Sun damage

Sun damage is the most common skin condition we are asked to treat. In Australia that is unsurprising - most of what people call ageing skin on the face, neck, chest and hands is cumulative ultraviolet damage rather than the passage of time.

What UV actually does

Ultraviolet radiation damages DNA in skin cells. Cells with damaged DNA do not replace themselves normally. Over years, that shows up in three separate ways:

Collagen and elastin breakdown - fine lines, deeper wrinkles, and lax skin
Disordered pigment - brown spots, patches, uneven tone and melasma
Vascular change - broken capillaries, persistent redness and blotchiness

UVA penetrates deeper and is associated with photoageing. UVB is the shorter wavelength responsible for sunburn. Both contribute to skin cancer risk.

The serious end of sun damage is not cosmetic. Sun-exposed skin can develop solar keratoses - scaly spots that are precancerous - and skin cancers, including melanoma. Those need medical assessment, not a cosmetic treatment.

What sun damage looks like

Brown spots and patches, particularly on the face, forearms, hands and chest
Uneven skin tone and blotchiness
Fine lines and crepey texture
Rough or scaly patches
Visible small blood vessels
Loss of firmness
New, changing or non-healing spots - these need checking rather than treating

Assessment first

Before any sun damage treatment, your skin is examined. There are two reasons this matters:

Some sun-damage lesions are not benign. A scaly patch may be a solar keratosis; a pigmented patch may be an early melanoma. Lasering or freezing an unassessed lesion destroys the tissue - there is nothing left to send to pathology.
Skin type changes what is safe. Light-based and ablative treatments carry a higher risk of pigment change in darker skin types. The right treatment for one person's sun damage is the wrong one for another's.

Treatments we use for sun damage

Laser and light

Different devices address different signs. CO2 and erbium lasers resurface, targeting texture and lines. Fraxel works fractionally, treating columns of skin and leaving intervening skin intact. Nd:YAG is absorbed by melanin and penetrates more deeply, so it is used for pigment. IPL and Laser Genesis address redness and diffuse pigment. Photodynamic therapy is used for field treatment of sun-damaged skin.

See laser treatments.

Chemical peels

A solution is applied to remove the outer layer of dead and damaged cells and prompt new cell growth. Peels are used for texture, tone and superficial pigment. Depth is chosen to match the problem - deeper peels do more, and carry more downtime and more risk. See skin peel treatments.

Skin needling

Controlled micro-injury to stimulate collagen, used for texture and fine lines. See skin needling.

Microdermabrasion and epidermal levelling

Physical exfoliation of the surface layer. Gentler, with minimal downtime, and generally used in a course. See microdermabrasion.

Cryotherapy and curettage

Used for individual lesions, including solar keratoses, once they have been assessed. See cryotherapy and curettage.

Cosmeceutical skincare

Medical-grade topical products - retinoids, vitamin C and other antioxidants, pigment inhibitors - used both to improve the skin and to hold results between treatments. Some topical treatments for sun damage are prescription-only and require consultation with a doctor. See cosmeceutical skincare.

What results are realistic

Sun damage treatment reduces the visible signs. It does not undo the underlying DNA damage, and it does not remove your skin cancer risk - you still need skin checks.

Most people need a course of treatments rather than one session, and results are held with sun protection and maintenance. Without sun protection, pigmentation returns. Individual results vary depending on skin type, the degree of damage and how consistently the plan is followed.

Prevention still does more than treatment

Broad-spectrum SPF 30 or higher, applied properly and reapplied
Shade, particularly in the middle of the day
Hat, sunglasses and long sleeves
No solariums
Regular skin checks, especially with a family history of skin cancer

If you are sunburnt: cool compresses or a cool bath, plenty of water, and avoid petroleum-based products, which trap heat. A severe burn with blistering should be seen by a doctor.

Risks

Redness, swelling and crusting after treatment
Blistering
Changes in pigmentation - darker or lighter patches - which can be persistent, and are more likely in darker skin types
Scarring
Infection, including reactivation of cold sores after facial resurfacing
Incomplete response, or recurrence of pigmentation
Prolonged sensitivity to sun after treatment

Some treatments are unsuitable if you are pregnant, taking photosensitising medication or have recently used oral acne medication. Tell your practitioner what you take. See risks and complications.

Cost

As at September 2024 and including GST, a skin assessment is $50 and a Cosmetic Doctor consultation is $150. Dermal skin treatments start from $130. A course is quoted after assessment. Cosmetic treatment is not covered by Medicare; treatment of solar keratoses and skin cancers may attract a rebate.

Booking

Me Clinic, 4 Burke Road, Malvern East VIC 3145. Phone 1300 852 050 or (03) 9569 3511, or use the online consultation form. Treatment-room skin work is provided by Michelle Casey, Paramedical Aesthetician.

Individual results may vary. Any surgical or invasive procedure carries risks. Before proceeding you should seek a second opinion from an appropriately qualified health practitioner.