What are these white spots on my face???

Hi Dr. I, I have been suffering from hypopigmentation under both eyes (nearer the outer corners and on the cheekbones, worse on the left than the right) since last fall (about seven months in total).....I tried everything, from using just plain soap and water (oatmeal soap) and sunblock (SPF 45) and nothing else product wise, to BioOil, to Palmer's Cocoa Butter Dry Oil, to that plain old big tub of Eucerin. Finally over a month ago, I went in to see a skin esthetician (out of a local plastic surgeon's office) who recommended the Obagi "Nu Derm" line of skincare. I have been using this religiously ever since (and ONLY this, no outside moisterizers, soaps, washes, etc. ) including the sunblock that is provided with the starter kit. (Really like this sunblock, it is greaseless, scentless and makes my makeup go on like a dream!)....anyway, the skin under both of my eyes, nearer the outer corners, and also on the actual cheekbones but much more pronounced on the left side is seemingly BRIGHT white without makeup and especially in the morning. I DID used to sleep on my sides and retain fluid which made this skin area stretch and shrink for a long time, (this was after a separate phone consult with a NYC plastic surgeon who viewed the pics I sent him of this with me online/via phone in 'real time"). He suggested that fillers might make them less noticable, etc. (not really much explanation of the whiteness/lack of pigment though, he thought it might be from a vitamin deficiency possibly)....he was wonderful though and suggested starting to sleep with my head elevated at night (been doing that ever since January and no more bags in the morning), better vitamin intake and better diet. However this mentioned skin on the cheeks especially seems worse and more wrinkly in addition to being BRIGHT WHITE in the mornings when I wake up. I avoid direct sun like the plague these days and NEVER leave the house without a GOOD sunblock and sunglasses (a ballcap too on days off). Do you have any idea if this could be permanent pigment loss? A dermatologist told me that it is NOT vitiligo which is what I first suspected back when it appeared initially back in the fall but that I have a mottled complexion and sunscreen should be my best friend (as it is and has been these past months)...she also said this is most likely sun damage and could or might not repigment on its own.its been four months since that diagnosis appt. and still no change.....Is there any hope this could be blended better (if it is permanent) by using the Obagi Nu Derm (I don't put under my eyes but was advised by my esthetician to use it from the cheekbone "down" which I have done since day one)....

Wow  – okay –  you gave a lot of good information here and the bottom line is still this…….you need an accurate diagnosis!   I would guess that most board certified dermatologists in this country, after reading your question, would vote for a tiny biopsy to find out exactly what this is.  It’s the only way to know for sure.  Was that Dermatologist you saw Board Certified?   Go to AAD.org to find out!   Even if he/she was, I think an academic center (University Hospital) dermatology clinic would be the place to go, if possible. 

There are several skin diseases that can cause this kind of whitening to occur and it’s impossible to treat it accurately without a good diagnosis!   Please do some research online and get on the phone today and make an appointment.   All the skin creams and well meaning advice are not going to help in this situation.      Hope this helps.  Dr. I

Dr. Brandith Irwin, MD

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