Dr Bhavin Garara
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Sun Damage

Sun Damage

Sun damage on the chest, neck, and hands is a common, gradually accumulating result of years of UV exposure to areas that are usually less protected than the face. It can appear as discrete age spots, diffuse mottling, redness from broken capillaries, and skin thinning. Poikiloderma of Civatte is a specific recognised pattern of sun damage often seen on the sides of the neck and the V of the chest. Treatment is layered: pigment clearance, vascular clearance, and regenerative skin treatments, alongside consistent daily SPF — without which any treatment is short-lived.

Medically reviewed by Dr Bhavin Garara, GMC 7155707 · Last reviewed: 16 June 2026

On this page

Poikiloderma of Civatte is a recognised medical condition, and more than one cause of mottled skin can look similar. This page is general information, not a diagnosis. Dr Garara will assess your skin and history in person, confirm what is actually going on, and only then discuss whether treatment is appropriate for you. Some skin changes — particularly new, changing, or asymmetric lesions — can indicate skin cancer or other conditions and benefit from dermatological or GP review before aesthetic treatment.

What it is

What Is Sun Damage?

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Sun damage — clinically photoageing — is the cumulative effect of ultraviolet light on the skin’s structural proteins, melanocytes, and small blood vessels over years. It typically appears as hyperpigmentation (age spots, diffuse tanning patterns, and patchy darkening), vascular change (broken capillaries and chronic redness), textural change (fine lines, crepey skin, loss of even tone), and skin thinning — loss of dermal density (atrophy) with prolonged exposure.

These can occur singly or together. Poikiloderma of Civatte is a specific combination — pigment, redness, and atrophy together — that affects the sides of the neck and the central chest.

Dr Bhavin Garara’s approach is targeted — identify which components of sun damage are present and treat each with the appropriate tool, rather than apply a single one-size-fits-all device.

Where it shows

Patterns of Sun Damage

  • Discrete pigmentation

    Individual age spots (lentigines) and freckles — usually well-defined dark marks. Most responsive to picosecond laser.

  • Diffuse mottling

    Patchy, less well-defined pigmentation across larger areas — combination of pigment laser and resurfacing.

  • Vascular component

    Broken capillaries and chronic redness — vascular/pigment laser is appropriate.

  • Poikiloderma of Civatte

    Combined pigment + vascular + atrophic pattern on the sides of the neck and V of the chest — needs a dual or triple-modality approach with particular care to skin fragility.

  • Skin thinning and atrophy

    Loss of dermal density alongside pigmentary change — regenerative skin treatments alongside pigment clearance.

What causes it

What Causes Sun Damage?

  1. 1

    Cumulative UV exposure

    The dominant cause. Most sun damage on the chest, neck, and hands reflects years of unprotected exposure — at the beach, in the garden, while driving, while walking.

  2. 2

    Lack of daily SPF

    The face is often the only area sunscreened daily; the neck, chest, and hands receive much less protection.

  3. 3

    Skin type

    Lighter Fitzpatrick types tend to show pigment and redness sooner; darker types tend to show post-inflammatory pigmentation in response to UV.

  4. 4

    Age

    Cumulative damage shows over decades.

  5. 5

    Specific occupational or lifestyle UV exposure

    Long-distance drivers, gardeners, outdoor sports, and those who have lived in sunny climates often have heavier sun damage.

Dr Bhavin Garara
Dr Bhavin Garara, MBBS, BMedSci, PGDip
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Dr Garara's approach

How Dr Garara Treats Sun Damage

At the clinics in London, Dr Garara assesses at consultation which components of sun damage are present, the Fitzpatrick skin type, the presence of any features that warrant dermatological / GP review (suspicious lesions, sudden change), and the area’s responsiveness to treatment. The plan usually layers pigment, vascular, and regenerative treatments, with conservative settings particularly on the décolletage (which scars more readily than the face).
  • Anatomy-led assessmentTreatment plans built around your unique facial structure and movement.
  • Personalised planCombinations chosen for your skin, goals, and lifestyle — not a one-size-fits-all protocol.
  • Natural resultsA refreshed, well-rested version of you — never a frozen or over-treated look.

Prevention

Prevention

Prevention is more effective than treatment, and treatment without prevention is short-lived.

Prevention

Features

Treatment Options for Sun Damage

Picosecond laser, vascular and pigment laser, non-ablative resurfacing, regenerative skin treatments, and radiofrequency microneedling.

Picosecond laser (PicoSure Pro)

Picosecond laser (PicoSure Pro)

Very short pulses of light energy designed to break down melanin clusters with reduced thermal effect — first-line for body-skin pigmentation.

See PicoSure Pro →
Vascular and pigment laser (Derma V)

Vascular and pigment laser (Derma V)

Targets visible blood vessels and reduces overall redness — used for broken capillaries, the redness of Poikiloderma, and any vascular component.

Non-ablative laser resurfacing (MultiFrax)

Non-ablative laser resurfacing (MultiFrax)

A 1550/1927nm dual-wavelength non-ablative fractional laser refines diffuse mottling and lifts generalised dullness with limited downtime.

See Multifrax laser →
Regenerative skin treatments

Regenerative skin treatments

Polynucleotides (Rejuran®), PDRN, multi-ingredient skinboosters (Profhilo, Sunekos, NCTF, klardie), and autologous PRP / platelet-derived exosomes address the atrophic component of photoageing.

Radiofrequency microneedling

Radiofrequency microneedling

Sylfirm X can be added where skin laxity accompanies photoageing.

See SkinPen microneedling →

Treatment is matched to the components present — pigment, vascular, atrophic — with conservative settings particularly on the décolletage.

Picosecond laser (PicoSure Pro)

  • Best for: Age spots and diffuse pigmentation
  • Downtime: 1–5 days of darkening and flaking
  • Lasts: Long-lasting with daily SPF

For discrete age spots and diffuse pigmentation, PicoSure Pro delivers very short pulses of light energy designed to break down melanin clusters with reduced thermal effect compared to longer-pulse lasers. It is the clinic’s first-line laser for body-skin pigmentation. Multiple sessions are typically needed.

Vascular and pigment laser (Derma V)

  • Best for: Broken capillaries, redness, Poikiloderma
  • Downtime: 1–3 days of mild redness or swelling
  • Lasts: Long-lasting

For broken capillaries, redness, and the vascular component of sun damage (including Poikiloderma), Derma V targets visible blood vessels and reduces overall redness.

Non-ablative laser resurfacing (MultiFrax)

  • Best for: Diffuse mottling and dullness
  • Downtime: A few days of flaking
  • Lasts: Long-lasting; results continue developing for months

MultiFrax (a 1550/1927nm dual-wavelength non-ablative fractional laser) refines diffuse mottling and lifts generalised dullness with limited downtime — typically a few days of mild flaking.

Regenerative skin treatments

  • Best for: Atrophy and thin skin from photoageing
  • Downtime: 1–2 days of mild bumps
  • Lasts: Around 6–12 months with a course

To improve the underlying skin quality and atrophic component of photoageing, polynucleotides (Rejuran®), PDRN, multi-ingredient skinboosters (Profhilo, Sunekos, NCTF, klardie), and autologous PRP / platelet-derived exosomes support fibroblast activity, hydration, and dermal thickness.

Radiofrequency microneedling

  • Best for: Photoageing with skin laxity
  • Downtime: 2–5 days of redness
  • Lasts: Long-lasting; collagen remodelling continues for months

Sylfirm X can be added where skin laxity accompanies photoageing.

Treatment for higher Fitzpatrick skin types (IV–VI) requires careful device selection and conservative settings to reduce the risk of post-inflammatory hyperpigmentation or, in some cases, keloid scarring. Dr Garara has particular experience in aesthetic medicine for skin of colour.

Considering treatment for sun damage?

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Compare at a glance

Treatments at a Glance

Picosecond laser

Best suited for
Age spots and diffuse pigmentation
Typical downtime
1–5 days of darkening and flaking
How long results last
Long-lasting with daily SPF
What it does
Breaks down melanin clusters

Vascular laser

Best suited for
Broken capillaries, redness, Poikiloderma
Typical downtime
1–3 days of mild redness or swelling
How long results last
Long-lasting
What it does
Targets visible blood vessels

Non-ablative laser resurfacing

Best suited for
Diffuse mottling and dullness
Typical downtime
A few days of flaking
How long results last
Long-lasting; results continue developing for months
What it does
Resurfaces the top layer

Regenerative skin treatments

Best suited for
Atrophy and thin skin from photoageing
Typical downtime
1–2 days of mild bumps
How long results last
Around 6–12 months with a course
What it does
Supports dermal density

Radiofrequency microneedling

Best suited for
Photoageing with skin laxity
Typical downtime
2–5 days of redness
How long results last
Long-lasting; collagen remodelling continues for months
What it does
Tightens and remodels

Downtime and duration figures are typical averages only. Individual results vary considerably. Dr Garara will give you a more personalised picture at consultation.

Safety & risk

Is Sun Damage Treatment Safe?

Energy-based pigment and vascular treatments are widely performed but the chest and neck scar more readily than the face. Conservative settings, careful test patches, and adequate intervals between sessions are essential. The risk of post-inflammatory hyperpigmentation in skin of colour is real and is managed by device choice and protocol tailoring.

We share this not to alarm you but because patients deserve full information. Dr Garara is happy to discuss specific risks at consultation. New, changing, or asymmetric lesions warrant dermatological or GP review before aesthetic treatment.
  • Qualified medical practitionerTreatment carried out by an experienced doctor with detailed anatomical training.
  • Reversal agents on handHyaluronidase and other complication-management tools are immediately available.
  • Full informed consentRisks, alternatives, and expected outcomes discussed in detail before any treatment.
Dr Bhavin Garara
Reviewed byDr Bhavin Garara

Frequently Asked Questions

Common questions about treating sun damage.

Read next

Related Concerns

Sun damage often appears alongside other neck, chest, and hand concerns. You may also want to read about:

Pigmented chestCrepey skinAgeing handsAge spotsPigmentation
← All hands, neck and décolletage concerns

For an overview of all the facial concerns we treat, visit our Hands, neck and décolletage hub.

Next step

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Consultation

Begin with a proper assessment.

Tell us a little about what you're looking for and we'll match you with the right consultation — at the clinic or virtually.

  • Your enquiry goes directly to Dr Bhavin's team.
  • We'll be in touch within one working day.
  • All consultations are strictly confidential.

This page is for general information and does not constitute medical advice. All treatments require a personal consultation. Suitability, risks, and expected outcomes will be discussed with you in detail before any treatment is carried out.