Dark marks are not the same as scars
One of the most common points of confusion at consultation is patients calling flat post-acne discoloration "scarring." Post-inflammatory hyperpigmentation (PIH) is not a scar — the skin's texture is completely normal, it's purely a pigment response to the inflammation of a healed breakout. That distinction matters, because PIH and true acne scarring are treated in almost entirely different ways.
PIH is more common — and more stubborn — on medium-to-deep skin tones, where the skin's inflammatory pigment response is naturally more pronounced. Treated with the wrong laser or overly aggressive settings, it's also possible to make PIH worse rather than better, which is why Dr. Mortazavi treats it with the same conservative, skin-tone-matched philosophy used for melasma, not with a one-size-fits-all approach.
PIH vs. true acne scarring
Pigment Only
Post-Acne Dark Marks (PIH)
Flat — no change to skin texture
Brown, red, or purple discoloration at former breakout sites
Often fades on its own over 6–12+ months without treatment
Treated with PicoLazer, conservative settings
Structural
True Acne Scarring
Textural — depressed (rolling, boxcar) or raised
Skin structure itself has changed, not just color
Does not resolve on its own over time
Dr. Mortazavi's clinical note
Most patients have both at once. It's very common to have some true scarring alongside PIH from the same breakout cycle — the scarring needs structural treatment like subcision, while the discoloration around it needs pigment-focused treatment like PicoLazer. Addressing both in the right order gets a noticeably better result than treating either alone.
What to expect
01
Assessment
Dr. Mortazavi confirms PIH vs. true scarring, and checks that active acne is reasonably controlled before starting.
02
Conservative Treatment
Skin-tone-matched PicoLazer settings target the discoloration without triggering additional pigment response.
03
Gradual Fading
Marks lighten progressively across sessions rather than disappearing all at once.
04
Protect
Daily SPF prevents new PIH from forming if breakouts recur, and protects treated skin from re-darkening.
Who benefits most
Strong candidates
Flat brown, red, or purple marks left after acne has healed
Active breakouts reasonably controlled or resolved
Any Fitzpatrick skin type — including medium and deep skin tones
Patients frustrated with marks lingering many months after clear skin
Worth addressing first
Active, uncontrolled acne — treat the breakouts before the marks
Textured or depressed marks — likely true scarring, needs subcision
Very recent marks (under 2–3 months) — often fade meaningfully on their own first
Marks combined with visible scarring — a combination treatment plan works best
If you have both dark marks and textural scarring, your treatment plan may combine PicoLazer for the pigment with our signature acne scar subcision protocol for the structural component — assessed and sequenced at consultation.
Pricing
Treatment pricing
PicoLazer — targeted spot or full-face session
Most PIH improves within 2–4 sessions. By appointment only.
View Pricing & Book →
Frequently asked questions
What is post-acne hyperpigmentation (PIH)?
Post-inflammatory hyperpigmentation, or PIH, is flat discoloration that develops at the site of a healed acne breakout. It is caused by excess melanin production triggered by inflammation during the healing process. PIH is not scarring — the skin's texture is unaffected — but the discoloration can persist for months without treatment.
Is PIH the same as acne scarring?
No. PIH is flat discoloration with normal skin texture, while true acne scarring involves a change in the skin's structure — depressed rolling or boxcar scars, or raised scars. PIH typically fades on its own over time, though this can take 6 to 12 months or longer without treatment. True scarring does not resolve on its own and requires treatments such as subcision or laser resurfacing.
Is PicoLazer safe for treating PIH on darker skin tones?
Yes, with the correct approach. PIH occurs more frequently and can be more persistent on medium-to-deep skin tones, and treating it with the wrong laser or overly aggressive settings can worsen the condition. PicoLazer's dual wavelength allows Dr. Mortazavi to select gentler, skin-tone-appropriate settings to reduce PIH without triggering additional pigment response.
How many sessions does PIH treatment take?
Most PIH improves within 2 to 4 PicoLazer sessions, spaced 3 to 4 weeks apart, though this varies based on how long the marks have been present and the patient's skin tone. Older, more established PIH can take longer to clear than recent marks.
Should I treat active acne before treating PIH?
Yes. Treating PIH while acne is still actively breaking out means new marks will continue to form as old ones clear. Active acne should be reasonably controlled first, so treatment addresses existing discoloration rather than chasing new marks as they appear.
How much does PIH treatment cost at Plump Medical Spa?
Post-acne dark mark treatment with PicoLazer is available as a targeted spot treatment or a full-face session for more widespread PIH. Current pricing is available on the Plump Medical Spa treatment menu.
Ready to clear your post-acne marks?
Consultations Tuesday through Saturday. Every session performed personally by Dr. Mortazavi.