Removing age spots and pigmentation with CryoPen

What are solar lentigines and why do they appear?

Solar lentigines, commonly called age spots or sun spots, are flat patches of increased pigmentation that develop on sun-exposed skin over time. They form when melanocytes (the cells that produce skin pigment) become overactive in localised clusters, usually in response to cumulative UV exposure. Unlike freckles, which are often hereditary and appear in childhood, solar lentigines typically emerge after decades of sun exposure and concentrate on the hands, décolletage, face and forearms.

The spots are benign but can look uneven or aged, which is why many patients seek treatment for cosmetic reasons. In my clinic, I see them most commonly in patients over 50, though earlier onset is increasingly common in people who spent significant time outdoors or in sunny climates when younger.

How CryoPen works on age spots

CryoPen is a handheld device that delivers a controlled, precise jet of extremely cold gas to the surface of the skin. The cold induces rapid freezing of excess melanin in the lesion without damaging the surrounding healthy tissue. The mechanism is selective: the concentrated cold ablates the melanocytes responsible for the pigmentation while leaving the dermis and deeper structures largely intact.

The device uses difluoroethane, which is gentler than traditional liquid nitrogen and allows for shorter, more controlled bursts. In clinical studies of cryotherapy for solar lentigines, efficacy ranges from 37% to 71%, depending on lesion depth, skin type and the number of treatment cycles. Most lesions respond within one or two sessions.

What I appreciate about CryoPen is the precision. I can target an individual spot without affecting the surrounding skin, which is crucial for delicate areas like the décolletage or thin skin on the hands.

The healing timeline: what to expect week by week

Understanding the healing process helps you avoid anxiety and poor aftercare decisions. Here is what typically unfolds after treatment:

• · Immediately after: You will feel a sting and see redness. The treated spot may look slightly darker or raised. This is normal.
• · First 24 hours: Swelling develops, often mild. The area remains red and may feel tender. A small blister or crust may begin to form.
• · Days 2-4: The crust or blister thickens and darkens. The skin around it may remain pink. Do not pick, scratch or deliberately remove the crust.
• · Days 5-10: The crust gradually loosens and lifts away naturally. Underneath, you will see new, often noticeably pink or lighter skin. This is fresh epidermis.
• · Week 2 onwards: The pink colour gradually fades as blood flow normalises and the new skin blends with surrounding tissue. Full settlement typically takes 1-3 weeks, though blending can continue subtly beyond that.

The treated spot will likely appear darker in the first few days before it flakes away. This is the body's natural response and not a sign that treatment has failed.

Sun protection: non-negotiable for 4-6 weeks

This is where many patients stumble. The new skin revealed after the crust sheds is highly photosensitive. Without rigorous sun protection, two things happen: the treated area can develop new pigmentation, undoing the treatment, or it heals unevenly, with patches darker or lighter than surrounding skin.

For 4-6 weeks post-treatment, you must use broad-spectrum sunscreen SPF 30 or higher, reapply every 2 hours if outdoors, and consider physical sun avoidance where practical. On the hands and décolletage, where CryoPen is often used, this means wearing gloves or long sleeves during peak sun hours, or simply staying in the shade. I recommend my patients treat this period as seriously as they would after a chemical peel.

If you are unable to commit to sun protection, postpone treatment until a season when you can. Picking at the crust or rubbing the area also delays healing and increases the risk of uneven pigmentation. Let the crust fall off on its own.

What CryoPen cannot treat: melasma and post-inflammatory hyperpigmentation

Not all pigmentation is the same, and CryoPen has clear limits. The most important contraindication is melasma, a condition characterised by symmetric patches of hyperpigmentation, often on the cheeks, forehead and upper lip. Melasma is triggered by hormonal changes, genetic predisposition and sun exposure. Cryotherapy is neither safe nor effective for melasma and can worsen it. Melasma requires entirely different approaches, such as tranexamic acid injections or topical depigmenting agents.

Post-inflammatory hyperpigmentation (PIH) is another scenario where CryoPen is inappropriate. This is pigmentation that develops after an injury, inflammation or previous aesthetic treatment. In patients with darker skin types especially, cryotherapy carries a significant risk of inducing or worsening PIH, creating a situation where the treatment causes more pigmentation than it resolves. In such cases, tranexamic acid or other systemic approaches are safer.

This is why a proper consultation matters. During assessment, I distinguish between solar lentigines (discrete, well-demarcated spots from sun damage) and other pigmentation disorders. If a patient comes in with melasma or a history of PIH, I will not recommend CryoPen and will instead discuss more suitable options.

A short safety note on practitioner selection

CryoPen is widely available, but the quality of assessment and aftercare varies enormously. Some practitioners will treat any spot presented to them without properly evaluating whether it is a suitable lesion. Others will not give clear aftercare guidance, leaving patients surprised by redness or confused about sun protection.

Ensure your practitioner takes time to examine the lesion, confirms it is a solar lentigo (and not melasma or PIH), discusses realistic expectations including the healing timeline, and provides written aftercare instructions. A good consultation should answer your questions and feel unhurried.

Realistic expectations and follow-up

CryoPen is effective, but not universally. Some lesions respond completely in one session. Others require a second treatment 4-6 weeks later. Very deep or stubborn spots may not resolve entirely but will typically lighten significantly. Age spots on the hands and décolletage, where skin texture is often varied, may leave faint marks even after successful treatment.

After treatment, it is normal for the skin to look slightly different in the short term. The new skin may be paler initially, then gradually blend. If uneven healing occurs despite good sun protection, a second session or topical treatments can refine the result.

I recommend a two-week follow-up review to assess healing and plan any further treatment. At Visage Aesthetics, this review is included as part of the CryoPen treatment package.

Key takeaways

• · Solar lentigines respond well to CryoPen because the cold selectively freezes excess melanin.
• · Healing takes 1-3 weeks, with the crust shedding naturally to reveal fresh skin beneath.
• · Sun protection SPF 30+ for 4-6 weeks post-treatment is essential and non-negotiable.
• · CryoPen is not suitable for melasma or post-inflammatory hyperpigmentation; these require different approaches.
• · Choose a practitioner who takes time to assess lesion suitability and provides clear aftercare guidance.

Common questions