Four devices treat pigment here, and they aren't interchangeable. The wrong one on the wrong skin doesn't just underperform — it can leave the pigment worse than it started.
Three things decide it: what kind of pigment you have, your skin tone, and how much downtime you'll actually accept. Melasma and sun damage are different problems requiring different devices — and treating melasma with heat can make it permanently worse. If you take one thing from this page, take that.
It's a category holding several different problems that happen to look similar in a mirror. They sit at different depths, respond to different mechanisms, and one of them gets worse when treated the way the others are.
Which is why the useful question isn't which laser is best — it's what have I actually got.
Not a diagnosis, but it points in a direction. Which of these describes yours?
Mixed answers are normal. Plenty of people have sun damage and melasma together, which is exactly the situation where treating it as one problem goes wrong.
Melasma responds to heat as a trigger. Intense pulsed light, ablative resurfacing, and aggressive settings on almost any device can provoke rebound darkening — and rebounded melasma is considerably harder to manage than what you started with.
This is the most common way pigment treatment goes wrong, and it usually isn't an exotic complication. It's a reasonable device used on the wrong diagnosis, often at a practice that didn't distinguish melasma from sun damage before treating.
If your pattern matches the melasma column above, that changes the entire approach — device, settings, intervals, and what happens alongside the laser. The melasma protocol.
Intense pulsed light gets marketed heavily for pigmentation. Here it's used for redness — flushing, broken capillaries, diffuse vascularity — and pigment goes to Pico.
The reason is mechanism: IPL works by melanin absorbing heat, which makes it least suitable exactly where pigment problems are most common and hardest to fix. What IPL is used for.
Treat only the surface and deeper unevenness remains. Reach deeper and overall brightness doesn't shift much. Repeating either alone tends to plateau partway — which is the usual reason a course of one device produces improvement that stops short.
The Pigment Protocol combines both across a series at a fixed price. It's built for sun damage and mixed photodamage — melasma is deliberately excluded, because a prepaid course is the wrong structure for a condition that may need the plan changed after session one.
Flat marks after acne frequently fade on their own given several months and consistent sun protection. Treating them means paying for something that was resolving anyway.
Recently tanned skin shouldn't be treated at all. Elevated melanin means elevated risk of the exact pigmentary change you came to fix. Wait for it to fade.
Pigment during pregnancy or breastfeeding often settles afterward. Treating through it is treating a moving target.
And without sun protection, none of this holds. Sun-driven pigment returns with sun exposure — usually within a season.
Most people arrive having already chosen their laser, usually from something they saw online. The device is the last decision, not the first — what matters is what the pigment actually is, and the difference between melasma and sun damage changes everything downstream. Get that wrong and the treatment can leave someone worse off than doing nothing, which is a hard conversation to have afterward.
How do I know if my pigment is surface or deeper?
Some signs point one way. Well-defined solid brown spots in sun-exposed areas, appearing gradually over years, usually sit near the surface. Grey-brown or muted patches that are broadly symmetrical across both cheeks or the forehead, particularly if they appeared during pregnancy or after starting hormonal contraception, suggest something deeper and hormonally driven. Examination under angled light or ultraviolet imaging is more reliable than a mirror, because depth changes which device is appropriate and getting it wrong has consequences.
Which laser is best for melasma?
Picosecond laser is generally the appropriate starting point, because it fragments melanin mechanically rather than by heating it — and heat is a melasma trigger. Heat-based devices including intense pulsed light and ablative resurfacing can provoke rebound darkening that leaves the pigment worse than before treatment. That said, no laser cures melasma. It is chronic and hormonally driven, and treatment works only alongside topical management and rigorous sun avoidance.
Which is safest for darker skin tones?
Picosecond laser carries the lowest risk, because minimal heat means minimal inflammatory stimulus, and post-inflammatory hyperpigmentation is driven by inflammation. Superficial thulium is next. Ablative resurfacing carries real risk in deeper skin and intense pulsed light is generally inappropriate, since it relies on melanin absorbing heat. Lower risk is not no risk — deeper Fitzpatrick types need conservative settings and longer intervals whatever the device.
What if I have both surface and deeper pigment?
Common, and it is the usual reason a single course of one device produces partial improvement. Combining a picosecond device with superficial thulium treatment across a series addresses both levels. This is only appropriate where the pigment is sun-driven — mixed pigment that includes melasma is handled with an individualised plan rather than a set series.
How much downtime should I expect?
It varies substantially. Picosecond treatment typically produces little visible downtime, sometimes mild redness for a day. Superficial thulium produces one to three days of redness followed by light shedding over about a week. Ablative erbium runs three to ten days depending on mode and depth. CO2 runs five to ten days of active healing followed by weeks of fading pinkness.
Can the wrong laser make pigmentation worse?
Yes, and this is the reason the choice matters more than it appears. Heat-based treatment of melasma can trigger rebound darkening that is harder to manage than the original pigment. Aggressive treatment in deeper skin tones can cause post-inflammatory hyperpigmentation lasting months. Treating recently tanned skin raises the same risk. These are not rare complications of exotic devices — they follow from using a reasonable device on the wrong patient.
Is laser always the answer for pigmentation?
No. Flat marks left after acne often fade without any intervention given time and sun protection, and treating them is spending money on something that was resolving anyway. Some pigment is better managed topically. And any lesion that is changing in size, shape, or colour needs examining rather than treating — that is a dermatology referral, not a laser decision.
The device is the last decision. Dr. Mortazavi identifies what's driving the pigment first — including when the answer is topicals, time, or nothing at all.
4667 MacArthur Blvd, Suite 310 — Newport Beach, CA 92660
(949) 568-7544 — info@plumpmedicalspa.com
Tuesday – Saturday, 10am – 6pm