Not all pigment is the same, and not all lasers treat it the same way. This guide walks through how to figure out what you're actually dealing with, and which treatment fits it.
Before choosing a laser, it helps to understand that "pigmentation" isn't one thing. It's a category that includes several different conditions, each behaving differently and sitting at different depths in the skin. The right laser depends entirely on which one you actually have.
Most patients don't have a single, uniform type of pigment — they have a combination of surface sun damage and deeper, more resistant discoloration. In these cases, one laser treating one depth leaves part of the problem unaddressed. The Pigment Protocol was built specifically for this, combining PicoLazer and ReVive Thulium across a structured series to treat both depths in the same plan.
Most patients come in already having decided which laser they want, usually based on what's trending. My job is to figure out what's actually happening in their skin first — the type, depth, and cause of the pigment — and recommend the treatment that matches that, not the one they walked in asking for. Every consultation starts there.
How do I know if my pigment is surface-level or deep?
Surface pigment, like sun spots and dullness, tends to look brown and sits close to the skin's texture, sometimes visibly raised or textured. Deeper pigment, like melasma or stubborn discoloration, often appears more gray-brown or blue-toned and does not respond as quickly to surface-level treatments. A consultation with imaging or a Wood's lamp exam can confirm the depth definitively.
What laser is best for melasma?
PicoLazer is generally preferred for melasma because its photoacoustic mechanism generates minimal heat, and heat is a known trigger for melasma flare-ups. Heat-based treatments like IPL carry more risk of worsening melasma.
What laser is safest for darker skin tones?
PicoLazer and ReVive Thulium are both considered safer options for darker skin tones because they generate less heat than IPL or more aggressive ablative lasers, lowering the risk of post-inflammatory hyperpigmentation.
What if I have both surface and deep pigment?
Many patients have a mix of both. In these cases, combining treatments that address different depths, such as PicoLazer for deeper pigment and ReVive Thulium for surface brightness, produces more complete correction than relying on a single modality.
How much downtime should I expect from a pigmentation laser?
Downtime varies significantly by device. ReVive Thulium requires about 1 to 3 days. PicoLazer typically has minimal to no visible downtime. IPL is similar. More aggressive resurfacing lasers like CO2 require 7 to 14 days.
Dr. Mortazavi will assess your skin and identify what's actually driving the discoloration before recommending a treatment.