We’ve come a long way from applying topical medications for our pigmentation. While these prescription creams do work, they often require a lot of patience and often only work for patients with mild pigmentation. Today, we have chemical peels and lasers that can treat even the most severe pigmentation with almost zero downtime.
But what works better for you? The answer to this will largely depend on your skin type, skin condition, preferred level of intensity and budget. Let’s look at the difference between the two.
A chemical peel utilises chemicals to improve the appearance of your skin. Generally, it works by gently removing the top layer of dead skin cells and pigmentation, allowing newer skin to grow through collagen remodelling. This newer generated skin is younger and smoother, rid of problems like wrinkles, comedones, acne scars and pigmentation. In Singapore, chemical peels are commonly used for acne and hyperpigmentation problems.
Chemical peels are often classified according to the depth they penetrate: superficial, medium, and deep. Each have different properties.
Superficial chemical peels reach only the epidermis layers of the skin, where surface exfoliation occurs. These chemical peels use AHA’s (glycolic, malic acid, lactic acid), BHA’s (salicylic acid) and light Jessner peels. Superficial peels are great for acne, hyperpigmentation from mild sun damage and fine lines.
Medium chemical peels exfoliate beyond the epidermis and penetrate the upper dermis or middle and outer layer of skin. Trichloroacetic acid (TCA), AHA’s, BHA’s and Jessner peels are usually used. Medium peels are suited for fine lines, mild acne scars and hyperpigmentation.
Deep chemical peels penetrate all the way down to the reticular dermis, completely removing the skin barrier. Extremely aggressive ingredients such as TCA in concentrated amounts and phenol are used. As deep chemical peels can result in serious side effects, they should only be performed by trained medical practitioners. Only one deep peel is recommended and recovery time can be long. However, deep chemical peels are soon to be obsolete as many lasers can now achieve the same results with less risk.
In theory, the deeper the chemical peel, the greater the skin resurfacing effects as not only can the powerful acids penetrate the skin, they can thoroughly remove damaged skin cells too. However, risks of side effects are way too high. For example, a deep chemical peel usually brings along severe discomfort and thus requires general anaesthesia. The immediate end result is often likened to a burn — think obvious peeling, redness and raw skin blistering with a downtime of 2-3 months. In addition, the risk of worsening hyperpigmentation is a lot higher.
In contrast, superficial chemical peels are a lot gentler with no obvious redness or downtime. Patients can even apply skincare and makeup right after! As such, I prefer using superficial chemical peels for pigmentation as they are capable of achieving obvious results without much risk. However, as chemical peels don’t penetrate and clear pigmentation as deeply as lasers. Occasionally, I like to combine superficial chemical peels with lasers to achieve synergistic results.
Lasers use different wavelengths of light to target varying skin concerns. In the case of hyperpigmentation, Q-switched and picosecond lasers are the superstars here due to their wavelengths and short pulse durations that are able to break apart melanin pigments in the dermis and epidermis.
In my practice, I’ve found pico lasers to be extremely effective for treating all sorts of pigmentation, including post-inflammatory hyperpigmentation. The picosecond laser beam produces a photoacoustic effect, shattering pigment effectively without causing damage on the skin. They also work well on various skin tones and come with no downtime. Fractional picosecond intensifies energy delivery even further, producing faster pigment clearance and additional skin rejuvenation effects.
At my clinic, I use the Discovery Pico Plus, Fractional Picosecond Laser, and Fractional Thulium Laser to treat pigmentation. You may read all about them here.
While lasers are effective, they are also highly operator-dependent; a skilled doctor who’s fully trained in operating the device is imperative. Lasers also have the potential to cause serious side effects like blindness and burns, so please take note to communicate any health issues you have to your doctor before consenting to the treatment.
More might not always be better — when performed too frequently, lasers can cause hyper- or hypo-pigmentation to develop or worsen. Weekly laser treatments are a huge no. I also always emphasize to my patients to apply sun protection before and after treatments to ensure the longevity of their laser treatments.
If your biggest concern is budget, then you ought to know that lasers are more expensive. However, you might require lesser treatment sessions as compared to chemical peels. Exactly how many sessions you’ll need respectively will depend on the pigmentation you have and its characteristics. I’d say find a doctor with a good track record, communicate any concerns, and let him/her advise what’s best.