Sun damage treatment guide: brown spots, texture, and photodamage at med spas

Sun damage is one of the most common reasons patients seek med spa treatments — encompassing brown spots, rough texture, uneven tone, and early pre-cancerous changes. The right treatment depends on the type and depth of damage. Here's how to navigate the options.

Types of sun damage and what they are

Solar lentigines ("liver spots," "age spots"): Discrete, well-defined flat brown spots. These are not moles — they're localized concentrations of melanin from UV exposure. Common on the face, chest, and hands.

Diffuse hyperpigmentation / dyschromia: Uneven skin tone, mottled appearance, a mix of darker and lighter patches. Often the baseline "background" of sun damage on the face.

Actinic bronzing / overall darkening: The overall tanning effect of cumulative UV — the "weathered" appearance.

Telangiectasias (broken capillaries): Small visible red/pink blood vessels from UV damage and chronic flushing/rosacea. Not melanin-based; require vascular-targeting treatment.

Rough texture / actinic keratoses: Thickening of the skin from UV damage. Actinic keratoses (AK) are pre-malignant lesions — rough, scaly patches that should be evaluated by a dermatologist before cosmetic treatment.

Important: If you have lesions that are changing, bleeding, or look suspicious, see a dermatologist for evaluation before any cosmetic treatment.

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Treatment matching by damage type

Solar lentigines (discrete brown spots)

Best treatments:
IPL (Intense Pulsed Light) / BBL: The reference treatment for discrete solar lentigines. The broad-spectrum light targets melanin in the spots; the spots darken ("coffee grounds" effect), crust, and flake off within 7–14 days. Excellent for Fitzpatrick I–III.
Q-switched Nd:YAG (1064 nm): Effective for deeper lentigines; safe for Fitzpatrick III–IV.
Q-switched 532 nm (KTP): Targets superficial brown pigment; very effective but limited to lighter skin tones.
Fractional laser (1927 nm): Also addresses surface pigment; more gradual improvement.
Chemical peel (TCA or VI Peel): Effective for multiple lentigines combined with texture concerns.

Caution for darker skin tones (Fitzpatrick IV–VI): IPL/BBL can cause PIH in darker skin. Nd:YAG 1064 nm is safer; consultation with a provider experienced in treating darker skin is essential.

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Diffuse hyperpigmentation and uneven tone

Best treatments:
IPL/BBL series: A series of 3–5 treatments addresses diffuse tone unevenness better than single spot treatments
Fraxel Dual (1927 nm): Fractionated non-ablative resurfacing for both pigment and texture
MOXI: Gentler 1927 nm option; good for Fitzpatrick III–IV
Chemical peel series (glycolic or TCA): Accelerates turnover and reduces surface pigment
Combination: BBL + MOXI ("Forever Young" protocol): Popular combination; BBL addresses discrete spots and vascular, MOXI addresses broader texture and tone

At-home maintenance: Tretinoin + SPF 30+ are the most effective topicals for maintaining treatment results and preventing recurrence.

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Facial redness, telangiectasias, and vascular sun damage

Best treatments:
IPL/BBL (560 nm or vascular filters): Targets oxyhemoglobin in blood vessels; shrinks telangiectasias
Pulsed dye laser (PDL, 595 nm): More targeted vascular laser; highly effective for discrete blood vessels and diffuse redness
Nd:YAG 1064 nm: For larger or deeper vessels
V-beam: A specific PDL device used widely for facial redness

These are separate from melanin-based brown spots — both can be addressed in same IPL session with appropriate filters.

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Rough texture and early actinic changes

Best treatments:
Chemical peels (TCA or medium depth): Resurfacing removes thickened damaged skin
Fractional ablative CO2 or erbium: More significant resurfacing for rough, damaged texture
Fraxel Dual: Non-ablative option with 5–7 day downtime

For actinic keratoses specifically: See a dermatologist. AKs may be treated with liquid nitrogen (cryotherapy), topical Efudex (5-fluorouracil), or photodynamic therapy (PDT) — procedures done in dermatology offices, not cosmetic med spas.

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IPL/BBL in detail: the most-used sun damage treatment

IPL (Intense Pulsed Light) and BBL (BroadBand Light, Sciton's version) are the workhorses of sun damage treatment at med spas.

How it works: Broad-spectrum light pulses are absorbed by melanin (brown) and oxyhemoglobin (red), creating localized heating that destroys the target. The skin clears the debris over 7–14 days.

The "coffee grounds" effect: Brown spots appear to darken and look worse for 7–14 days post-treatment before flaking off. This is the expected treatment response — not a complication.

Sessions: 3–5 sessions for optimal clearing; single sessions improve but a series is needed for comprehensive results.

Maintenance: Annual or biannual IPL maintains results. Sun protection is essential to prevent new damage.

Contraindications:
Active tan (UV-stimulated melanin absorbs the light and can burn)
Melasma — IPL can worsen melasma by triggering melanocytes; this is a significant contraindication
Fitzpatrick IV–VI skin — significant PIH risk with standard settings; requires experienced provider and conservative settings

Cost: $300–$600 per session; $900–$2,500 for a series.

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The importance of SPF in treatment plans

All sun damage treatments will fail or partially reverse without consistent SPF use. UV exposure drives new melanin production and recurrence.

The protocol:
SPF 30+ broad spectrum, daily, even on cloudy days
Reapply every 2 hours with sun exposure
Physical (zinc oxide, titanium dioxide) sunscreens are often preferred post-treatment as chemical filters can cause more sensitization

This isn't optional — it's the reason some patients think their treatments "didn't work" when they see recurrence in 6 months without SPF compliance.

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Questions to ask before treatment

What type of sun damage am I presenting with — discrete spots, diffuse pigment, redness, or a mix?
What is my Fitzpatrick skin type, and is IPL appropriate for me?
Could any of my spots be melasma? (This changes the treatment approach)
Are there any lesions I should have evaluated by a dermatologist before cosmetic treatment?
What at-home skincare routine do you recommend to maintain my results?

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