Uneven Skin Tone

What is skin tone?

Skin tone is a fascinating study in environmentally engineered evolution. There is a direct correlation between skin type and UV exposure. If your ancestors spent a lot of time in a warm climate with plenty of sunshine you will have darker skin. If your heritage hails from further north where people were bundled up and it was cloudy then you will have lighter skin. Darker skin types naturally provide more protection from the sun. Cool, right?

Skin pigment is primarily controlled by melanocytes, a type of cell that is responsible for melanin production (skin pigment). Lighter skin individuals typically have a more reddish/bluish hue to their skin due to the lack of pigment hiding their underlying blood vessels and capillaries. This is also why when blood vessels dilate, maybe from exercise or embarrassment, light skinned people develop a subtle (or not so subtle) blush.

The skin has three main layers. From top to bottom: the epidermis, the dermis, and the hypodermis. The epidermis is our waterproof barrier and contains the cells for skin tone. The dermis lies beneath and contains hair follicles, sweat glands, and connective tissue. The hypodermis is the deepest layer, and contains fat and connective tissue.

What causes skin tone to become uneven?

Uneven skin tone is generally caused by disproportionate amounts of melanin (skin pigment) although abnormal vasculature can darken skin. The underlying cause of uneven skin tone can be genetic, or tone discrepancies can develop over time due to environmental exposures (like sunlight) or injury. When there is excess melanin skin becomes hyperpigmented (darker), and if there is not enough melanin skin is hypopigmented (lighter).

What are the main concerns related to uneven skin tone?

Uneven skin tone can be classified in multiple ways depending on the underlying cause. A general overview is outlined below:

• Broken Capillaries: Capillaries are the tiniest blood vessels in your body. They are where arteries carrying oxygenated blood and veins carrying away deoxygenated blood pool. Little breaks and leakages in this pooling area can create the appearance of broken blood vessels at the skin surface.
• Freckles: Freckles are clusters of hyperpigmented (darker) areas of skin. They can be genetic or develop with sun exposure. They are more noticeable in lighter skinned people.
• Liver Spots (a.k.a. Age Spots or Sun Spots): These are a type of lentigines similar to freckles. They usually appear on skin that has spent years soaking up the sun (hands, face, shoulders, upper chest). They are more common in fair skinned, light haired, and light eyed individuals.
• Post-Inflammatory Hyperpigmentation: This is a hypermelanosis (excessive melanin or skin pigment) reaction to a previous skin injury that more commonly occurs in people with darker skin tones.

Who may wish to seek treatment for uneven skin tone?

Your skin is a protective wrap around your entire body, and it is the first line of defense against rain, wind, sunlight, injury, germs, and any number of things that bombard us throughout the day. It’s not really that surprising then that the skin accumulates some damage over time. Men and women of any age may experience undesirable skin tone due to genetics or damage, and, therefore, wish to seek treatment for uneven skin tone.

How can someone treat broken capillaries?

Broken capillaries are caused by vascular abnormalities. Vein Treatments, Laser Skin Resurfacing, and Topical Medications are good options to improve skin appearance and smoothness.

• Sclerotherapy: A Vein Treatment can improve the appearance of broken capillaries/spider veins by essentially stopping blood flow through the blood vessels and encouraging the body to resorb the tissues.
• Laser Skin Resurfacing: IPL, excel® V, LED Light Therapy, Halo™, or Pulsed Dye Laser cause damage to offending soft tissues encouraging the body to remove and heal the area.
• Topical Medication: Tretinoin can help treat and prevent broken capillaries by altering the way the body handles damaged skin and promoting healing processes.

How can someone treat freckles?

Laser Skin Resurfacing, Microdermabrasion, and Topical Medications can be used to lighten the appearance of freckles.

• Laser Skin Resurfacing: Procedures like IPL and Halo™ can stimulate the body to remove and heal areas of hyperpigmentation.
• Microdermabrasion: Techniques like Crystal Microdermabrasion and Diamond Tip Microdermabrasion basically remove the top or layer of skin revealing healthier tissues and encouraging healing.
• Topical Medications: Tretinoin and hydroquinone alter skin cell formation, destruction, and the production of the skin pigment.

How can someone treat liver spots or post inflammatory hyperpigmentation?

In the case of lentigines like liver spots, sun spots, and age spots techniques like Chemical Peels, Laser Skin Resurfacing, Dermabrasion, Microdermabrasion, Plasma Skin Resurfacing, and Topical Medications can all be utilized to encourage removal of damaged skin cells and formation of new, healthy cells. These same techniques can also be used to treat post inflammatory hyperpigmentation.

• Chemical Peels: Such as Superficial Chemical Peels (Glycolic Peel, Salicylic Acid Peel, Jessner’s Peel), Medium Depth Chemical Peel (ViPeel, TCA Peel), and Deep Chemical Peels (Croton Oil Peel and Phenol Peel) can be utilized to rejuvenate skin appearance. The depth of the procedure will be determined by an individual's needs.
• Dermabrasion and Microdermabrasion: Crystal Microdermabrasion and Diamond Tip Microdermabrasion are used to remove damaged skin and encourage new skin formation.
• Laser Skin Resurfacing: Can promote new skin growth and remove damaged skin via an ablative or non ablative procedure. Ablative Non-Fractional Laser Skin Resurfacing, Ablative Fractional Laser Skin Resurfacing, Ablative CO2 Laser, Ablative Erbium Laser, CO2RE, Fraxel Repair, SmartSkin, Pixel CO2, Icon 2940, Deka Dot, Pearl Laser, Profractional Laser Therapy, and Fraxis Duo. Non-Ablative Non-Fractional Laser Skin Resurfacing, Non-Ablative Fractional Laser Skin Resurfacing, Clear + Brilliant, IPL, and Pulsed Dye Laser. Halo™ is an effective Hybrid Fractional Laser.
• Plasma Skin Resurfacing: These procedures do not use lasers, rather they force nitrogen into deep tissues to promote collagen production.
• Topical Medications: Hydroquinone and Tretinoin can enhance cell growth and renewal to restore skin.

For a comprehensive overview of all of the treatment options outlined above, check out our complete guide to Even Skin Tone Solutions.