American Society of Plastic Surgeons
For Medical Professionals

Seven ways to undo sun damage, discoloration and other sins of summer

In the summertime when the living's easy, it's also easy to brush off that second application of sunscreen, or to not think twice about a peeling sunburn. Yet, these seemingly innocent choices can accumulate into serious trouble for your skin for years to come.

"One of the things that we see, particularly this time of year, is the repentance of a full summer of no sunscreen and no physical protection of the skin, so we see a lot of sun damage," says Washington D.C. plastic surgeon Troy Pittman, MD. "We see a lot of dyschromias, which are different reds and browns of the skin, the skin tends to be a little under-moisturized, pores are a little stretched out, so there's that summer complexion that we see, and right around now, once summer vacations are over, people come in."

With the amount of sun damage that can occur in the summer months, it's no surprise that according to the 2020 annual procedure report from the American Society of Plastic Surgeons, multiple procedures such as IPLs and Chemical Peels, which can help replenish damaged skin, were two of the top five minimally invasive procedures in 2020.

And what are they asking for? Read on to hear from two plastic surgeons, Dr. Pittman and New York City-based Lesley Rabach, MD, for their go-to treatments to help patients erase the sins of summer.

Reevaluate your skincare

"The first thing I do with a patient that comes in is to ask about their skincare regimen," says Dr. Pittman. "One of the things I try to elicit from the patient is, why do you have all this sun damage? Or what were you doing over the summer and how can we prevent this from happening in the future?"

He starts by asking whether they use a serum and a moisturizer, as well as what their daily sun protectant is. "I often, particularly for men, recommend a vitamin C serum, which are very effective antioxidants, so not only is that going to help with the free radical damage that causes sun damage, but anything that gets through your sunscreen," says Dr. Pittman. "If you're not going to use sunscreen regularly, whether that's in your moisturizer or makeup, at least use antioxidants, so we're doing something for your skin."

Chemical peels

Chemical peels are a hot commodity in Dr. Rabach's West Village practice, and her go-to for patients seeking a quick-fix for their summer skin. "Chemical peels, between the salcylic acid, the Jessner, or TCAs (trichlorectic acid), they really help with any sort of brown spots, fine lines and wrinkles," she says. "It also helps the pore size to make them appear smaller."

Peels can vary from light, superficial exfoliations, to medium or deep chemical options that resurface the skin's texture, wash away clogged pores and even out skin tone. However, "deeper peels are usually reserved for people that have more chronic sun damage," she says. They're also super easy for patients, taking about 10 minutes, and a few days of recovery, depending on the severity of the peel.

"The acid basically coats the inside of the pre and works from the inside out, reducing the production of oil and pigment from the cells. If you have fine lines, it helps smooth them out," she says, adding that the visible results wane after about two months, but they technically last forever because "you've made a change at the cellular level and over time, it trains your skin to behave in a different way."

Intense Pulsed Light (IPL)

To target lighter sun spots, which usually present as brown and red asymmetric-looking skin growths and patterns, Dr. Pittman opts for a round of IPL, which he calls "a very nice, basic" treatment, which are especially popular with first-time patients.

"We can really kind of zap the spots with this laser, which is a high energy light that basically brings the browns and reds to the surface and they flake off," he explains. "So someone who has freckling or sun damage, you can do an IPL treatment, and it all turns into what feels and looks like coffee grounds – it gets really dark over the course of about five days, then it exfoliates off."

A usual course of treatment is two to three procedures, four months apart, due to the pigment laying "in different layers of the skin," requiring a few appointments to really hone in and remove the discoloration.

Microneedling with radio frequency

"Microneedling works at the collagen level," says Dr. Rabach, making it a perfect option for someone with "much deeper lines from sun damage" by "improving the collagen layer, which overall makes things more youthful."

Her favorite course of treatment for patients with sun damage is alternating between chemical peels and microneedling every four to six weeks, which she says "will give you as good, if not better, at a fraction of the cost" of lasers.

"We like to alternate because their mechanisms are slightly different: One is basically medication going into the area, the chemical peel, and the other, microneedling, is creating micro holes that stimulate at a different layer than the skin surface into the collagen layer, so you're treating two different layers," she explains. "And the combined effect of treating both the skin surface and this slightly deeper layer really rejuvenates the skin in a really exponential way."

And one of the best things about microneedling with radio frequency? It's a great option for skin of color, thanks to the insulated tips, meaning that the radio frequency is only coming out of the very tip of the needle, says Dr. Pittman, so "you can treat skin of color where the energy is being delivered and go past the melana sites, so they are not going to get dark."

CO2 laser

Unlike the CO2 lasers of yore the years past, treatment with the newer models doesn't trigger such extreme redness or give skin a raw appearance during the week-long recovery. "If you need to go to the supermarket on day three, you're not going to be scaring small children," laughs Dr. Pittman, adding that you'll probably not want to go to your best friend's wedding immediately after, but you will just look like you have a moderate sunburn that's peeling.

"The CO2 lasers now are fractionated lasers, which means that the damage to the skin is in little pinpoints, whereas 10 years ago, those were unfractionated CO2 lasers, where you basically just lasering the skin and creating a controlled burn with significant downtime," he explains. His favorite fractionated laser is the Fraxis Pro that works in a patterned movement that pricks one point on the skin, skips the point beside it, then makes another prick, all over the skin to create a grid formation. "What that does is for every one point of damage the laser is making, there are two points on either side of it of healthy skin," says Dr. Pittman. And the components in the healthy skin really help that one little piece of damaged skin heal, so the downtime is much less, but the benefit is equivalent."

Microneedling with radio frequency + CO2 laser combo

One of the newer devices, Secret PRO, combines the two technologies – radiofrequency microneedling with a fractional CO2 laser – in a single device to heal sun-damaged skin and stimulate collagen for skin revitalization.

"What we found with combining those two treatments is that we can treat the mid and superficial dermis with microneedling radio frequency to stimulate collagen, to tighten pores, and to reorient the skin to reduce fine lines," explains Dr. Pittman, of his go-to treatment. "Then we use the CO2 laser to treat the more superficial layers, so we get off the sun damage, treat fine lines, make the skin smoother and give it more of a glow."

If it sounds like the Holy Grail of blurring skin imperfections, that's because it basically is. "You're doing a little bit of everything with this treatment, and there's no more downtime combining them than there is from just doing a CO2 laser alone, just about a week," he says.

Microneedling with PRP

Nearly everyone's familiar with the 'Vampire Facial' or microneedling with PRP (platelet-rich plasma), but a new innovation from SoMe Skincare, really takes the procedure to the next level with at-home skincare made from your own PRP.

"It's a proprietary blend of vitamins and growth factors in a serum container, and we mix the patient's PRP with that, and it gives them three months' worth of a serum to use before their moisturizer," explains Dr. Pittman. "So they're actually giving themselves a PRP serum at home for three months."

This insanely customized serum helps patients heal more quickly from a microneedling treatment because they're treating their wound from the procedure with PRP, which is known to be super anti-inflammatory, says Dr. Pittman. "It lets patients extend the visible results of the treatment and continue the healing at home. It couldn't be easier."

The takeaway

"You can't really reverse the damage, not fully," she says. "If you got a blistering sunburn, which is just a sunburn where your skin then peels off, that type of damage goes deep and the chance of creating damage that will then turn into skin cancer later on in life is much higher."

Missing a spot when putting on sunscreen happens to the best of us, says Dr. Rabach, but "it's not okay to be reckless with your skin."

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.


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