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I wanted to dedicate an entire section to this skin care condition because it is so often overlooked by patients and doctors alike. It is a condition of concern to many patients and a condition that can be so predictably improved and with the minimal intervention. This means use of only skin creams alone, occasionally adding medial peels.


I am a huge advocate of the treatment of skin pigmentation problems. This treatment is determined by the nature and the anatomy of your pigmentation. Pigmentation can be something you are born with, like freckles. It can be acquired and deeper, like the spots (melasma) of pregnancy or cancer drug use. Spots can be superficial and acquired through years of sun exposure or just the aging process. All these can be treated. All of these can get results with the cream program.


Most patients who present for treatment of pigmentation problems have sun-damaged skin. This effect is usually superficial with spots and blemishes or large areas of discolored skin. Since sun-damaged skin is usually superficial, it can virtually completely be cured. The other conditions of deeper pigmentation, such as those related to pregnancy, chemotherapy, or just present since birth can also be effectively treated. Virtually any condition of pigmentation of facial or non-facial skin can be improved by our program.


In your examination there are usually small discrete multiple spots, usually in groups. There can be larger blotches, which are usually lighter in color than spots but still darker than your surrounding skin. Large broad discolored areas can also be present. These areas are usually predictable, such as on the sun-exposed side of a driver’s face, areas of perfume application, around the eyes and cheeks, and so on.

Program Basics and Overview

This is the basic outline for treating pigmentation. It will be modified according to your expectations, history, anatomy and lifestyle.


  • Medical Peel. This is mostly to exfoliate and prepare the skin for better penetration of products. It also smoothes fine lines, tightens the skin, and removes some of the superficial pigmentation.
  • Begin the Products. This is the combination of Retin-A and hydroquinone that is highly customized to your skin and lifestyle and very effective at removing pigment.
  • Home Program. This will of course be necessary and customized
  • Repeat Peels. This may be helpful to accelerate the results and provide smoother skin.
  • Intensify and Customize Products. Depending on your motivations and skin condition we will constantly monitor the dosages of Retin-A and other products.
  • Maintenance. Once your results are obtained, you will only need to use the creams 2-3 times a week and maybe occasional peels.
  • Monitoring. We will examine you and review your results, expectations and program on a regular basis or as needed once in maintenance.

The specific products and protocols utilized for your skin pigmentation condition will depend on several factors such as the anatomy of your spots, your lifestyle, how quickly you want results, and your home program.


No matter what the issues are above, I will customize a program that will get you results. We will match your skin, lifestyle and expectations to the correct products and you can see results very quickly.

Skin Pigmentation Conditions That Can Be Treated
  • Freckles
  • Spots and blotches
  • Pigmentation from pregnancy (melasma)
  • Pigmentation from chemotherapy
  • Spots from inflammation or acne. Post Inflammatory Hyperpigmentation (PIH)
  • Sun spots
  • Age spots
Products and Protocols for Treating Skin Pigmentation
  • Exfoliating cleanser, toner, Vitamin C to prep
  • Hydroquinone 4% or customized up to 20%
  • Kojic and Azuleic acids as an option
  • Retin-A, if indicated, 0.025%, 0.05%, 0.1%, standard or micronized
  • Glycolic acid or medical peels to prepare the skin for better product penetration
  • Sun screens

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