Discoloration & Pigmentation
Throughout history, one of the most universal and enduring ideals of beauty has been clear, evenly-toned skin. Dr. Rieder has treated hundreds of patients who have sought to even their complexion with exceptional results. One of the most critical things that people must remember when approaching pigmentation is remembering that clear, even toned often requires a chronic investment in sun protection.
There are many reasons for discoloration and unwanted pigmentation, and the first step that Dr. Rieder will do is obtain your history and make a firm diagnosis. This can typically be achieved in an initial consultation. In general, Dr. Rieder sees several conditions that result in unwanted pigment: sun damage and dark spots, melasma, dark circles, and discoloration due to medical conditions.
Sun Damage and Dark Spots
Sun damage and dark spots typically arise in adults with chronic exposure to the sun but might arise in younger patients whose skin leaves pigment behind after the resolution of inflammation of the skin (e.g. acne dark spots or eczema dark spots). Dr. Rieder’s approach focuses on eliminating any triggers, repairing your skin barrier with the use of customized skincare and/or prescription medications, meticulous use of sunscreen, and nearly always, in-office gentle and effective lasers or chemical peels. The most effective lasers for sun damage and dark spots tend to be fractionally ablative and non-ablative lasers such as Fraxel, LaseMD, and CO2 lasers. These lasers deliver precise, pinpoint columns of energy in a gridlike fashion to the skin. The result is a gentle exfoliation over the course of a week that results in improved skin tone and reduction/elimination of dark spots.
Dark Circles
Dark circles under the eyes are exceptionally common, but often develop for a complex set of reasons. Genetics, poor sleep, fluid shifts, changes in anatomy with age, thinning skin, and sun damage can all contribute to dark circles. This is a truly an area where an in-person examination is critical. In the office, Dr. Rieder will be able to provide the most accurate diagnosis – through multiple types of lighting with multiple directed eye movement. From there he will be able to provide the most comprehensive treatment recommendations. Treatments vary, but typically combination treatments are recommended. Lasers can be very helpful for removing pigmentation and the blueish discoloration of visible veins. At-home skin care can help to build collagen and constrict blood vessels. Soft tissue fillers, when used in precise quantities, can help restore volume to sunken eyes. Platelet rich plasma and fractionated lasers can help improve wrinkling – both mild and deep. If all non-invasive options have been exhausted or are unlikely to yield substantial improvements, Dr. Rieder will recommend plastic surgery (blepharoplasty).
Melasma
Melasma is one of the most common and challenging inflammatory conditions of the face. Typically occurring in women, and less commonly seen in men, melasma is characterized by brown patches of the face – typically the forehead, cheeks, and upper lip. However, melasma is an inflammatory condition that is fed by overgrown blood vessels as well, so people living with this condition might also notice redness of the face. Although melasma typically does not have symptoms, it is notorious for worsening with sunlight or with hormonal disruptions. Many women find that melasma will flare with oral contraceptives, a pregnancy, or with sunlight exposure.
The treatment of melasma critically relies on sun protection – which includes sunscreen and other over-the-counter topical products, sun protective clothing, and minimizing sun exposure. Dr. Rieder will recommend a customized combination protocol to his patients that will always involve over-the-counter topical preparations – both prescription and non-prescription, and may involve prescription oral medications as well as in office procedures such as chemical peels and lasers. This is a long term condition that can wax and wane, thus adherence to a treatment regimen with intermittent procedures to treat flares is often the best option.
