Causes and Treatments for Solar Lentigos

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A lady went into a clinic to treat a sun spot on her cheek. The doctor said it was a solar lentigo, and suggested CO2 laser treatment, with expected recovery time of about a week, so she went for it. She estimated the recovery time was more than enough as she had a wedding to attend in two weeks. However, 24 days later it looks deep and red, even without complications during or after the procedure. She asks how long she should wait before it improves, and how if it will leave a scar in the future since it’s so deep.

New York Oculoplastic surgeon Amiya Prasad, MD reviews her photos and concerns in this video, explaining the cause of solar lentigos, and how he would approach treatment:

1:45 - Dr. Prasad’s background training, and experience in using CO2 laser since the original ones in the mid 1990s
2:31 - How a solar lentigo is a brown spot between the dermis and epidermis of the skin, which is a concentration of pigment cells
3:00 - How solar lentigos are treated with a TCA peel, or thermal energy devices like IPL, erbium, and CO2 laser
3:51 - How the crescent shaped defect in her skin is a cause for concern since it’s 24 days after the procedure, so she should ask her doctor why he chose CO2 laser, and what was the aftercare involved
4:30 - How Dr. Prasad is concerned about the healing of the dermis due to the depth of the defect
4:58 - How different treatments used have different depths: IPL focus on pigment at the top layer of skin, and CO2 laser gets deep penetration
5:55 - How aftercare of skin is also an important factor
6:03 - How Dr. Prasad is worried she may be left with a slight depression in her skin
6:12 - How her doctor should give her guidance for this situation
6:21 - How laser treatment can involve her problem with a deep depression in her skin, such as crust formation, inflammation, and infection
6:50 - How CO2 laser does have variable depth and energy settings
7:02 - How Dr. Prasad is concerned with healing, and improving the appearance without an indentation in the skin
7:22 - How she is still healing from the procedure, but she should have healed well enough that a depression should not have formed, but multiple passes with the CO2 laser may have been done because of the depth of the pigment, so she needs to communicate with her doctor about it

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