Pigment From the Sun
What Sun Damage and Brown Spots Are
Sun damage is the visible result of years of ultraviolet exposure: flat brown spots, dense freckling, blotchy pigment, rough texture, and background redness that appear first on the face, chest, shoulders, and hands, arriving earlier and more heavily in Scottsdale’s roughly 300 days of sun a year. At Aesthetica by Ashley Howarth MD, it is treated primarily with BBL HERO broadband light, along with MOXI, HALO, and chemical peels depending on skin type, with HydraFacial for summer maintenance between laser seasons.
Sun damage is the visible change in skin caused by years of ultraviolet exposure: flat brown spots called solar lentigines, dense freckling, blotchy or uneven pigment, a rough or leathery surface, and a background of fine lines and redness. It appears first on the face, chest, shoulders, and backs of the hands because those areas get the most sun. In Scottsdale, with about 300 days of sun a year and a summer UV index that regularly reaches 11 or higher, it arrives earlier and more heavily than in most of the country. At Aesthetica by Ashley Howarth MD, the med spa of Howarth Plastic Surgery in Scottsdale, brown spots and photodamage are treated primarily with BBL HERO, Sciton’s broadband light in the IPL class, and with MOXI, HALO, and chemical peels depending on skin type and how much texture accompanies the pigment.
Two distinctions matter before any treatment. First, sun spots are not melasma. Melasma is a hormone- and heat-sensitive pigment disorder that appears as symmetric patches on the cheeks, forehead, and upper lip, and it can worsen with the same light treatments that clear sun spots, so the team identifies it at the skin assessment and treats it differently. Second, not every brown spot is a sun spot. Arizona has one of the highest skin cancer rates in the country, and a spot that is irregular, changing, or unlike its neighbors is evaluated by a dermatologist before any cosmetic treatment. Summer maintenance with HydraFacial keeps skin clear between laser seasons.
What the Sun Leaves Behind
What Patients With Sun Damage Notice
Most people who come to Aesthetica by Ashley Howarth MD for sun damage describe the same pattern: the spots multiplied over a few Arizona summers, they no longer fade in winter, and makeup covers them less well each year. The common findings are these.
- Flat brown spots on the cheeks, temples, and forehead
- Freckling across the nose, chest, and shoulders that no longer fades
- Spotted, mottled backs of the hands
- A blotchy, uneven skin tone under makeup
- A tan that never fully goes away between summers
- Skin that looks older than the face around it
Pigment is the most correctable sign of sun damage. Broadband light clears most solar lentigines in a short series, and the result holds as long as daily sunscreen continues. Prevention of new spots is the part no treatment can do for you.
Surgeon-Directed Care
More Tools in the Toolbox: Why a Plastic Surgeon Directs This Care
Aesthetica by Ashley Howarth MD is the medical aesthetics practice of Ashley Howarth, MD, FACS, a board-certified plastic surgeon and instructor in plastic surgery at Mayo Clinic. Brown spots are the one cosmetic concern that can hide a medical one. Lentigo maligna, an early melanoma, can look like a large, uneven sun spot on the face of a long-term Arizona resident, and light treatment of that spot can lighten it enough to delay a diagnosis. Dr. Howarth sets the protocol that every pigmented lesion is examined before it is treated, that anything irregular or changing goes to a dermatologist first, and that darker skin types are treated at settings that do not trade one pigment problem for another. In a state with one of the highest skin cancer rates in the country, that examination is the point of coming to a physician-led practice.
Aesthetica by Ashley Howarth MD is the med spa of a plastic surgery practice, and that changes what can be offered. Most skin concerns are treated without surgery, and most patients never need it. When skin care and nonsurgical treatment reach their limit, the conversation does not end at the door: the same physician evaluates the next step, from deep laser skin resurfacing performed by Dr. Howarth to eyelid surgery, facelift, and neck lift. A surgeon directing the plan means more tools in the toolbox, and an honest answer about which one you need.
SCOTTSDALE · MODERN OFFICE SETTING
Where to Start
Who This Is For, and What Happens First
Treatment for sun damage at Aesthetica by Ashley Howarth MD is for adults with brown spots, freckling, or uneven pigment on the face, neck, chest, arms, or hands who are untanned at the time of treatment and can protect the treated skin from sun for two to four weeks afterward. The skin assessment comes first. A member of the physician-led team examines the distribution and character of the pigment, separates solar lentigines from melasma and from any lesion that needs a dermatologist, records your Fitzpatrick skin type and recent sun exposure, and reviews retinoid and skincare use. Fair skin with discrete spots usually starts with a BBL HERO series. Diffuse pigment with texture usually adds MOXI or HALO. Darker skin types, Fitzpatrick IV to VI, are treated at conservative settings or with peels and MOXI rather than broadband light. In summer the plan usually begins with sunscreen correction and HydraFacial, with light and laser treatment reserved for October to April.
Dr. Ashley Howarth, MD, FACS is a board-certified plastic surgeon and an instructor in plastic surgery at Mayo Clinic. Aesthetica by Ashley Howarth MD is the medical aesthetics brand of her practice, Howarth Plastic Surgery, at 7373 N. Scottsdale Road, Suite C150, Scottsdale, Arizona 85253.
Matched to the Pigment, Not the Menu
How Sun Damage and Brown Spots Are Treated in Scottsdale
BBL HERO Broadband Light
BBL HERO is the first treatment for discrete brown spots and freckling on fair to medium skin, typically 2 to 3 sessions about four weeks apart between October and April.
BBL HERO is the first treatment for discrete brown spots and freckling on fair to medium skin. Broadband light is absorbed by melanin in the spot, which darkens within a day and flakes away over 7 to 14 days. Most patients need 2 to 3 sessions about four weeks apart, scheduled between October and April, with one maintenance session each fall.
MOXI for Diffuse Pigment
MOXI is a gentle 1927 nm fractional laser that lifts diffuse, blotchy pigment with minimal downtime, and is the safer option for darker skin types and when melasma is part of the picture.
MOXI is a gentle 1927 nm fractional laser that lifts diffuse, blotchy pigment and improves tone across the whole face with 1 to 2 days of pinkness. It is the pigment treatment for darker skin types and for patients who want minimal downtime, usually as a series of 3 sessions. It is also the safer option when melasma is part of the picture.
HALO for Pigment Plus Texture
HALO combines ablative and non-ablative wavelengths to treat sun damage that has moved into rough texture, enlarged pores, and fine lines, with results that build over months.
Chemical Peels and HydraFacial
Chemical peels lift superficial pigment for patients who cannot use light, while HydraFacial with a brightening booster keeps tone even during the summer between laser seasons.
Chemical peels in a series of 3 to 6 lift superficial pigment and are the resurfacing choice for patients who cannot use light. HydraFacial with a brightening booster is the summer maintenance treatment that keeps tone even between laser seasons without pigment risk.
Planning at a Glance
Sessions, Downtime, and Season
Sessions, downtime, and the months each brown spot treatment is scheduled in Scottsdale. Individual plans are set at the skin assessment.
| Treatment | Sessions | Downtime | Scottsdale season |
|---|---|---|---|
| BBL HERO | 2 to 3, four weeks apart | Minimal; spots darken and flake for 7 to 14 days | October to April; one maintenance session each fall |
| MOXI | 3, four weeks apart | 1 to 2 days of pinkness, 3 to 5 days of fine texture | October to April; select summer cases |
| HALO | 1 to 2 | 5 to 7 days of peeling | October to April |
| Chemical peels | Series of 3 to 6 | 1 to 5 days of flaking, by depth | Year-round; lighter peels in summer |
| HydraFacial | Monthly | None | Year-round; the summer maintenance treatment |
A Visit Built Around Your Skin Type
What to Expect at a Sun Damage Visit at Aesthetica by Ashley Howarth MD
A brown spot visit at Aesthetica by Ashley Howarth MD has three parts: an examination that decides whether the spots can be treated with light at all, the treatment itself, and a written sun plan. The examination is the part that separates a medical practice from a spa.
Every spot is looked at before any spot is treated
The team examines the pigment under magnification, notes your Fitzpatrick skin type and recent sun exposure, distinguishes sun spots from melasma, and flags any lesion that needs a dermatologist first. Tanned skin postpones light and laser treatment.
Light, laser, or peel matched to your skin
BBL HERO takes about 20 to 30 minutes for the face with a snapping warmth at each pulse. MOXI and HALO use a topical numbing cream first. Peels take 15 to 20 minutes. Treated spots darken over the first day; that is the expected sign the light reached the pigment.
A sun plan in writing
You leave with a mineral SPF 30 or higher to reapply every two hours outdoors, instructions not to pick at flaking spots, a hat-and-shade plan for two weeks, and the date of your next session in the series.
Clear Information. Informed Choices.
Safety and Limitations of Treating Sun Damage
Light and laser treatment of brown spots is safe when the settings match the skin type and the skin is untanned. Most side effects are expected and short-lived. The one that matters most in Arizona is post-inflammatory hyperpigmentation, a new darkening of treated skin that is more likely on tanned skin, on darker skin types treated too aggressively, and on skin exposed to sun while healing. That risk is why the team screens skin type, schedules most treatment between October and April, and treats darker skin conservatively.
Possible Side Effects Include
- Redness, warmth, and mild swelling for a few hours to two days
- Spots that darken and flake for 7 to 14 days
- Post-inflammatory hyperpigmentation, especially with sun or tanned skin
- Temporary dryness, sensitivity, or sandpaper texture after MOXI
- Rarely, blistering, crusting, temporary lightening, or scarring
What Treatment Cannot Guarantee
- Permanent clearance while daily sun exposure continues
- A complete result from a single session
- Improvement of melasma with broadband light
- A result identical to another patient's photos
- A substitute for skin cancer screening
What Happens After BBL HERO
Recovery After Brown Spot Treatment
Recovery from BBL HERO for brown spots is short and predictable, and it looks worse before it looks better. The treated spots darken, lift, and flake away on their own. The timeline below is for BBL; MOXI follows a similar course with 1 to 2 days of pinkness, and HALO adds 5 to 7 days of visible peeling.
The skin feels warm like a mild sunburn for a few hours. By evening the treated brown spots look darker and more defined, sometimes described as coffee grounds on the skin. Mineral sunscreen goes on before leaving the office. No makeup for the rest of the day; a gentle cleanser and moisturizer that night.
Redness settles within one to two days and makeup is fine. The darkened spots lift and flake away on the face over roughly a week. Do not pick, scrub, or exfoliate; let the pigment shed on its own. Retinoids and acids stay paused. Hats, shade, and reapplied SPF 30 or higher every two hours outdoors.
Flaking finishes on the face by about two weeks and on the chest and hands by three to four weeks, where skin turns over more slowly. Tone looks more even and remaining spots are fainter. The second session in the series falls at about four weeks, once the skin is calm and still untanned.
After 2 to 3 sessions most solar lentigines are cleared or markedly lighter. The result holds as long as daily sunscreen continues; new spots reflect new sun, not returning old ones. Most Scottsdale patients book one BBL HERO session each October and use HydraFacial through the summer.
Before & After
Sun Damage, Before and After Treatment
Brown spot results are best judged in photographs taken in the same light before the first session and four weeks after the last. Aesthetica by Ashley Howarth MD maintains before-and-after galleries for BBL HERO, MOXI, and HALO, and the team can show you cases that match your skin type, the areas you want treated, and the time of year during your visit.
Patient Case Summaries
Selected Sun Damage & Brown Spots Case Summaries
These deidentified case summaries illustrate how the physician-led team at Aesthetica by Ashley Howarth MD plans treatment for sun damage and brown spots in Scottsdale. They include long-term residents and new arrivals, fair and darker skin types, summer and laser-season timing, single treatments and combinations, and a consultation in which the recommendation was a dermatologist before any laser. Each summary connects the patient’s concern and skin assessment with the treatment performed or the recommendation made.
Case 01
Long-term resident
Thirty years of Scottsdale sun and a face full of discrete brown spots
Patient presentation
A woman in her sixties who had lived in Scottsdale since her thirties asked about dozens of flat brown spots on her cheeks and temples and a mottled tone on her chest. She had used sunscreen only at the pool.
Skin assessment
The assessment found numerous uniform solar lentigines on fair, Fitzpatrick II skin with mild background redness, no melasma pattern, and no lesion with irregular borders or recent change. She was untanned in early November.
Procedure performed
A series of three BBL HERO sessions to the face and chest spaced four weeks apart, with a daily mineral SPF 30 started at the first visit and retinoid paused the week before each session.
Clinical rationale
Discrete lentigines on fair skin respond best to broadband light, and a November start let the whole series finish in February, well ahead of spring UV.
Follow-up
After the third session the facial spots had cleared and the chest tone was even; she returns for one maintenance session each October.
Case 02
New arrival
Freckling that appeared after one Arizona summer
Patient presentation
A woman in her thirties who moved from Seattle the previous spring noticed dense new freckling across her nose, cheekbones, and shoulders after her first summer and asked whether it was permanent.
Skin assessment
The freckling was ephelides and early lentigines on Fitzpatrick II skin, with dehydration from the dry air and a routine that contained no daily sunscreen. She was still lightly tanned in September.
Recommendation
A daily mineral SPF 30 and hydrating routine immediately, a HydraFacial in September, and a two-session BBL HERO series scheduled for late October and November once the tan faded.
Clinical rationale
New freckling from a single season clears quickly with broadband light, but treating tanned skin raises the pigment risk, so protection came first and light came after the tan faded.
Follow-up
The two fall sessions cleared most of the freckling; she now treats sunscreen the way she treated an umbrella in Seattle.
Case 03
Darker skin type
Uneven pigment on Fitzpatrick V skin, and why BBL was not the answer
Patient presentation
A man in his forties with deep brown skin reported darker patches along his cheekbones and forehead after years of outdoor work and asked for the same laser a coworker had used.
Skin assessment
The assessment showed diffuse post-inflammatory and sun-related hyperpigmentation on Fitzpatrick V skin. Broadband light carries a meaningful risk of further darkening at this skin type, and the pigment was diffuse rather than in discrete spots.
Procedure performed
A topical pigment program for six weeks, then a series of three conservative-density MOXI sessions in winter combined with light chemical peels between sessions. BBL HERO was not used.
Clinical rationale
On darker skin types the non-ablative 1927 nm fractional laser at conservative settings, paired with peels and topical suppression, evens pigment with far less risk than broadband light.
Follow-up
Over one winter the patches lightened noticeably, and he continues the topical program and daily SPF year-round with a single MOXI session each laser season.
Case 04
Summer timing
A request for BBL in July before a September wedding
Patient presentation
A woman in her fifties asked for a BBL series in July to clear the sun spots on her face and chest before her daughter’s wedding in mid-September.
Skin assessment
Her skin was tanned from a summer of swimming, and she could not realistically avoid sun for two to four weeks after each session. The pigment risk of treating in that state outweighed the benefit before the event.
Recommendation
Two HydraFacial treatments with a brightening booster in July and August, a corrected mineral SPF habit, a light chemical peel three weeks before the wedding, and a BBL HERO series booked for October.
Clinical rationale
Hydration and superficial resurfacing are safe in full sun and improve tone enough for photographs; broadband light on tanned skin was more likely to leave marks than remove them.
Follow-up
She was pleased with her skin at the wedding and completed the BBL series between October and December.
Case 05
Combination plan
Sun spots plus rough texture treated with BBL and HALO together
Patient presentation
A man in his fifties who hiked most weekends described brown spots on his temples and forehead along with a rough, leathery texture and enlarged pores he had accepted as normal.
Skin assessment
The assessment found solar lentigines with significant photodamage of the skin surface on Fitzpatrick III skin, untanned in December, with no lesion needing referral.
Procedure performed
BBL HERO followed immediately by HALO in a single January visit, with a second BBL HERO session six weeks later and strict sun protection on the trail.
Clinical rationale
Pigment alone responds to broadband light, but texture from years of sun needs fractional resurfacing; combining the two in one visit in peak laser season addressed both with one recovery period.
Follow-up
After a week of peeling the texture was smoother and the spots had cleared; at three months the improvement continued, and he now hikes in a wide-brimmed hat.
Case 06
Honest guidance
One spot among many that needed a dermatologist before a laser
Patient presentation
A woman in her seventies who had lived in Arizona all her life asked to have a scattering of brown spots on her left cheek treated with BBL before a family reunion.
Skin assessment
Most spots were typical solar lentigines, but one larger spot had an irregular edge, uneven color, and had grown over the past year according to her family. The physician-led team does not treat a lesion it cannot characterize.
Recommendation
Referral to a dermatologist for evaluation of the single lesion before any light or laser treatment. BBL HERO for the surrounding spots was held until the dermatologist’s clearance.
Clinical rationale
Lentigo maligna can resemble a large sun spot on long-exposed skin, and light treatment could lighten it enough to delay diagnosis. In a state with one of the highest skin cancer rates in the country, screening comes first.
Follow-up
The lesion was biopsied and managed by the dermatologist, and she returned the following season for a BBL HERO series on the remaining sun damage.
From First Visit to a Plan You Can Keep
Booking, Planning, and Follow-Up at Aesthetica by Ashley Howarth MD
Aesthetica by Ashley Howarth MD is a medical practice with a spa’s convenience. Established patients book online. New patients can book online or request a consultation, and the team responds usually the same day.
Online booking or a consultation request
Book a skin assessment directly online, or request a consultation and describe the spots you notice and when they appeared. Either path starts with the same examination of your pigment.
A series, not a single appointment
You leave your first visit with a written plan: BBL HERO, MOXI, HALO, or peels; how many sessions; which months they fall in; and the sunscreen and home routine that protects the result.
Maintenance timed to laser season
Most Scottsdale brown spot plans repeat annually: a fall BBL HERO session, summer HydraFacial, year-round mineral sunscreen. A-List members have the next season scheduled before they leave the last one.
Your Questions, Answered
Sun Damage & Brown Spots Frequently Asked Questions
For discrete brown spots on fair to medium skin, a series of 2 to 3 BBL HERO broadband light sessions between October and April is the most effective first treatment. Diffuse pigment or darker skin types are treated with MOXI, and sun damage with rough texture is treated with HALO. Aesthetica by Ashley Howarth MD in Scottsdale sets the plan at the skin assessment.
BBL HERO delivers broadband light that is absorbed by the melanin in a brown spot and converts to heat, which breaks up the pigment. The spot darkens within a day, then flakes off over 7 to 14 days as the skin sheds it. Most patients need 2 to 3 sessions about four weeks apart, then one maintenance session a year.
Most patients need 2 to 3 BBL HERO sessions spaced about four weeks apart to clear solar lentigines on the face. The chest and hands may need one more because the skin turns over more slowly. After the series, one session each fall maintains the result as long as daily sunscreen continues.
Light and laser treatments for pigment are generally deferred to October through April in Arizona because they require untanned skin and two to four weeks of strict sun avoidance afterward. In summer, Aesthetica by Ashley Howarth MD uses HydraFacial, light chemical peels, and a corrected sunscreen routine, then starts the BBL HERO series in the fall.
Broadband light carries a higher risk of post-inflammatory hyperpigmentation on Fitzpatrick IV to VI skin, so it is used at conservative settings or replaced with MOXI at conservative density, chemical peels, and topical pigment suppression. The skin assessment identifies your skin type before any treatment is chosen.
Sun spots, or solar lentigines, are discrete flat brown spots from ultraviolet exposure that respond well to broadband light. Melasma is symmetric patchy pigment on the cheeks, forehead, or upper lip driven by hormones, heat, and light, and it can worsen with BBL. Melasma is treated conservatively with topicals, strict sunscreen, and gentle resurfacing.
Yes. Most brown spots are harmless sun damage, but lentigo maligna, an early melanoma, can resemble a large uneven sun spot, and Arizona has one of the highest skin cancer rates in the country. Any spot that is irregular, changing, multicolored, or unlike its neighbors is referred to a dermatologist before any cosmetic treatment.
MOXI is a non-ablative 1927 nm fractional thulium laser that targets the upper layers of skin where sun-related pigment sits. It evens blotchy tone, lightens diffuse freckling, and improves early texture with 1 to 2 days of pinkness and a few days of fine sandpaper feel. It is usually done as a series of 3 sessions about four weeks apart.
Treated spots do not return, but new spots form wherever sun exposure continues. In Scottsdale, with about 300 days of sun a year, that means daily broad-spectrum SPF 30 or higher, hats, and shade are part of the treatment, and most patients schedule one BBL HERO maintenance session each fall.
Established patients can book online. New patients can book online or request a consultation through this page; the team responds usually the same day. Aesthetica by Ashley Howarth MD, the med spa of Howarth Plastic Surgery, is located at 7373 N. Scottsdale Road, Suite C150, Scottsdale, Arizona 85253, and can be reached by call or text at 480.535.5021.
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