IPL (Intense Pulsed Light) for Dark Spots and Redness: Who Is It Suitable For, and What Should You Watch Out For?

What is IPL and how does it work?

IPL is the abbreviation of 'intense pulsed light'. A flash lamp inside the device produces very short, high-intensity pulses of light. Whereas lasers emit light at a single wavelength, IPL emits broadband light containing many wavelengths at once. Filters fitted to the handpiece determine which part of this light reaches the skin.

The light that reaches the skin is absorbed by the targeted coloured structures and converted into heat. In dark spots the target is melanin, the pigment that gives skin its colour. In redness and vessels the target is the haemoglobin in the blood. The heated pigment breaks up and is shed from the skin within days; the heated fine vessel closes over time and is cleared away by the body.

The fact that the light is broadband makes IPL versatile: both dark spots and redness can be targeted in the same session. On the other hand, the same feature means that the light can also be absorbed by pigment that is not the target. Reviews report that in properly selected cases IPL can give results close to those of lasers; however, comparative studies with long follow-up are limited. The darker the natural colour of the skin, the more light is absorbed and the greater the risk of burns and pigmentation. For this reason the filter, energy and pulse duration are chosen individually for each person.

What is it used for?

• Sun spots: well-defined brown spots that appear over the years as a result of the sun on the face, backs of the hands, décolleté and arms
• Freckles: after a physician’s assessment, together with sun protection
• Diffuse facial redness and fine thread veins: especially the persistent redness and visible vessels that accompany rosacea

IPL is also used for hair reduction; this subject is covered in the article “Laser Hair Removal: How It Works, Who It Suits and What to Watch For”. This article deals only with its use for dark spots and for vessels and redness. For the types and diagnosis of dark spots, see the article “Dark Spots and Melasma: Causes, When to See a Physician and What Treatments Are Available”, and for the underlying cause of redness, “Rosacea: Symptoms, Triggers and Treatment Options”.

Who is it suitable for?

The people expected to benefit most from IPL are those who are fair-skinned, are not tanned and have a diagnosed problem with dark spots or vessels. The kind of response that can be expected in each situation is summarised in the table below; individual suitability can only be determined by examination.

Who is it not suitable for, and what should you watch out for?

In the situations below, IPL is either not carried out or a decision is made only after a detailed assessment by the physician:

• Tanned skin: in skin darkened by the sun, sunbeds or tanning products, the risk of burns and pigmentation increases markedly; the procedure is usually postponed.
• Darker skin: when the skin naturally contains more melanin, more light is absorbed at the surface. In darker skin the physician will often recommend another method.
• Melasma: heat and inflammation can make melasma worse. In melasma, IPL is considered only in selected people, in addition to cream treatments and strict sun protection, and with cautious settings.
• Undiagnosed spots and moles, or those changing in shape or colour: applying light can alter the appearance of a skin cancer and delay diagnosis. For this reason a diagnosis must be made first.
• Medicines that cause light sensitivity: medicines such as some antibiotics, retinoids, some diuretics and some painkillers can increase the skin’s reaction to light. This includes herbal products.
• Conditions that flare with light: conditions made worse by sunlight, such as lupus, and light-related skin rashes
• An active cold sore, infection, open wound or flare of a skin condition in the treatment area
• A tendency to poor scarring or to keloids (raised scars at the site of a wound)
• Pregnancy: because there is not enough data on its safety and the tendency to pigmentation increases in pregnancy, the procedure is usually postponed.
• A tattoo in the area, or cosmetic pigment in areas such as the lips or eyebrows: the pigment can absorb the light and cause a burn.

Do not stop the medicines you take on your own; your physician decides which of them is a problem for the procedure and what should be done. It is worth knowing that in men IPL to the beard area can thin the hair, and that a similar effect may be seen on the scalp and around the eyebrows. For pregnancy and breastfeeding, you can look at the article “Medical Aesthetics in Pregnancy and Breastfeeding: Which Treatments Should Be Postponed, and What Should You Discuss with Your Physician?”.

Who should perform it, and where?

With IPL, the most important factors determining the result and safety are the right diagnosis and the right settings. Distinguishing whether a spot is a sun spot, melasma or a mole that needs to be examined is a medical assessment. For this reason it is recommended that the diagnosis and the decision on treatment be made by a physician who knows skin diseases and light-based treatments, and that the procedure be carried out under a physician’s responsibility.

For the general framework on who is authorised, see the article “Who Can Perform Medical Aesthetic Treatments? What You Need to Know as a Patient”. IPL devices used at home are designed for hair reduction; trying to treat dark spots or vessels with these devices increases the risk of burns and pigmentation.

Preparing for the procedure

• At the examination the dark spot or redness is diagnosed; if necessary the physician examines the spot with a magnifying instrument (a dermatoscope).
• Protect yourself from the sun in the weeks before the procedure; do not use sunbeds or tanning products. Your physician will tell you how long is needed.
• Report all the medicines, herbal products and products applied to the skin that you use. Ask your physician when to pause retinoids, acid-containing products and peels.
• If you have a history of cold sores, or have had pigmentation or a burn after laser or light treatment before, be sure to say so.
• Your physician may wish, especially in situations considered higher risk, to carry out a test pulse on a small area first and see how the skin reacts.
• On the day of the procedure there should be no make-up, perfume or sunscreen on the area; arrive with clean skin.

The day of the procedure, step by step

• Your medical history and expectations are reviewed; the informed consent form is read, your questions are answered and the form is signed.
• The skin is cleansed. Your eyes and those of everyone in the room are protected with special protective goggles or eye shields.
• A cold gel is applied to the area; the gel both helps to transmit the light and cools the surface.
• The handpiece is placed on the skin and the light pulses are delivered. With each pulse you may feel brief heat and a sensation like the snap of a rubber band.
• The level of discomfort varies from person to person. If you feel a burning sensation that is hard to bear, say so immediately; this may indicate that the settings need to be reviewed.
• The gel is wiped off, the skin is cooled and sunscreen is usually applied. Aftercare advice is given, and you can go home the same day.

After the procedure: the first 24 hours, the first week, the first month

• First 24 hours: redness resembling sunburn, a feeling of heat and mild swelling are common. A cool compress can be soothing; do not apply ice directly to the skin. Avoid hot showers, saunas, Turkish baths and intense exercise.
• First week: the targeted spots may darken within a few days and form fine crusts resembling coffee grounds. This is to be expected; do not scratch or rub the crusts off, and wait for them to fall away by themselves.
• First week: use a mild cleanser and moisturiser. Ask your physician when you can return to retinoids, acid-containing products and peels.
• First month and after: use a broad-spectrum sunscreen every day, and do not neglect a hat and shade. The sun both increases the risk of new pigmentation and shortens the result achieved.

For the general principles of aftercare, the article “Aftercare Following Medical Aesthetic Procedures: General Principles and Warning Signs” may also be a useful guide.

Expected side effects

• Redness and a feeling of heat: usually lessen within hours to a few days.
• Mild swelling: may last a few days, especially around the eyes and on the cheeks.
• Temporary darkening and fine crusting of spots: mostly fall away within a week or two.
• Bruising: sometimes seen after treatments aimed at vessels, and passes within days.

Less commonly, burns and blistering, a change in colour in the form of darkening or lightening of the skin, a cold sore flare-up, infection and scarring can occur. Colour changes mostly improve over months; however, in some people they may last a long time or may not reverse. Light reaching the eye without protection can cause serious eye damage. The causes and management of these problems are described in detail in the article “Burns and Pigmentation Changes after Laser and IPL: Darkening, Lightening and Scarring — Prevention and What to Do”.

Normal, consult a physician, or an emergency?

When is the result seen, and how long does it last?

With sun spots, the first change is mostly noticed within a week or two, as the darkened spots fall away. With redness and vessels, improvement is slower and appears as the sessions progress. Most people need several sessions weeks apart; the number of sessions is determined by the type of problem, how widespread it is and how the skin responds.

How long the result lasts depends largely on sun protection and on the underlying condition. Even if a treated sun spot fades, sun exposure leads to new spots. In ongoing conditions such as rosacea, new vessels and redness may appear over time; for this reason, repeat sessions at intervals may be needed. In melasma, the tendency for the pigmentation to return is high.

Realistic expectations: what can IPL not do?

• It does not erase every dark spot entirely and for good; nor does it prevent new spots from forming.
• It does not get rid of melasma; in some people it can make it worse.
• It does not cure rosacea; it can only reduce signs such as redness and vessels. Acne-like bumps require treatment with medicines.
• It is often not enough for thick, deep or bluish vessels or for leg veins.
• It does not correct deep wrinkles or sagging. Although some improvement in skin texture and tone has been reported, this effect is limited.
• It does not take the place of sun protection; without sun protection the result is short-lived.

Alternatives

For details of these methods, see the articles “Chemical Peels: What They Are, Who They Suit and What Recovery Involves” and “Thread Veins on the Face and Legs (Spider Veins): Why Do They Appear, and How Are They Treated?”. Which method is suitable for you should be decided together with your physician, who determines the type of spot or vessel at the examination. This content is for information; it does not replace an examination.