Removing age spots and sun spots: face, hands and décolleté
Age spots and sun spots, known medically as lentigines, are the most visible trace of years of sun. They sit where the skin receives the most light: on the face, the backs of the hands, the décolleté and the shoulders. This page explains how to tell them apart from other spots, when a dermatologist should take a look first and which technique suits which area and which skin type.
The SIACSKIN devices featured are the DERMAFORCE BBL PRO for whole areas, the PICOLO XL and the PICOLO L for individual spots, the non-ablative TULIX and the Skin Analyzer Pro for skin analysis. Also covered: procedure, healing, sessions and sun protection.
What are age spots (lentigines) and why do they appear on the face, hands and décolleté?
Age spots are benign, sharply demarcated brown spots caused by UV exposure accumulated over years, not by age itself. At this site in the epidermis the pigment-forming cells multiply and permanently release more melanin. That is why the spots sit where the skin receives light throughout life: forehead, cheeks, backs of the hands, forearms, décolleté and shoulders. Unlike freckles, they do not fade in winter.
Because the pigment lies superficially, age spots respond well to light and laser. For many spots across an area there is the DERMAFORCE BBL PRO, which lists sun damage and hyperpigmentation among its applications. You treat individual spots in a targeted way with the PICOLO XL or the PICOLO L.
How do I recognise an age spot and when should a dermatologist look at it first?
A typical age spot is flat, evenly light to medium brown, clearly demarcated and hardly changes over months. Any spot that is out of the ordinary belongs with a dermatologist: several shades of colour, a jagged or blurred border, rapid growth, itching, bleeding or a raised, rough surface. This also applies to a single spot that is noticeably darker than all the others. The reason: a laser removes pigment, it does not examine tissue. If a suspicious spot is lightened, later assessment becomes more difficult.
In the studio, the Skin Analyzer Pro helps to assess the skin appearance. It captures the skin with white light, UV and polarised light and evaluates pigment using AI. This does not replace a medical diagnosis.
What is the difference between age spots, seborrhoeic keratoses and moles?
Age spots are flat pigment spots in the epidermis, seborrhoeic keratoses are raised, keratinised growths, and moles are nests of pigment cells that have often been present since youth. That determines the treatment. An age spot can be lightened with light or a pigment laser. A seborrhoeic keratosis feels rough and as if stuck on, a pigment laser is not enough here, and it is removed by a doctor. Moles are not lasered for cosmetic purposes. They belong under medical supervision and, if necessary, are excised and examined.
For true age spots, the DERMAFORCE BBL PRO is suitable for whole areas and the 532 nm wavelength on the PICOLO L or the PICOLO XL for individual spots. Both PICOLO lasers list age spots as an application.
Age spots on the face: what suits individual spots and what suits many small ones?
Individual, clearly outlined spots are treated precisely with a short-pulsed pigment laser, whereas many small spots with an uneven skin tone are better treated over the whole area with light. With the laser, a small spot size hits only the age spot, the surrounding skin remains untouched, and 1 to 3 sessions are usually enough. If the cheeks and forehead are blotchy overall, with redness and fine thread veins as well, working point by point would produce a patchy appearance. Here a light treatment evens out the whole area.
The PICOLO XL and the PICOLO L have spots of 2 to 10 mm and 532 nm for superficial pigment. The DERMAFORCE BBL PRO works with 400 to 800 nm and 9 filters and is intended for skin types I to IV. Many studios combine the two: first the area, then the stubborn remnants.
How can age spots on the hands be removed and what is different about the back of the hand?
Age spots on the back of the hand respond well to light and pigment lasers, but need more cautious settings and more patience than on the face. The skin there is thin, has few sebaceous glands and a poorer blood supply, so it renews itself more slowly. The darkened spots usually only come away after 2 to 3 weeks. Less energy is used and, if in doubt, one more session is preferable. Because hands are constantly washed and exposed to the sun, the aftercare determines the result.
For narrow areas such as the back of the hand, the DERMAFORCE BBL PRO has a spot of 30 × 12 mm. You follow up on individual dark spots with the PICOLO L. For daily care, SIACSKIN offers the Hand Cream Aloe.
Which treatment suits sun spots on the décolleté and shoulders?
On the décolleté and shoulders, treating the whole area with light or a non-ablative fractional laser is more suitable than lasering individual points. There are seldom single spots there, but rather a pattern of many brown speckles, redness and pale areas in between. The skin on the décolleté is thin and does not forgive too much energy, so lower settings than on the face and a healing time of 2 to 3 weeks apply. On the shoulders there are often large, star-shaped spots following sunburn, which need more than one session.
The DERMAFORCE BBL PRO covers large areas with the 45 × 15 mm spot. For darker skin types or skin that is also crepey, the TULIX is the alternative, and it lists sun damage and age spots among its applications.
Which wavelength removes age spots best: 532 nm, 755 nm or 1064 nm?
For light to medium brown age spots on fair skin, 532 nm is usually the most effective wavelength, because melanin absorbs green light very strongly and it hardly penetrates deeper than the epidermis. The 755 nm wavelength is also well absorbed by melanin, reaches somewhat deeper and places less strain on the fine vessels. That helps with darker spots and lightly pigmented skin. The 1064 nm wavelength is absorbed the most weakly and penetrates the deepest. It is the choice for darker skin types, but needs more sessions for pale spots.
The PICOLO XL offers all three wavelengths plus 1320 nm. The PICOLO L works with 532 nm and 1064 nm and thus covers the two most common cases.
What can a non-ablative thulium laser do for many fine sun spots and dull skin?
A non-ablative thulium laser renews the epidermis over the whole area and in doing so lightens many fine sun spots at once, instead of removing individual points. The 1927 nm wavelength is absorbed by the water in the epidermis. Microscopically fine zones are created through which pigmented cells are shed in the days that follow: the skin feels rough, flakes finely and afterwards looks more even and fresher. The usual course is 3 to 5 sessions at intervals of around 4 weeks. Pronounced, dark individual spots respond faster to a pigment laser.
The TULIX from SIACSKIN combines 1927 nm thulium with 1550 nm erbium glass, lists sun damage and age spots among its applications and is specified for all skin types. Downtime is short.
Which technique for age spots suits which skin type from I to VI?
For skin types I to III, light and 532 nm are suitable, for type IV cautiously dosed light or longer wavelengths, and for types V and VI only 1064 nm at low energy or a non-ablative fractional laser. The darker the skin, the more melanin lies around the spot and the more likely it is that the energy will also hit the healthy skin. There is then a risk of dark borders or pale areas that are more conspicuous than the spot was before. In dark skin, moreover, brown spots are often not age spots, and the cause should be clarified beforehand. A test patch is mandatory from type IV upwards.
The DERMAFORCE BBL PRO is intended for skin types I to IV. The PICOLO XL and the PICOLO L offer 532 nm and 1064 nm, and the TULIX is specified for all skin types.
What happens during age spot removal and what does the pulse feel like?
For individual spots the treatment takes only a few minutes: cleanse the skin, assess and photograph the spot, put on protective eyewear, give a test pulse, then the spot is covered pulse by pulse. With a pigment laser, each pulse feels like a short, hot pinprick, and with light treatment more like a warm flick. A numbing cream is seldom necessary for individual spots. When hit correctly, the spot immediately turns greyish white or slightly darker, and the surrounding skin reddens a little. The area is then cooled and sun protection applied.
With the PICOLO XL and the PICOLO L, the SIA AI sets the parameters automatically. The DERMAFORCE BBL PRO cools via sapphire contact cooling. For greater comfort, the skin can additionally be cooled with the cold air of the KYROMASTER.
Why do age spots get darker at first after treatment and when does the crust fall off?
The spot becomes darker because the targeted pigment migrates to the surface with the dead cells. That is the sign that the treatment has worked. After 1 to 2 days the area looks like a dark crumb. On the face this fine crust comes away after around 5 to 10 days, on the hands and décolleté more likely after 2 to 3 weeks. Underneath, the skin is pink at first and evens out within a few weeks. Do not scratch, do not exfoliate, do not scrub: anyone who pulls off the crust risks a new spot.
After a session with the DERMAFORCE BBL PRO, the redness usually subsides within hours. After precise spot lasering, for instance with the PICOLO XL, the area may be slightly swollen for 1 to 2 days. The care steps are set out in the aftercare guide.
Why do some age spots disappear after one session while others need several?
That depends above all on how much pigment the spot contains and where it is located. Dark, clearly demarcated spots absorb a lot of energy and often come away after one session. Pale spots offer the light little to act on and respond more weakly, as do spots on the hands and décolleté, where a more cautious dose is used. Slightly raised, keratinised spots hardly respond to pigment lasers. The usual course is 1 to 3 sessions at intervals of around 4 weeks, or for a course of light treatment for the overall complexion 3 to 5 sessions every 3 to 4 weeks.
If a remnant is left after treating the whole area with the DERMAFORCE BBL PRO, it can be followed up in a targeted way with 532 nm on the PICOLO L or the PICOLO XL. Images taken with the Skin Analyzer Pro show what has changed in a before-and-after comparison.
Why do new age spots appear after removal and how do I protect my hands and décolleté?
An age spot that has been removed often stays away for years, but new ones appear next to it because the surrounding skin carries the same sun damage. The treatment removes the visible pigment, while the pre-existing damage in the neighbouring cells remains. Every further dose of UV turns this into new spots. The most effective protection is applying sun protection factor 50 daily to all areas that are exposed to light. For the hands this means reapplying after every hand wash, and also when driving, because UVA penetrates glass. On the décolleté, every neckline counts.
Under UV light, the Skin Analyzer Pro shows where pigment is already accumulating. The DERMAFORCE BBL PRO is suitable for 1 to 2 top-up sessions a year. The SIACSKIN skincare range includes the Suncream Sensitiv SPF50.
Do creams help with age spots or are laser and light needed?
Creams can lighten age spots a little over months, but seldom remove them. Active ingredients such as vitamin C, niacinamide, azelaic acid or retinoids slow pigment formation and speed up skin renewal. This improves the skin tone overall and helps to prevent new spots. An established age spot, however, consists of permanently altered, pigment-rich cells that a cream can hardly reach. Light and laser hit precisely this pigment, usually in 1 to 3 sessions. The two work best together: the device for the existing spots, skincare and sun protection for maintenance.
For removal, SIACSKIN offers the DERMAFORCE BBL PRO and the PICOLO L. The accompanying skincare includes the Serum Vitamin C and the Suncream Sensitiv SPF50 from its own range.
Which device does a studio or practice need for removing age spots?
For most cases two tools are enough: a light treatment for whole areas and a short-pulsed pigment laser for individual spots. With light you treat the face, hands and décolleté on fair skin in short sessions and address redness at the same time. The pigment laser takes care of dark individual spots and remnants and at the same time opens up further treatments such as tattoo removal and the carbon peel. If many clients with darker skin come to you, a non-ablative fractional laser belongs in the line-up as well. Who may carry out which treatment is regulated differently from country to country.
At SIACSKIN these are the DERMAFORCE BBL PRO for whole areas, the PICOLO L as a Q-switched laser or the PICOLO XL as a picosecond laser with 280 ps for individual spots, and the TULIX for all skin types. Which line-up is suitable for your business is something you discuss in the free consultation.
