A Knoxville nurse on how brown spots form, what laser treatment does to them, and why a new or changing spot sees a dermatologist before any treatment.
By Sarah Hitchcox, RN, BSN
Most of the sun spot questions I get start the same way. A woman is washing her face or putting on makeup, and she notices a brown spot on her cheek she doesn’t remember. Or she looks down at her hands on the steering wheel and sees spots that look like her mother’s. She isn’t upset. She just wants to know what it is and whether anything takes it off.
I’m a registered nurse, and I own an aesthetics practice with offices in Knoxville and Farragut. Here is how I answer that question in the room.
Where the spots come from
Sun spots and age spots are the same thing. They’re flat brown spots where the skin made extra pigment after years of sun. They show up on the places that get the most light: the face, the backs of the hands, the chest, and the shoulders. Freckles are smaller spots of the same pigment.
The spot you notice at forty or fifty usually isn’t from last summer. It’s the sum of every summer. That’s why people who have been careful for the last ten years still get them. The skin keeps a long memory. They can also be hormonally driven and worsen with age in some patients.
What a laser actually does
A laser for pigment sends short pulses of light into the spot. The brown pigment absorbs that light and breaks into tiny pieces. The skin around the spot doesn’t absorb much, so it’s left alone. Over the next few weeks your body clears the broken-up pigment on its own, and the spot lightens.
That’s different from creams, which work on the top layer of skin and can take months to show much. Chemical peels work faster and can show reduced pigment in as little as a week, but the laser goes to the pigment itself.
A session takes about twenty to thirty minutes. Most people feel a quick snap with each pulse. Right after, the area can look a little pink. Then comes the part I warn everyone about: for a few days the spots look darker. That’s expected. It means the pigment is breaking up. Over the next one to two weeks the darkened spots flake off or fade.
Most people need a series, usually three to five sessions about four weeks apart, and the plan depends on the spot and the skin. We treat the face, the hands, the chest, and the back, and each area gets its own plan. If you want to read how I describe it on my own site, the page on laser treatment for sun spots and age spots in Knoxville covers the same ground.
The spot I won’t treat
This part matters more than the laser. A laser fades pigment. It can’t tell you what the spot is. So before I treat anything, I want to know it’s an ordinary sun spot and not something that needs a diagnosis.
A spot goes to a dermatologist first, before any laser or peel or cream, when it’s new and you can’t explain it, when it has changed in size, shape, or color, when it has more than one color in it, when the edge is ragged, when it’s raised, or when it itches, bleeds, or crusts. Any one of those is reason enough. A dermatologist can examine it properly and biopsy it if there’s any doubt. I can’t do that, and I don’t pretend to.
Lasering a spot that needs a biopsy would be worse than useless. It would lighten the very thing a doctor needs to see. So if I’m not sure, I say so, and I’d rather lose the appointment than guess. Early on I was too quick to talk about the laser before I’d asked how long a spot had been there and whether it had changed. Now that question comes first.
A client I’ll call Denise came in about her hands. One spot on the left hand was larger and darker than the rest, with an uneven edge. I sent her to a dermatologist before we did anything, and I told her the laser would still be here afterward. That’s the order it has to go in.
If a dermatologist has already looked and told you it’s benign sun damage, bring that with you. It makes the consult simple.
What to expect in the room
The consult is free. I look at the spots, ask about your sun history, and tell you honestly whether the laser is the right tool for them. Sometimes it isn’t, and I’ll say so.
The treatment room is plain. A white chair, a gold tray on a stand, the laser in the corner. Nothing about it is dramatic. You can go back to work afterward, and the darker spots can be covered with makeup if you’d rather not explain them.
Keeping the spots from coming back
Sun made the spots, and sun makes new ones. The laser treats the pigment that’s there. It doesn’t change what your skin will do next July. So after a series I ask for two things: a broad-spectrum sunscreen every morning, including the backs of the hands, and a hat on long days outside. Reapply when you’re out for hours. Driving counts, because the window doesn’t stop everything. The hands are the ones people forget. They put sunscreen on their face, then wash it off their hands at the kitchen sink ten minutes later.
Skincare matters too for anyone with pigment concerns. I want every one of these patients using a good quality vitamin C, a retinol, something with glycolic or lactic acid, and a mineral SPF every day.
Wanting the backs of your hands to match the rest of you is a reasonable thing to ask for. It’s about looking presentable, which is different from an intense focus on appearance. Just ask in the right order. Anything in doubt goes to a dermatologist. The ordinary spots can come to me.