Pigmentation is the change that ages a face fastest and gets treated last. Most people accept spots as inevitable, cover them, and never learn that they are among the more treatable things on the face. They are also the change that responds least to skincare, because the pigment sits deeper than anything topical reliably reaches.
Sam Assassa, MD is a member of the American Society for Laser Medicine and Surgery and has worked with energy based devices across three decades of practice in Los Angeles. He founded Beverly Hills Aesthetics in 1995 and is board certified in Internal Medicine.
What Causes Age Spots
Almost all of it is sun. Ultraviolet exposure stimulates the cells that produce melanin, and over years of accumulated exposure that production becomes uneven and localised, forming flat brown patches on the areas that got the most light: the face, the backs of the hands, the chest, and the shoulders.
They are called age spots because they appear with age, but age is not the cause. Time is simply how long the exposure has been accumulating. Two people the same age with different sun histories look nothing alike.
Genetics affects how readily you form them, and hormonal changes can drive a different kind of pigmentation that behaves differently.
Telling the Types Apart
Sun spots and age spots are flat, well defined, brown, and appear on sun exposed areas. They tend to have clear edges and they do not fade seasonally.
Melasma is different, and worth identifying because it is treated differently and is easier to make worse. It appears as larger, more diffuse patches with soft edges, usually across the cheeks, forehead, and upper lip. It is driven by hormones as much as by sun, so it commonly begins in pregnancy or with hormonal contraception, and it can worsen with heat as well as with light. Aggressive laser treatment can aggravate melasma rather than clearing it.
Post-inflammatory hyperpigmentation is darkening left behind after a spot, an injury, or an inflamed lesion resolves. It fades on its own over months and responds well to treatment.
Anything changing in size, shape, colour, or border is a different conversation entirely and should be assessed by a dermatologist rather than treated cosmetically.
Why Skincare Alone Rarely Clears Them
Topical agents work on the surface and on melanin production going forward. They can lighten pigmentation and they are genuinely useful for prevention and maintenance. What they do not do is remove pigment that has already settled into the deeper layers, which is why people plateau after a few months of a brightening serum and assume nothing works.
Treatment that reaches the pigment is what clears it. Skincare then keeps it from coming back.
How Pigmentation Is Treated
- Fractional CO2 laser resurfacing removes damaged tissue and delivers the most improvement per session, with recovery to plan around.
- Chemical peels lift the pigmented surface layers, with depth matched to your skin.
- Microneedling improves tone and texture with less pigmentary risk, which matters in deeper skin tones.
Skin type genuinely changes the recommendation here. Deeper skin tones carry a higher risk of post-inflammatory hyperpigmentation from ablative treatment, meaning the treatment can leave darkening worse than what you came in for. That is assessed before anything is scheduled rather than after.
Have Your Pigmentation Assessed in Beverly Hills
Dr. Assassa will identify which type of pigmentation you have, since sun damage and melasma respond to different approaches, and recommend a treatment depth appropriate to your skin. Request a consultation or schedule your appointment online.