Why "pigmentation" isn't one thing
Almost every patient who comes to Plump Medical Spa for pigment concerns describes it the same way: "dark spots" or "discoloration." But sun spots, melasma, and post-acne marks are three genuinely different conditions — different causes, different depths, and critically, different tolerances for how aggressively they can be treated.
Treating melasma the way you'd treat a sun spot is one of the most common reasons patients say a laser treatment "made things worse." Understanding which type you actually have is the first step to getting it treated correctly.
The three main types
PatternScattered, well-defined, flat brown spots
CauseCumulative UV exposure over years
LocationFace, hands, chest, shoulders
TreatsFastest — often 1–3 sessions
PatternSymmetric, diffuse patches, both sides of face
CauseHormones (pregnancy, birth control) + sun
LocationCheeks, forehead, upper lip, chin
TreatsSlowest, conservative — 4–8 sessions
PatternFlat marks at former breakout sites
CauseInflammation from healed acne
LocationAnywhere acne previously occurred
TreatsModerate — typically 2–4 sessions
How to tell them apart at home
A physician assessment is the most reliable way to confirm your pigmentation type — but these questions give you a strong starting signal before you book.
Three questions to ask yourself
A simple self-check
01
Is it symmetric on both sides of your face? Melasma tends to mirror itself — cheeks, forehead, or upper lip on both sides. Sun spots and PIH are usually scattered or one-sided, following wherever exposure or breakouts happened to occur.
02
Did it start or worsen with pregnancy, birth control, or hormonal changes? This is the hallmark trigger for melasma. Sun spots and PIH are not hormonally driven.
03
Is it sitting exactly where a pimple used to be? If the mark traces the outline of a former breakout, it's very likely post-acne pigmentation (PIH), not sun damage or melasma.
Most patients have some overlap — sun spots and PIH together, or melasma with a few isolated sun spots layered on top. A physician assessment at consultation maps out the distribution so each type gets treated at the right intensity within the same plan.
Why the distinction changes your treatment
Factor
Sun Spots
Melasma
Post-Acne (PIH)
Treatment intensity
Direct, faster
Conservative, gradual
Moderate, cautious
Rebound risk
Low
High if too aggressive
Moderate on deeper skin tones
Recurrence
Low, unless re-exposed
High — chronic condition
Low once acne is controlled
Typical sessions
1–3
4–8
2–4
This is why the same device — PicoLazer — is used for all three conditions at Plump, but never with the same settings. Learn more about each condition specifically: sun spot removal, melasma treatment, and post-acne dark mark treatment.
Body pigmentation is treated as its own category too. Hands, chest, and body skin heal differently than facial skin. If your primary concern is on your hands, chest, or body rather than your face, see our dark spot removal guide for hands, chest & body.
Frequently asked questions
What is the difference between melasma, sun spots, and post-acne pigmentation?
Melasma is a symmetric, diffuse, hormonally-driven pattern typically on the cheeks, forehead, and upper lip, prone to worsening with aggressive treatment. Sun spots are well-defined, scattered brown spots caused by cumulative UV exposure, generally the most responsive to treatment. Post-acne pigmentation (PIH) is flat discoloration at former breakout sites caused by inflammation, distinct from true acne scarring. Each requires a different treatment approach and intensity.
Can I have more than one type of pigmentation at once?
Yes, and it's common. Many patients have sun damage layered with melasma, or post-acne marks alongside sun spots. A physician assessment identifies the distribution of each type so the treatment plan addresses them with appropriately different intensity, rather than treating everything identically.
Which type of pigmentation is easiest to treat?
Sun spots are generally the most straightforward and fastest to treat, often clearing in 1 to 3 sessions with more direct laser settings. Post-acne pigmentation typically takes 2 to 4 sessions. Melasma is the most complex, usually requiring 4 to 8 sessions with conservative settings due to its tendency to worsen with aggressive treatment.
How do I know if my pigmentation is melasma?
Melasma tends to appear as symmetric, diffuse patches on both sides of the face — cheeks, forehead, upper lip, or chin — often triggered or worsened by pregnancy, birth control, or other hormonal changes, and typically worsens with sun exposure. Unlike sun spots, melasma is rarely a single isolated spot; it presents as broader, blotchy discoloration. A physician assessment is the most reliable way to confirm melasma versus another pigmentation type.