost skin layer and works its way deeper into the skin’s layers.

Q-Switched Laser for sunspots (FAQ)

Although people with medium or dark complexions naturally have more melanin (skin protection) than people with light complexions, they can still experience sun damage. Irregular pigmentation and wrinkles can appear with age and sun exposure.

How can I tell the difference between age and liver spots from freckles?

Age or liver spots usually develop in large numbers, especially soon after repeated sun exposure and develop more often in advancing age. Freckles usually develop earlier in life and appear as red or light brown.

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