“Pigmentation” is not one condition. Melasma, solar lentigines, post-inflammatory hyperpigmentation and freckles are different diseases with different mechanisms — and treatment that clears one can permanently worsen another. Diagnosis comes before any laser.
WhatsApp Dr Sin Yong →Melasma is a chronic, relapsing disorder driven by far more than sunlight: current reviews describe photodamage, hormonal influence, vascular changes and dermal inflammation acting together on genetically susceptible skin [1]. It forms soft-edged, symmetrical patches. Solar lentigines (sunspots) are discrete, sharply bordered marks of cumulative UV. Post-inflammatory hyperpigmentation is the footprint of a resolved insult — a pimple, a burn, or an over-aggressive treatment. Freckles are genetic and UV-responsive. Under the physician's lamp and history-taking these separate cleanly; to the bathroom mirror they all look like “dark spots”.
Lentigines and freckles respond well to pigment lasers. Melasma is the trap: heat the wrong melasma with the wrong settings and the disease flares — a network meta-analysis of melasma treatments ranks combination approaches built around topicals and gentle modalities above aggressive monotherapy lasers, precisely because rebound pigmentation is a recognised outcome [2]. This is why Dr Sin Yong will not laser a brown patch that has not been diagnosed, and why “pigmentation removal” packages that skip diagnosis are a red flag anywhere.
For melasma: strict photoprotection including visible light, evidence-based topicals, and — where indicated — conservative low-fluence laser toning as an adjunct, accepting that maintenance is part of the plan [2,3]. For lentigines and freckles: targeted pigment lasers such as the picosecond platforms on the T2 Frax Radiance and laser toning pages. For PIH: treat the cause first, then the pigment. The melasma page covers Dr Sin Yong's staged protocol in depth.
“Whitening” facials do not reach dermal pigment. Scrubbing exfoliates the surface while the melanocytes producing the pigment sit below, unbothered — and friction itself can deepen melasma. And any clinic promising to cure melasma is promising a relapse: the honest endpoint is control.
“Melasma is managed, not cured. A clinic promising a cure is promising a relapse.”
— Dr Sin Yong
Symmetry and softness are the clues: melasma forms mirror-image, soft-edged patches on cheeks, forehead or upper lip. Confirmation needs a physician's examination — sometimes with specialised light.
Either the diagnosis was melasma treated with too much heat, or the treatment triggered post-inflammatory hyperpigmentation. Both are known, documented complications of mismatched treatment.
For melasma it is the single non-negotiable. Reviews implicate visible light as well as UV, which is why tinted, iron-oxide-containing sunscreen is standard advice.
Melasma appearing in pregnancy can fade postpartum, though not always fully. Persistent patches deserve diagnosis before any active treatment.
Only if they bother you — they are benign. They respond well to pigment lasers but return with sun exposure if unprotected.
Epidermal PIH often fades over months; dermal PIH is slower and may need targeted treatment. Faster is possible; instant is not honest.