Doctor V – How Treat Dark Marks

So today’s topic is going to be tackling why we get these dark marks on our cheeks, why they join together and then start to spread across the face. Why does it happen more in skin of color? How do we treat it? The step-by-step routine. And at the end, I’m going to tell you the classic mistakes that people make trying to treat these dark marks that actually worsen the condition and leads to more pigmentation. If that sounds good to you, please give me a thumbs up. Let’s dive right in.

So, first thing to note is that these little dark marks tend to start on the cheek. About 70 to 80% of pigmentation or melasma starts on the cheeks, the zygoma area we call it. Then usually starts in your mid to late 20s, depending on where you are. If you are from a hot country and you haven’t been wearing SPF 50 and you have skin of color, it may well start in your early 20s. If you are from a cooler country and you have been wearing your SPF 50, it may start in your mid 30s, late 30s, or even your 40s. So it does depend on your UV exposure.

Now, what it looks like is tiny little freckles and initially you might even think they’re cute. However, they are a warning sign that you are not protecting your skin and your skin is being damaged. So it is not something that’s desirable or something that we want. Because what then happens is if you don’t heed that warning sign at that point and start slapping on your sunscreen, SPF 50 every couple of hours, then what happens is those little dark marks join together and foam patches. And they form evenly, they’re symmetrical patches.

Then because of something called cell talk, which is basically chemical communicators if you want to call it that. Across the face, it means that pigmentation spreads across the face and usually it goes straight from here to here, the upper lip area, and then just spreads across the full cheek. So it can really cover a large portion of the face. I actually remember quite clearly at medical school starting to get early melasma. And it was only because my mom was so aware of skincare that she actually, an Asian mom is always going to be very critical of her baby.

I remember her saying to me, “Vanita, what’s that thing on your face?” And I said, “Well, what’s on my face?” And she started doing that to my face and I thought it was just some mascara the that are falling down or some eyeliner that are falling down, but no, it didn’t shift. And she said, “You are getting early signs of melasma.” And I’m so grateful that she picked up on it and she knew what melasma was at that age because I then became really obsessive with skincare and my SPF 50 protecting my face and wearing my wide brimmed hats, which basically my friends laugh at me for.

I’m really glad that they caught it at that point and this is what I want for us. I know there’s a lot of parents who watched this channel and I know a lot of parents and children watch this channel together, which I love, but it means that hopefully our children don’t go through the same mistake. They shouldn’t even get to the point where they’re getting early melasma because we should have been so vigilant with their SPF 50 from a young age that they don’t even get to that point. So for me growing up really, SPF 50 wasn’t even a thing. You put moisturizer on your face. Your parents would slap moisturizer on her face and that would basically be it.

SPF 50 wasn’t a thing. Whereas now my children on the way to school, I’ll put their moisturizer on and the SPF 50. And then in the car on either side, they have the skincare. In the door they have their moisturizer and their sunscreen, and they know how to dot it and rub it in. And it’s just part of the daily routine like you would brush your teeth because, yes, they shouldn’t be getting the same early sun damage that we got.

So there are three main causes or influences or triggers that will make this occur. So the first one is genetics. It can run in families. And so there’s really nothing you can do about genetics. If you’re predisposed to melasma, then you just need to be even more vigilant with your sunscreen. The second is UV exposure. So how much UV you’ve had. If you’ve been out, for example, when there’s a high UV index for many years, you are likely to see some form of sun damage on your face. And the third is estrogen. So this is why it tends to worsen during pregnancy, why it worsens during menopause or when you take the pill, or if you start taking HRT during menopause. These are the times that you’re likely to see melasma worsening.

If you want me to do a video specifically for dark marks or melasma during pregnancy, then can you write it down below? Because actually it’s quite a slightly different routine because you need to be wearing your mineral sunscreen, not chemical sunscreen. You can’t wear vitamin A, which is really honestly in the vast majority of discoloration serums and creams, et cetera. So if you want me to do that, can you write down below please pregnancy pigmentation? And I will do that for you.

So the question people ask is how do I treat it? So let’s talk about professional grade treatments. So the common ones are things like laser. Laser will increase energy in the skin and can actually lead to more pigmentation in skin of color, which is why I’m not a fan of laser to treat hyperpigmentation for skin of color. It’s fine for Caucasian skin, but for us I would sidestep.

The next one that is very popular is microdermabrasion. So the way microdermabrasion works is that it basically takes the top layer of skin away. And so temporarily your skin will look brighter because you’ve taken away those skin cells at the top that were packed with excess melanin, but your skin is a living organ. Those skin cells will go from the basal layer where the melanocyte will seep melanin into the skin cells, skin cells come to the surface like visually like a conveyor belt, and then you see it. So imagine you’ve taken that top layer off, that’s fine, but guess what? That conveyor belt hasn’t stopped, it’s going to just keep coming to the surface, which means that unless you calm down the melanocyte, slow down the rate of melanin production you can peel and do as much microdermabrasion as you want. You are only going to get temporary results.

The other common treatment are chemical peels, such as TCA peels or [inaudible 00:07:00] glycolic acid. If you’ve watched enough of my videos, you’re going to know that I’m not a fan of those because they can burn the skin and lead to more pigmentation. I do tend to say glycolic acid up to 5% maximum for skin of color because it’s a tiny molecule, can fly through the skin and lead to hotspots especially at high percentages. If there are some molecules that you haven’t neutralized, it can lead to issues with skin of color. So I tend to say avoid that too.

Then the other common one is hydroquinone. Now hydroquinone. I know it’s the gold standard for treating pigmentation. But for skin of color, it does lead to rebound pigmentation. So I actually did a poll on my Instagram, which was very interesting. And I asked you about treatments that you’ve done for pigmentation and the results that you’d seen, and these were the results. So the first question I asked was, “Did you see good results with hydroquinone when treating your melasma?” 736 of you responded. 35% said yes, 65% said no.

Then I said, “Did your melasma returned when you stopped using hydroquinone for skin of color?” 566 of you responded and 78% of you said it came back again. And then I said, “If it returned, was it worse than before?” 492 responses and 57% of you said it was worse than before. I’m very lucky that I get to even ask these polls and I get to have hundreds of you and thousands of you responding so we have an accurate representation of what we should and shouldn’t be doing for skin of color. I’ve always suspected hydroquinone leads to rebound pigmentation just from what I’ve seen in my clinic, but having these numbers just solidified it for me. Yes, that’s the reason I avoid hydroquinone.

So this is a reason for skin of color, I prefer a cocktail of tyrosinase inhibitors. To be honest, one or two tyrosinase inhibitors don’t really get you results, especially if you have dark pigmentation that’s been there for a long time. I’ve found from our clinical trials we only started seeing results when we were combining eight to 10 tyrosinase inhibitors together simultaneously, which are being absorbed into the skin simultaneously that we started seeing a reduction in pigmentation.

So the way pigmentation works is the mechanism of action is that tyrosine converts to melanin using the enzyme tyrosinase. So if you are able to control that enzyme tyrosinase, you could slow down the rate of melanin production. So this is a whole category of ingredients of tyrosinase inhibitors. And I’m going to go through my favorite tyrosinase inhibitors for skin of color for these dark marks. So my favorite ingredients are alpha arbutin, sodium ascorbyl phosphate, that’s water soluble vitamin C. It’s an antioxidant and a tyrosinase inhibitor.

Tetrahexyldecyl ascorbate. That’s a fat-soluble vitamin C so it is absorbed into the dermis. That’s a deeper layer of skin. Kojic dipalmitate, licorice root extract is also another effective tyrosinase inhibitor, bilberry extract. Retinaldehyde, a retinyl palmitate and retinol. These are three different forms of vitamin A. That means that they are antioxidants, they’re also anti-aging and they treat pigmentation. Also, lactic acid and vitamin E. So these are all my favorite tyrosinase inhibitors for skin of color.

So these are a cocktail of tyrosinase inhibitors, exfoliants and antioxidants specifically for skin of color pigmentation. And I looked and there was no product in the world that had all these ingredients together that was NAFE safe. So no DHA, alcohol, fragrance, or essential oils, which is important for skin of color. So I decided to make it for you. I actually create the world’s first facial pigmentation kit called Skin of Color. It’s a two-piece kit, which has your tyrosinase inhibiting cream and your skin soothing cream.

What I always say, however, is start cheap. So don’t start with this kit. Start with a 2% alpha arbutin from The Ordinary or use tranexamic acid or try 10% niacinamide. These are five, 10 pound products. Start cheap. Because if those ingredients are working for you, then no need to do anything else and you don’t need to buy anything else. You should be happy at that point. If off to three to six months of doing that you haven’t seen any results, then you have the option to upgrade to the Dr. V Facial Pigmentation Kit.

But this is not your first line treatment. This is your second line treatment if the other single actives don’t work for you. And the reason I made it is that I really wanted my skin of color family to have an option to upgrade because before this, there really was nothing. You had to try the single ingredient actives. Maximum you would ever see is three ingredients together, but you would never see everything that you need in one cream. It just didn’t exist, especially in the NAFE safe version of it.

So I wanted to do that for you, but again, like I said, it is expensive and you don’t start with this. “So Dr. V, what is the step-by-step routine for how I treat my dark marks on my face?” So first thing in the morning when you wash your face, wash with a Micellar gel. You want to remove any dirt or any actives from the night before. Then you apply your fatty, non-fragrance moisturizer, something like Cetraben or CeraVe. Then you apply your SPF 50. I always recommend mineral sunscreen over chemical sunscreen for skin of color when pigmentation is the issue because zinc oxide is antiinflammatory, and you’ve already got inflammation taking place on your skin.

So I was struggling to find a few years ago, I was struggling to find a mineral sunscreen that was SPF 50 invisible on skin of color without a white cast, but had antioxidants that were UV stable, but didn’t enter the bloodstream and that I could wear under my makeup without a flashback, and then on top of my makeup as well. As I suffered with melasma myself, I also wanted UV stable tyrosinase inhibitors that I could wear in the morning that would help me throughout the day, not just the tyrosinase inhibitors that I would wear at night time before I went to sleep. And this sunscreen just didn’t exist.

And so I decided a few years ago that I was going to attempt to make it for you. However, it took me years of failing before we succeeded. So I’d like to introduce to you, this is basically the factory sample it’s called Inzincable. So put about quarter of a teaspoon on there. We did a clinical study on 51 candidates to see if it was invisible on skin of color, but also if it reduced pigmentation and feels anti-aging.

So when it first goes on, it does look white initially and so you create a film. After one minute, a film forms where it is suddenly invisible, but you now have protection from UV and you get your SPF 50 broad spectrum protection. Okay, so here you go. So it’s been about, so maybe 20, 30 seconds and you should have no white cast. It should be invisible on your skin. I’m wearing it under my makeup right now. I think the most exciting thing for me with Inzincable was there was the clinical studies to see 80% have seen a reduction in pain, mentation from switching, from any sunscreen to Inzincable for skin of color was the reason why I created Inzincable. Why I went through so much torture and trauma trying make it for you that plus being non-comedogenic.

So it does have a dewy finish, but it is non-comedogenic. So, yes, I think it’s probably the thing I’m most proud of. So that product releases the first week of July 2021, the link will be down below. Okay, so then in the evening you have to wash your face. I would double cleanse at this point because if you’ve been wearing moisturizer and sunscreen, you need to take that off. Otherwise, you’re not going to have any penetration of actives. So I tend to say use an oil-based cleanser, something like DHC cleanser oil cleanser is good followed by your Micellar wash. That’s called double cleansing, oil and them Micellar gel.

Once you’ve done that, you can tone with a hydrating toner if you want. Hada Labo does a very good anti-aging hydrating toner or you can go straight into active. So you can wear your alpha arbutin from niacinamide, possibly you can wear The Ordinary from niacinamide and that’s a quite good combination you can purchase. The other monotherapy that’s quite good is tranexamic acid. So Be Minimalist does a good one, so does Naturium. So there’s quite a lot of these single active ingredients or three active ingredients together. So try those first because they are reasonably priced.

And after this, apply your moisturizer, your SPF 50. You would do this every night for three to six months. See the results. If you are happy at that point, great. If you feel like you’ve seen a little bit of reduction, but you want to see more, then you can upgrade and take out those two serums and instead apply your Facial Pigmentation Kit. But see how you go first and always start cheap. So these kits are available from So the link is down below and each kit does 110 pounds. I’d start off with one kit to, see how you get on for about four months. You tend to see best results at six months. And so just make a decision at four months if you need another one or if it’ll last you the full six months.

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