[Dr. Bellview Column 85.] How to Identify Occult Melasma, Vascular Melasma, and Future Melasma

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Bellevue Clinic, Beauty for Everyone

Dr. Bellview, nice to meet you

I’m here to greet you again today.

They all look similar at first glance? The identity of pigmentation varies widely

The pigmentation that appears on our skin may seem similar at first glance. But depending on the cause of development and the depth, even the name and treatment method are completely different. Melasma, which many people are familiar with, appears irregularly in the dermis and superficial layers due to a wide range of factors such as hormones and sunlight. If a laser that is too strong is used, it can actually become darker, which is why melasma is a difficult condition to treat. Melasma needs to be treated gently and over time to avoid unwanted side effects later.

There is also something called solar lentigines, which is less widely known than melasma. Compared with melasma, its borders are relatively clear, and when touched, its texture also feels somewhat rough and different from the surrounding skin. It is mainly caused by UV exposure or aging. In the case of Ota nevus or bilateral nevus of Ota-like macules (ABNOM), the roots lie deeper in the skin (the dermis) than in ordinary melasma, so a laser with a special wavelength is required. For these pigmentation disorders, repeating weak toning like with melasma is almost ineffective.

A wrong diagnosis leads to

A vicious cycle that results in wrong treatment,

And incorrect pigmentation treatment can also cause

The side effect of

'Existing pigmentation + post-inflammatory hyperpigmentation.'

Finding 'hidden melasma' that cannot be seen with the naked eye

At Bellevue Clinic, the Mark-Vu imaging process is a must before any procedure. It is a device dedicated to skin analysis at Bellevue. Mark-Vu is a kind of camera that uses four light sources to photograph the skin from multiple angles. It can clearly reveal pigmentation that is not visible to the naked eye, including pigmentation that has not yet surfaced in the future (with ultraviolet light). In other words, it makes it possible to identify potential pigmentation.

Even if an area currently looks clean, you can identify 'future melasma' that is ready to rise from deep within the skin, allowing a clearer treatment direction to be set. Of course, it is also possible to determine the depth of the pigmentation currently visible. By identifying whether the pigmentation is in the epidermis or deep in the dermis, it helps us precisely set the type and intensity of the laser.

It can also distinguish vascular melasma

When photographed in Mark-Vu polarization mode, melasma accompanied by a particularly strong red tone (blood vessels) can be called vascular melasma. In the case of vascular melasma, which is often seen in Koreans, recurrence can be prevented only when vascular laser is used together, rather than ordinary toning. Because melasma itself is closely related to blood vessel formation, removing only the pigment without removing the blood vessels is like pouring water into a bottomless jar.

If the melasma looks darker right after washing your face or after using a sauna, or if you have frequent facial flushing and high skin sensitivity, it may be vascular melasma, or future vascular melasma cannot be ruled out. First, the redness needs to be addressed. In fact, this kind of skin is in a very fatigued state, so it is necessary to carry out skin repair work on the dermis by combining skin boosters such as Rejuran or Juvelook. It is not enough to treat only the pigmentation, and that is why it is said to be difficult to treat, but it is not impossible. Treatment is possible by considering [pigmentation + blood vessels + dermis] at the same time.

The problem is, face it rather than avoid it

For Mark-Vu imaging, nothing should be applied to the skin right before the test, and accumulated waste and sebum also need to be removed to some extent. That is why you must wash your face first. You may find it bothersome and inconvenient to wash your face outside, and if you are particularly sensitive, you may feel anxious because you cannot trust the hygiene standards of facilities or towels shared with others. The process of facing your bare, unfiltered skin with others can itself feel a little uncomfortable.

However, not going through this process before treatment may actually be a greater loss. It is no different from trying to solve a problem without knowing what the problem is. In the end, it is a waste of time, money, and everyone’s effort. The most important thing in treatment is diagnosis, so if you skip the Mark-Vu imaging that helps with this diagnosis.... well. I’ll stop there.

However, Mark-Vu imaging and diagnosis are not done every time you visit the clinic, so please do not worry too much. When the medical staff recommends it as necessary based on their judgment, please be willing to undergo it even if it means putting up with a bit of inconvenience. If you have a map, even unfamiliar roads can be found quickly without getting lost. That is the role it plays. Treating pigmentation disorders, distinguishing them, diagnosing them, testing them, and treating them are all a little difficult, but if you are with Bellevue, an experienced guide, it will not be that hard. I will continue to maintain the mindset of always striving to become your sherpa. Thank you.

"A clinic oriented toward specialized skin diagnosis"

Bellevue Clinic

The Mark-Vu skin diagnosis test can identify various skin concerns that are difficult to confirm with the naked eye all at once, including skin texture, pigmentation, pores, wrinkles, skin tone, dark circles, radiance, redness, melanin, sebum, and acne bacteria.

At Bellevue, based on this, we scientifically analyze your skin and provide a final diagnosis for the necessary procedures. Through detailed consultations, we will do our best to perform the most effective procedures for each patient.

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