Understanding Hyperpigmentation
Hyperpigmentation is one of the most common skin concerns we see at Karwal Aesthetics. It can affect anyone regardless of age, skin type, or tone, and it's one of those issues that can feel disproportionately frustrating. The patches themselves might be small, but the impact on confidence can be significant, particularly when they're on the face.
The good news is that hyperpigmentation is treatable. But getting results that actually last requires an accurate diagnosis, the right combination of treatments, and a clear understanding of what's driving the pigmentation in the first place.
What Is Hyperpigmentation?
In simple terms, it's any area of skin that appears darker than the surrounding skin. This happens when melanocytes, the cells responsible for producing melanin (the pigment that gives skin its colour), become overactive. They produce more melanin than usual, and the result is patches, spots, or uneven areas of darker skin.
The triggers vary. UV exposure, hormonal changes, inflammation, and genetics can all play a role. Often it's a combination of factors, which is why a one size fits all approach rarely works.
The Most Common Types
Not all hyperpigmentation is the same, and knowing which type you're dealing with matters because the treatment approach differs.
Melasma is probably the most well known form. It shows up as symmetrical brown or greyish patches, usually across the cheeks, forehead, upper lip, or bridge of the nose. Hormones are a major driver, which is why it's so common during pregnancy, in women taking hormonal contraceptives, or those on hormone replacement therapy. Melasma can be stubborn and tends to flare with sun exposure, making it one of the trickier forms to manage long term.
Post inflammatory hyperpigmentation, often called PIH, develops after the skin has been injured or inflamed. Acne is one of the most common causes, but eczema, psoriasis, burns, and even aggressive skincare treatments can trigger it. The inflammation kicks melanin production into overdrive, leaving dark marks behind long after the original issue has healed. PIH is particularly common in darker skin tones.
Sun spots, also known as solar lentigines, are the small, flat brown spots that develop on areas of skin that have had years of cumulative sun exposure. They're most common on the face, hands, chest, and shoulders, and they become more prevalent with age.
Freckles are slightly different in that they have a strong genetic component. They appear on sun exposed areas and tend to darken with UV exposure, but they're driven as much by your DNA as by the sun.
Hyperpigmentation vs Tear Trough Hollowing
This is something we see misdiagnosed regularly. Many people come in concerned about dark circles under their eyes, assuming it's a pigmentation issue. Sometimes it is. But very often, the darkness is actually caused by a tear trough deformity, which is a structural problem rather than a skin colour problem.
True hyperpigmentation under the eyes involves actual darkening of the skin due to excess melanin. The colour stays consistent regardless of lighting or angle, and it responds to treatments that target pigment.
A tear trough deformity, on the other hand, is a hollow or depression between the lower eyelid and the cheek. This creates a shadow that looks like dark circles but is actually caused by volume loss, fat pad displacement, and changes in the underlying bone structure. The appearance shifts with different lighting and head positions, and it requires a completely different approach, typically dermal filler to restore the lost volume.
Getting this distinction right at the outset is essential. Treating a tear trough with pigment targeting products won't achieve anything, and treating true pigmentation with filler won't either. At Karwal Aesthetics, this is one of the first things Dr Karwal assesses during your consultation.
How We Treat Hyperpigmentation
Our approach is evidence based and tailored to the individual. There's no single miracle product for hyperpigmentation. The most effective results come from combining treatments that work through different mechanisms.
Hydroquinone remains the gold standard for treating hyperpigmentation. It works by inhibiting tyrosinase, the enzyme that drives melanin production. At concentrations between 2 and 4%, it can produce significant improvement within 8 to 12 weeks. It's particularly effective when combined with other active ingredients.
Vitamin C, specifically L ascorbic acid at 20% concentration, is a powerful addition to any pigmentation protocol. It inhibits melanin synthesis, provides antioxidant protection against UV damage, and stimulates collagen production. We use high concentration formulations to ensure the vitamin C actually penetrates the skin at a level that makes a meaningful difference.
Retinoids, whether prescription strength tretinoin or over the counter retinol, accelerate cell turnover and help disperse melanin that's already been deposited in the skin. They also enhance the penetration of other depigmenting agents, which is why they're so valuable in combination protocols. Tretinoin delivers more potent results, while retinol offers a gentler option for those with sensitive skin.
Sunekos is an injectable treatment we offer that combines hyaluronic acid with a specific amino acid complex to stimulate collagen and elastin production. While it doesn't target melanin directly, it improves overall skin quality and regeneration, which can help create a more even, healthier looking complexion over time. It's particularly useful as part of a broader treatment plan.
The research consistently supports combination therapy as the most effective approach. At Karwal Aesthetics, we typically combine hydroquinone with retinoids for enhanced efficacy, use vitamin C during the day for antioxidant protection alongside retinoids at night for repair, and layer topical treatments with in clinic procedures for comprehensive results.
Treating Tear Trough Deformity
For patients whose under eye darkness is caused by structural hollowing rather than pigmentation, the approach is entirely different. We use hyaluronic acid dermal fillers to restore the lost volume beneath the eye, correcting the depression and eliminating the shadow that creates the appearance of dark circles.
This is a delicate area that requires precise technique and a conservative approach. Dr Karwal assesses the anatomy carefully and builds volume gradually to ensure natural looking results. Patient satisfaction with tear trough filler is consistently high when performed by an experienced practitioner, and the results typically last well.
Why Sun Protection Is Non Negotiable
This deserves its own section because it's genuinely the most important part of any hyperpigmentation treatment plan. Without consistent, daily sun protection, even the most effective treatments will produce limited or short lived results. UV exposure stimulates melanocytes directly, and it can reverse weeks or months of progress in a matter of days.
We recommend broad spectrum SPF 30 to 50 every single day, regardless of weather or season. Physical protection like hats and sunglasses helps too, and reapplication every two hours when you're spending time outdoors is essential. This isn't optional advice. It's the foundation that everything else is built on.
Your Treatment Plan at Karwal Aesthetics
Every patient who comes to us with pigmentation concerns receives a thorough assessment before any treatment is recommended. We look at the specific type of hyperpigmentation, the contributing factors, your skin type and sensitivity, any previous treatments you've tried, and crucially, whether the concern is true pigmentation or something structural like a tear trough deformity.
From there, we build a personalised protocol that addresses the root cause, not just the visible symptom. This might include a combination of prescription topicals, in clinic treatments, and a tailored maintenance plan to protect your results long term.
If uneven skin tone or under eye darkness is something you've been struggling with, book a consultation at our Mayfair clinic. We'll give you an honest assessment of what's causing it and a clear plan for how to treat it effectively.
