color
Light brown, dark brown, grey-blue, and reddish-brown may have different treatment goals.
PREMIUM PIGMENTATION GUIDE
Guide to treating melasma, pigmented spots, and pigmentation explained by a dermatologist
Melasma, freckles, solar lentigines and post-inflammatory hyperpigmentation require different treatment considerations. This guide explains clues for distinguishing pigmentation, how options such as laser toning, picosecond lasers and IPL are selected, and what to consider during recovery. Individual treatment plans and recovery vary.
01: · PIGMENT MAP
How do you identify brown spots?
The first step in pigmentation treatment is not choosing a laser, but distinguishing the type of lesion. First, check whether it is large and dull brown, small and has clear boundaries, occurs at the site of inflammation, appears gray-blue and deep, and whether the surface is rough or has recently changed.
| category | What the patient usually feels | Clues checked during treatment | Basic treatment principles |
|---|---|---|---|
| Melasma | Broad, irregular brown color on both cheekbones, forehead, and upper lip | Left and right symmetry, relationship with season, heat, hormones, and ultraviolet rays, accompanied by flushing | Photoprotection and prescription treatment are basic, and laser and light treatment are optional and combined. |
| freckles | Small spots that are visible from childhood or become darker after sunlight | Small, numerous, and with relatively clear boundaries | Consider targeted pigment laser or IPL and continue photoprotection to prevent new lesions |
| solar lentigo | Relatively large brown spots that appear on sun-exposed areas | The boundaries are clear and often remain regardless of the season. | Check whether it is benign first and then select local laser, IPL, or other removal methods. |
| Post-inflammatory hyperpigmentation (PIH) | Acne, eczema, brown marks on wounds or procedure sites | Consistent with the location of previous inflammation/irritation | Reduce the cause of inflammation and irritation first, prioritize prescriptions and photoprotection, and apply equipment selectively. |
| dermal pigment | Gray, bluish-gray, or brown spots on cheekbones and temples | The color appears deep and may appear on both sides in adulthood. | After diagnosis, the wavelength appropriate for the depth is selected, and multiple observations and long-term follow-up may be required. |
| Raised/keratinous lesions | Brown lesions that are thick or rough and sticky when touched | Surface, thickness, keratin, growth pattern | A flat pigment laser and other removal methods may be needed, so diagnosis is required first. |
| changing lesions | Asymmetry, irregular border, multiple colors, growth, bleeding, itchiness | Appearance different from other lesions, changes over time | Before cosmetic laser, dermatological examination, dermoscopy, and biopsy if necessary |
Six things we look at during consultations
boundary
Check whether it is cloudy and wide or a clear spot.
depth
Estimate whether it is epidermal-centered or dermal pigment mixed.
distribution
Check whether it is symmetrical, whether it is an area exposed to sunlight, or whether there is inflammation.
surface
Check whether it is completely flat, rough or chunky.
change history
Check to see if they are new, enlarged, have changed color, or have worsened since a previous procedure.
02: · MELASMA
Why can't melasma be removed with just one powerful laser?
Melasma is not just a problem of melanin, but is a chronic and recurrent pigment disease that involves ultraviolet rays, visible light, heat, hormones, inflammation, blood vessels, and the photoaged dermal environment. PIH or rebound worsening may occur after strong energy, so it is controlled over a long period of time based on skin reaction.
Optical protection
Use plenty of broad-spectrum sunscreen and reapply during outdoor activities. At melasma, you can review tinted products containing iron oxide to suit your skin tone.
prescription treatment
Topical tranexamic acid, hydroquinone, retinoid, azelaic acid, and combination prescriptions are taken into consideration skin condition, pregnancy/nursing status, and potential for irritation. The suitability of oral tranexamic acid is determined after checking the risk of blood clots and medical history.
Inflammation/barrier management
Dermatitis, excessive exfoliation and friction are reduced, and if redness is present, pigment and vascular reactions are also assessed.
optional energy equipment
Fractional devices such as laser toning, picosecond, IPL, thulium/erbium glass/needle radiofrequency are used to assist with skin tone, depth, and previous reactions. No device can eliminate the possibility of recurrence.
03: · FRECKLES & LENTIGINES
Are freckles and solar lentigo treated differently from melasma?
Freckles and solar lentigo are usually superficial spots with relatively clear boundaries and can be considered for topical targeted treatment. However, if melasmas are spread together or have an irregular shape, we do not treat them all with the same energy and first check whether they are benign lesions.
Selection criteria for topical spot treatment
- small, clear spotsYou may want to consider targeted pigment treatments from the Picosecond or QSwitch series.
- Small spots and redness in large areasTogether, you can review the IPL series.
- Color tone, skin texture and photoagingIf you are concerned, you can consider additional fractional equipment such as thulium/erbium glass/needle radiofrequency.
- Recent tanning, dark skin tone, history of PIHIf so, determine the energy and area conservatively and consider test treatment.
Targeted spots may temporarily darken and develop microscabs following treatment. Do not force it off, but keep moisturizing and blocking UV rays. Even if the existing spots have faded, new lesions may form if exposure to UV rays continues.
04: · POST-INFLAMMATORY HYPERPIGMENTATION
How do you treat skin marks and post-inflammatory pigmentation?
PIH is a condition in which melanin remains after inflammation from acne, eczema, wounds, burns, friction or procedures has subsided. The first step is to reduce new inflammation and recurrent irritation, and laser is an adjunctive treatment of choice in stable pigments.
red or purple marks
Vascular changes may be central. First distinguish between active inflammation and vascular response.
brown or grey-brown marks
Melanin is likely central. If the two changes come together, the blood vessels and pigments can be divided into plans.
- 1Control active acne, dermatitis, and folliculitis first.
- 2Reduces irritants that increase inflammation, such as friction, scrubbing, self-comedone extraction, and repeated peeling.
- 3Use UV protection and prescription topical products according to the condition of the skin barrier.
- 4After sufficient time has passed, low-stimulation laser or fractional treatment is selected for the remaining lesions.
- 5If it becomes darker after the procedure, do not repeat the same energy and recheck the cause and diagnosis.
People with darker skin may have PIH for longer and have a higher risk of pigmentation occurring again after the procedure. In this type, treatment that does not create new inflammation is more important than ‘getting rid of it quickly’.
05: · DERMAL PIGMENT
What is the pigment that looks deep gray-blue?
Grayish-blue or brownish-gray spots that appear bilaterally on the cheekbones and temples may be dermal pigments such as acquired bilateral nevus of Ota (ABNOM). Because the appearance may overlap with melasma or solar lentigo, you should not self-diagnose or repeat the same toning just by looking at photos.
Dermal pigmentation may require multiple treatments and ample intervals. Q-Switch Nd:YAG or picosecond lasers can be selected based on depth and skin tone, but are evaluated step by step, taking into account the possibility of swelling, scabs, and PIH.
06: · DIAGNOSIS FIRST
For some pigments, diagnosis comes first before laser?
Lesions that are unusually different from other spots or have recently changed shape should be examined by a dermatologist first, as the laser can change the tissue and delay diagnosis. Although the findings below do not all indicate skin cancer, it is safe to determine whether they are benign through dermoscopy and, if necessary, biopsy before deciding on a treatment method.
- Asymmetry where the left and right shapes are clearly different
- Changes in which boundaries become jagged or blurred
- Multiple colors such as brown, black, red, and white are mixed within one lesion.
- Becoming larger or thicker in a short period of time
- Recurrent bleeding, oozing, itching, pain, or stubborn wounds
- An ‘ugly duckling’ lesion that is noticeably different from other moles around it.
07: · DEVICE ROLES
What are the different roles of Seoul N Dermatology’s pigmentation equipment?
Diagnosis of lesions and target wavelength, pulse width, energy, and irradiation area are more important than the name of the equipment. The table below is a consultation role for the equipment currently available on the website, and actual application and settings will be determined after examination.
| equipment | method | When considering in consultation | Important things to note |
|---|---|---|---|
| mark view | Multiple light source skin photography | Comparison of the standard photo and distribution of color tone and redness by light source, progress under the same conditions | It is not a treatment and does not confirm the diagnosis through imaging alone. |
| piccolo premium | picosecond laser | Selected topical pigments, deep pigments, or lack of response to existing treatments. | Picoseconds are not automatically superior for all melasma·pigmented spots, wavelength and skin tone are important. |
| Helios 3 | Q switch Nd:YAG series | Toning or targeted treatment depending on pigment depth and goal | We do not look at skin reactions, do not fix the number of times or energy, and check for the possibility of PIH, reactive pigmentation, or hypopigmentation. |
| element | Long pulse 532 nm Nd:YAG series laser | In some cases, there is a brown tint with superficial blood vessels and redness, or red marks from acne remain. | Depending on your skin tone, recent tanning, and inflammation, settings are adjusted to account for the likelihood of PIH and purpura. |
| Select V | IPL series | When there are widespread superficial spots and redness together | Consider melasma, darker skin tone, and recent tanning at risk for exacerbation and PIH. |
| Ravian | 1927nm thulium series fractional | In some cases, both superficial skin tone and rough skin texture and photoaging occur together. | Redness, warmth, micro-scabbing, dryness and possible PIH may occur. |
| Selas Evo | Non-ablative fractional laser | Adjunctive treatment in cases where skin texture, pores, photoaging and color tone problems exist together | It has a different role from equipment that directly removes local pigment and confirms the recovery response. |
How do I connect the equipment according to my concerns?
| main concern | Check first | Equipment direction available for consultation |
|---|---|---|
| Wide, cloudy melasma | Skin barrier, redness, previous toning reaction, photoprotection | Individual review of the possibility of assistance with Piccolo and Lavien, focusing on hypoallergenic toning such as Helios 3 |
| Bright freckles/solar lentigo | Benignity, depth, recent tanning | Choose between Piccolo Premium, Helios 3 or Cellec V according to the lesion. |
| Brown and red together | Proportion of vascular marks and melanin | Examine pigment and blood vessel targets separately using Element's long pulse 532 nm Nd:YAG series laser or Cellec V. |
| Brown skin marks after inflammation | Persistence of new inflammation, skin barrier, self-comedone extraction | Prioritize treatment of the cause of inflammation and topical medication, and select Q-Switch, Pico, and Fractional after stabilization. |
| Gray-blue dermal pigment | Melasma·ABNOM differentiation, pigment depth | Stepwise treatment review focusing on Q-switch Nd:YAG or picosecond laser |
| Concern about color tone, pores, and skin texture | Active inflammation and PIH risk | Additional review of fractional products such as La Vien and Sellas Evo |
This table is not a prescription for selecting equipment prior to your appointment. Even for the same person, the plan for each area may be different, such as managing melasma on the entire cheek with low stimulation and treating individual clear spots with separate targeted treatment.
08: · COURSE & MAINTENANCE
What is expected after pigmentation treatment?
The recovery process varies depending on the equipment, wavelength, energy, treatment area and skin response. Rather than judging the results based solely on brightening or swelling immediately after the procedure, changes in color tone and side effects are evaluated together over several weeks under the same lighting and shooting conditions.
Day of procedure – 3 days
Redness, warmth, mild swelling, and stinging may occur. Avoid aggressive facial cleansing, saunas, vigorous exercise, scrubs, and exfoliation for as long as instructed.
Approximately 3–10 days
Spots treated with topical targeted treatment may temporarily darken or develop microscabs. Maintains moisture and light protection without forcefully removing it.
Approximately 2–6 weeks
Under the same shooting conditions, evaluate whether color tone becomes lighter, bounceback worsens, or PIH occurs.
maintenance
Reduce ultraviolet rays, visible light, heat and friction and continue using prescribed topical medications and moisturizing. Rather than viewing relapse as a treatment failure, we adjust the maintenance plan.
DERMATOLOGIST'S PRINCIPLE
Dermatologist's principles of pigmentation treatment
The key to pigmentation treatment is not the strongest equipment, but accurate diagnosis and setting a ‘stop and look standard’. If the color darkens or the skin becomes sensitive after treatment, the inflammation, barrier, diagnosis, and treatment interval are rechecked without repeating the same energy.
- Type and depth of pigment
- Skin tone, recent tanning and history of PIH
- Whether accompanied by flushing, acne, or dermatitis
- Pregnancy, lactation, medications, and possible photosensitivity
- Previous laser types, frequency, reactions and side effects
- Critical timeline and acceptable recovery period
09: · FAQ
Frequently Asked Questions About Pigment Treatment
The type of lesion and skin reaction take precedence over the name of the equipment or the set number of times. The answers below are for general understanding and actual treatment may vary after examination.
How to distinguish between melasma and pigmented spots?
Melasma often appears wide and blurred on both cheekbones, forehead, and upper lip, while freckles and solar lentigo are often individual spots with relatively clear boundaries. In reality, multiple pigments may exist together, so distribution, color, boundaries, surface, and change history must be confirmed through examination.
Can melasma disappear with just one laser treatment?
Melasma is a chronic and recurrent disease involving ultraviolet rays, visible light, heat, hormones, inflammation, and the dermal environment. Rather than a single strong treatment, it is common to selectively apply energy equipment based on skin reaction based on photoprotection and prescription treatment.
Is the more laser toning the better?
More times is not always better. If the treatment is too frequent or the accumulated energy is excessive, hypopigmentation, post-inflammatory pigmentation, and rebound worsening may occur, so the skin reaction and progress must be checked each time and the interval and settings must be adjusted.
Is pico laser always better than regular laser?
Picosecond lasers also have different roles depending on wavelength, pulse width, energy, lesion depth, and skin tone. It is not automatically superior to all melasmas and pigmented spots and is selected when necessary after diagnosing the lesion.
Can IPL be used for melasma?
IPL may be considered in some cases where there is a combination of diffuse superficial spots and flushing. However, in cases of melasma, dark skin tone, or recent tanning, the indications and settings are conservatively judged considering the possibility of post-inflammatory pigmentation or worsening.
Is the same treatment for red and brown acne marks?
Red or purple marks are more likely to be vascular changes, while brown or grey-brown marks are more likely to be melanin-driven. The two changes can occur together, allowing you to create a treatment plan that controls active acne first and then separates vascular and pigment targets.
When does the scab fall off after a pigment laser?
After topical targeted treatment, the spots may temporarily darken or develop fine scabs, which usually fall off naturally within a few days to about 10 days. Do not force it off, but keep moisturized and block UV rays. The speed of recovery depends on the treatment method and skin reaction.
What should I do if the pigment becomes darker after the procedure?
The possibility of post-inflammatory hyperpigmentation or rebound worsening should be checked. It is important not to repeat the same energy right away, but to re-evaluate the inflammation, skin barrier, diagnosis, medications taken, and procedure intervals to adjust the treatment direction.
Can I receive pigmentation treatment while pregnant or breastfeeding?
During pregnancy and lactation, pigment changes may be affected by hormones, and there are limitations in the selection of medications and procedures that can be used. Be sure to inform the patient whether you are pregnant or breastfeeding, plan with a focus on photoprotection and safe management, and determine the necessary treatment individually.
Can a suddenly changed mole be removed with a pigment laser?
Lesions with asymmetry, irregular borders, multiple colors, rapid growth, bleeding, or poorly healing wounds should be diagnosed before cosmetic laser treatment. A treatment method must be decided after confirming benignity through dermoscopy and, if necessary, biopsy.
CONTENT STANDARD & SAFETY
Content standards and safety guidelines
- Date of original creation
- 2026-08-29
- Last modified date
- 2026-09-01
- information personality
- Medical Information Reviewed by a Board-Certified Dermatologist
Treatment options may vary depending on your skin condition, medical history, medications you are taking, whether you are pregnant or breastfeeding, recent tanning, and recovery time. This information is intended to aid general understanding and is not a substitute for face-to-face examination and individual diagnosis. Equipment application, energy, interval and frequency are determined after examination.
Following a pigment laser, redness, swelling, microcrusting, PIH, rebound exacerbations, and hypopigmentation may occur. Please inform us of pregnancy/nursing, recent tanning, photosensitivity medications, active dermatitis/infection, keloids or past PIH, and reactions to existing pigment treatment during your consultation.
REFERENCES
Public page references
- 1.McKesey J, Tovar-Garza A, Pandya AG. Melasma Treatment: An Evidence-Based Review. Am J Clin Dermatol. 2020;21:173-225.
- 2.Castanedo-Cazares JP, et al. Near-visible light and UV photoprotection in the treatment of melasma. Photodermatol Photoimmunol Photomed. 2014;30:35-42.
- 3.Lee YS, et al. The Low-Fluence Q-Switched Nd:YAG Laser Treatment for Melasma: A Systematic Review. Medicina. 2022;58:936.
- 4.Feng J, et al. Efficacy and safety of picosecond laser for the treatment of melasma: a systematic review and meta-analysis. Lasers Med Sci. 2023;38:84.
- 5.Mukovozov I, et al. Treatment of Lentigines: A Systematic Review. Dermatol Surg. 2023;49:17-24.
- 6.Mar K, et al. Treatment of Post-Inflammatory Hyperpigmentation in Skin of Colour: A Systematic Review. J Cutan Med Surg. 2024;28:473-480.
- 7.Lee WJ, et al. Q-Switched Nd:YAG Laser Therapy of Acquired Bilateral Nevus of Ota-like Macules. Ann Dermatol. 2009;21:255-260.
- 8.Modena DAO, et al. Thulium laser (1927 nm) for dermatological conditions: a systematic review. Lasers Med Sci. 2025;40:518.
- 9.Zipser MC, et al. Melanoma after laser therapy of pigmented lesions—circumstances and outcome. Eur J Dermatol. 2010;20:334-338.
- 10.American Academy of Dermatology. What to look for: ABCDEs of melanoma.
Interpretation of evidence Note: Pigment laser research requires different skin tone, equipment, wavelength, energy, treatment interval, and evaluation method, so the results cannot be directly applied to a specific patient or specific equipment. References are not intended to guarantee effectiveness, but rather to support the principles of diagnosis, safety, and treatment.
SEOUL N DERMATOLOGY · OFFICIAL NAVER BLOG ARCHIVE
Dr. Park Se-young's Melasma, Pigmentation, Nevus of Ota & Tattoo Removal Clinical Column Archive (35 columns)
Complete topic-indexed archive of clinical columns, peer-reviewed paper reviews, and treatment principles written directly by Board-Certified Dermatologist Dr. Park Se-young on the official Naver Blog (blog.naver.com/csderma).
Featured Deep-Dive Clinical Columns
Red Brow Tattoo Remnants
Cheongju Tattoo Removal: Understanding Reddish Brow Remnants (Ferric Oxide Reduction) After Laser Removal & 532nm Pico Care
Fact-checks the photochemical reduction of iron-oxide brow pigments into reddish tones and details staged 532nm and Picolo Premium laser clearance without scarring.
Pediatric Nevus of Ota Course
Cheongju Nevus of Ota: How Much Can a Child's Cheek Nevus of Ota Fade? 13-Session Pigment Laser Clinical Course
Documents the 13-session clinical progression of pediatric dermal Nevus of Ota treated with staged high-precision pigment lasers while preserving epidermal integrity.
Vitiligo SST Grafting Case
Cheongju Vitiligo Case: Awakening 'Melanin Seeds' with SST Skin Grafting After 6 Months of Plateaued Excimer Phototherapy
Reports a stable vitiligo case refractory to 6 months of phototherapy where SST micro-punch skin grafting implanted viable melanocytes to restart perifollicular repigmentation.
4 Pillars of Skin Quality
Cheongju Dermatology '4 Pillars of Skin Quality' Part 2: Tone, Texture, Elasticity & Barrier Balance Strategy
Translates the vague wish for 'better skin' into 4 measurable clinical metrics: tone (pigment/vascular), texture (pores), elasticity (dermal density), and barrier hydration.
Porcelain Glow Skin Optics
Cheongju Porcelain Glow Skin Science: Optical Light Reflection on the Stratum Corneum & Dermis
Explains skin radiance through optical physics: smooth stratum corneum alignment for specular reflection combined with dense, clear dermal collagen for subsurface scattering.
4 Skin Metrics Diagnostic Guide
Cheongju Dermatology '4 Pillars of Skin Quality' Part 1: Turning Vague Skin Concerns into Objective Diagnostics
Shows how multi-spectral Mark-Vu imaging and dermatologist evaluation quantify pigment, vasculature, pores, and laxity to prioritize treatments without over-treating.
Complete Chronological Column Index (29 columns)
- 2025-10-31Brightening Red-Light Phototherapy ('White Tanning'): Revitalizing Skin Tone and Recovery
- 2025-10-07The Truth About 'White Tanning' (Red-Light Therapy): Restoring Your Natural Skin Tone and Barrier Health
- 2025-09-16Lavieen BB Laser (1927nm Thulium Laser) Reels Video: Achieving Filter-Free Skin
- 2025-09-16Is 'Glass Skin' a Mirage or Reality? A Dermatologist's Guide to Authentic Skin Radiance
- 2025-09-16Entering the Filterless Skin Era: Lavieen 1927nm Thulium ('BB') Laser
- 2025-09-06Why You Shouldn't Ignore a Child's Persistent 'Blue Spot' (Ectopic Mongolian Spot)
- 2025-08-17A Journey of Hope: Treating a Child's Persistent Blue Birthmark (Ectopic Mongolian Spot)
- 2025-07-13Everyday 'Blue Light' from Screens vs. Therapeutic 'Red Light': Comparing Their Effects on Skin Pigmentation
- 2025-07-13Is the Skin Tone in Your Mirror Simply What You Were Born With? Constitutive vs. Facultative Pigmentation
- 2025-07-13Intense Summer Sunlight and Skin Health: Why East Asian Skin Has Built-In Photoprotection (and Its Unique Pigment Risks)
- 2025-06-16Why Do Skin Tones Differ Across Populations? Comparing East Asian and Caucasian Skin Through the Science of Melanin
- 2025-06-14Extra UV Caution by the Water and Beach: Preventing Surface Reflection Sunburn and Photodamage
- 2025-03-14Spring UV Surge (UVA/UVB): Sunscreen Application Rules to Prevent Photoaging
- 2025-01-25Why You Still Need Sunscreen in Winter and Indoors: Long-Wavelength UVA and Photoaging
- 2024-04-14Cheongju Dermatology: Why Spring Sunlight Is Harsher on Melasma and Pigmentation
- 2024-03-24Cheongju Dermatology: Comprehensive Guide to UV Protection and Sunscreens
- 2024-01-28Glutathione: The Master Antioxidant for Skin Brightening and Cellular Defense
- 2023-12-16Latest Literature Review on Melasma (Part II) — From an Oxidative Stress Perspective
- 2023-12-14Understanding Melanin Pigment: Biological Role vs. Hyperpigmentation Care
- 2023-11-28Latest Literature Review on Melasma Pathogenesis and Treatment (Part I)
- 2023-11-09The Long Clinical Journey of Treating Pigmented Skin Lesions
- 2023-09-21Introducing the 'Laviola' Brightening & Pore Texture Program
- 2023-09-03Carboxy Therapy: Bohr Effect Microcirculation and Skin Revitalization
- 2023-08-19Introducing Lavieen: 1927nm Thulium Fractional 'BB Laser'
- 2022-12-27Introducing Picocare / Picolo Premium Picosecond Laser for Pigmentation & Scars
- 2021-10-15A Board-Certified Dermatologist's Brief Reflections on Melasma (Part I)
- 2021-10-10Clinical Thoughts on Sunscreen Selection and Daily Application (Part I)
- 2021-09-27Cheongju Pigmentation Clinic: Tailored Laser Solutions for Melasma, Freckles & Lentigines
- 2021-09-15Cheongju Melasma Laser Care: Restoring Clear and Radiant Skin Tone
Check the type of pigment first and consult.
Rather than deciding on equipment in advance, it will be helpful for consultation if you tell us about changes in the lesion, previous treatment response, medications you are taking, and important schedules.