Key facts
- What a freckle is
- A small, flat epidermal deposit of melanin that darkens with sun and fades without it
- Wavelength logic
- Short wavelengths such as 532 nm for superficial pigment; longer wavelengths kept for deeper or darker-skin work
- What to expect
- Immediate greying or whitening, then a fine crust that flakes away on its own
- Risks specific to freckles
- Darkening around treated spots, pale dots if over-treated, and a changing mark being mistaken for a freckle
- Why they return
- Sun exposure prompts new freckles in skin that is inclined to make them; protection continues
- Fee
- Set in writing after assessment; see how fees are quoted
How are freckles confirmed, and what else could they be?
Freckles are confirmed by their look, their distribution and their history before pico laser is offered. True freckles, called ephelides, are small, flat, light-brown dots on sun-exposed skin that darken in sunny months and fade when the sun is avoided, and they often run in families. Dr Sin Yong examines them with a dermatoscope where needed, because a sun spot, a flat mole, early melasma and, uncommonly, a lentigo maligna can all be called a freckle by the person wearing it.
The distinction changes the plan. A solar lentigo, the sun spot, is a larger, fixed deposit that does not fade in winter and often sits in older or more sun-damaged skin. Melasma makes symmetrical patches rather than dots and is provoked by heat. Any mark that is changing in size, shape or colour, has an irregular edge or is darker than its neighbours is examined first and may be referred to a dermatologist before any laser is considered. The facial pigmentation guide sets out how the browns are told apart; the freckles removal article covers why freckles come back.
What does pico laser do to a freckle?
Pico laser fragments the melanin in a freckle with a very short pulse, so the pigment is broken up mainly by a pressure effect rather than by heat and is then cleared by the skin. A freckle is a superficial target, so the wavelength chosen is usually a short one, such as 532 nm, which melanin absorbs strongly and which does not penetrate far. The 785 nm picosecond emission can be used where freckles are denser or the skin darker, because it is absorbed less by the surrounding epidermis.
Each freckle is treated as a spot rather than across the whole face. The visible endpoint on the day is an immediate greying or whitening of the dot, which fades over minutes; a fine crust then forms and flakes away on its own. Freckles that are faint or very numerous may be approached with lower-energy passes across the area instead, and the two approaches can be combined.
“Four different diseases wear the same brown coat, and one of them — melasma — punishes the wrong laser badly.”
Dr Sin YongOn why every brown mark is diagnosed before any laser
How are the settings chosen for freckles in Asian skin?
Settings for freckles are chosen to clear the dot without injuring the skin around it, which in Fitzpatrick III to V skin is the whole difficulty. A short wavelength such as 532 nm is absorbed by the surrounding epidermal melanin as well as by the freckle, so the energy is kept to the lowest level that produces the whitening endpoint, the spot size is matched to the dot, and overlapping passes are avoided. A test area on a less visible site may be treated first when the skin is darker or has reacted to lasers before.
Interval follows healing. The crust must have cleared and any redness settled before the same area is treated again, and anything that has darkened rather than cleared is reviewed, not retreated. A recent tan is a reason to wait, because tanned skin absorbs more energy and darkens more readily afterwards. The article on pico laser on Asian skin explains how fluence, spot size and interval are balanced.
What are the risks specific to freckle treatment?
The risks are the risks of putting energy into pigment-rich skin. Post-inflammatory hyperpigmentation can form as a brown halo around a treated spot, particularly if the crust is picked, the skin is exposed to sun while healing or the energy was too high for the skin. The opposite problem, a pale dot where the freckle was, follows over-treatment and is slower to recover. Both are more likely in darker skin and are reduced, not removed, by conservative settings and strict photoprotection.
The risk that matters most is misdiagnosis. A changing pigmented mark that is lasered away as a freckle loses the chance of being examined, so any dot that does not behave like its neighbours is assessed first. Blistering, pinpoint bleeding and a flare of cold sores around the mouth are uncommon effects that should be reported the same day. The complication care page lists the signs that need prompt attention.
What is combined with pico laser, and what determines the fee?
Sun protection is combined with every freckle plan, because the laser removes the deposit and the sun prompts new ones. A broad-spectrum sunscreen worn daily, a hat outdoors and shade in the middle of the day are the measures that keep freckles lighter; a doctor may also discuss a topical retinoid or other prescription lightening agent after assessing the skin, with their irritation and sun-sensitivity explained. Where freckles sit alongside sun spots or uneven tone, the same session may address both within the T2 Frax Radiance protocol.
The fee follows the work rather than a list. It depends on the area treated, how many spots there are and how dense they sit, which wavelength and mode are used, whether a test area is treated first and how the plan is staged around healing. Singapore's rules prevent clinics from advertising prices, so no figures are given here; a written, itemised quote follows the consultation, as the how fees are quoted page explains.
