Hello.
I'm a board-certified dermatologist, thinking about your skin 10 and 20 years from now.
Pigmentation treatment is one of the treatments people most often ask about at dermatology clinics.
But as common as it is, there are many misconceptions about it.
Many people think all the pigmentation they see on their face is the same problem and expect it to clear up if it is erased strongly with a laser.
In reality, however, pigmentation treatment is not that simple.
Lesions on the face may all look similar, but their cause, depth and skin response can differ.
Melasma, dark spots, freckles, post-inflammatory hyperpigmentation, nevus of Ota, solar lentigines and post-dermatitis hyperpigmentation all have different characteristics.
The most important thing in pigmentation treatment is not which laser is good, but first identifying what the pigmentation you are seeing actually is.
Pigmentation treatment should avoid forcefully repeating strong lasers, as well as scattering the energy so thinly that there may be too little change.
Today, I'll explain the principles and effects of pigmentation treatment, the questions patients ask most often, the differences between pico toning and similar devices, and the factors that produce real results.
The starting point of pigmentation treatment: what is melanin?
Melanin acts as a kind of shield that the skin produces to protect itself.
When exposed to UV rays, the skin increases melanin production to reduce damage.
That is why the skin darkens with a lot of sun exposure, and melasma can develop when more pigment builds up in certain areas.
Melanin is produced by melanocytes and transferred to the surrounding keratinocytes.
When this process is balanced, skin color stays relatively even.
But when factors such as hormonal changes, inflammation and skin irritation, not just UV, keep recurring, melanin production can become excessive or concentrate in certain areas, and pigmentation disorders can appear.
Pigmentation treatment at our Haeundae Jung-dong clinic is not only about removing melanin that has already formed.
We also assess why melanin keeps being produced, which stimuli make it worse and at what depth in the skin the pigment lies, and build this into the treatment.
The effects of pigmentation treatment come from three main directions.
The first is reducing the melanin pigment that has already formed.
Laser toning delivers energy to the melanin particles accumulated in the skin, helping break the pigment down into smaller pieces.
The pigment is then gradually cleared through the body's macrophages and lymphatic circulation.
The second is improving the environment in which melanin is overproduced.
Treatments that help restore the skin barrier help regulate the environment that drives excessive melanin production.
Finally, the third is managing the irritants that make pigmentation worse.
Repeated inflammatory responses in the skin can cause hyperpigmentation, so easing them is important.
And because pigmentation can be affected not only by UV but also by heat and vascular responses, it is best to address these at the same time.
Melasma is difficult to treat because irritating the skin to remove the pigment can actually bring more pigment to the surface.
In skin with a lot of visible melasma, the melanocytes are sensitively activated.
If the skin is irritated at this point, the melanocytes are stimulated further, and the melasma can actually darken and recur.
That is why a board-certified dermatologist sets the goal of melasma treatment not as 'complete removal' but as 'keeping it stably lighter'.
Melasma is not a condition that is over just because it has improved for a while, because it can darken again due to hormonal changes, skin irritation and so on.
So it is best to take careful daily care with sunscreen and brightening products, and to continue stable pigmentation treatment together with treatments that restore the skin barrier.
Pico toning VS laser toning
Both pico toning and conventional laser toning are used to reduce pigmentation.
The difference between the two is the time over which the energy is delivered.
Conventional toning uses pulses measured in nanoseconds, while pico toning, as the name suggests, uses pulses measured in picoseconds (best understood as an even shorter time).
Short pulses are described as offering a photoacoustic effect that breaks pigment particles down finely while reducing the burden on surrounding tissue.
To be honest, if the aim is to address all types of pigmentation faster and more safely, pico toning does have the advantage.
| Category | PicoWay pico toning | Conventional laser toning devices |
|---|---|---|
| Device type | Picosecond laser | Mainly nanosecond lasers |
| Typical pulse width | Picoseconds | Nanoseconds |
| How the energy works | Emphasizes a photoacoustic effect that delivers energy in an extremely short time to break pigment particles down finely | A relatively larger share of photothermal effect, delivering heat energy to the pigment to reduce melanin gradually |
| Main purpose | Used for pigmentation treatment such as melasma, sun spots, hyperpigmentation, tattoos and skin tone improvement | Used to manage melasma, skin tone, hyperpigmentation and sun spots |
| How pigment is broken down | Can be described as breaking pigment particles into finer pieces | Repeatedly stimulates the pigment gently to reduce it gradually |
| Heat burden | Expected to reduce the heat burden on surrounding tissue thanks to the short pulse width | Heat accumulation can be relatively greater depending on the device and settings |
| Approach to melasma | Can be used as low-intensity repeated toning, adjusted so as not to irritate melasma | The method long and widely used in conventional melasma toning |
| Approach to sun spots | Depending on wavelength and settings, can also be used to treat individual pigmented lesions | Sun spots can be treated depending on the type of device, but mainly centered on low-output toning |
| Use for skin texture and pores | With a fractional handpiece, can also be used to treat skin texture, pores and scars | Toning alone may be limited for improving skin texture and pores |
| Post-treatment reactions | Redness, warmth and dryness may generally occur, and scabbing is possible depending on settings | Redness, warmth and dryness may occur; watch for skin sensitivity with repeated treatment |
| Advantages | Short pulse width, fine breakdown of pigment, versatility for treating various pigmentation and skin texture | Long track record, stable low-intensity repeated pigmentation care, accessibility |
| Cautions | Being a pico device does not mean stronger is always better. Intensity control is important for skin with melasma | The more repeated treatments, the more caution is needed regarding hypopigmentation, skin sensitivity and rebound hyperpigmentation |
| Recommended for | Those whose response to conventional toning was disappointing, or who want melasma, sun spots and hyperpigmentation treated separately and more precisely | Those who want stable, repeated care for widespread melasma and dull skin tone |
Factors that produce results in pigmentation treatment
First, an accurate diagnosis
Distinguishing whether it is melasma, post-inflammatory hyperpigmentation or a nevus is the most important thing, isn't it?
Because if the diagnosis is wrong, the treatment can go completely off course.
A board-certified dermatologist looks at the color, borders, distribution, time of onset, aggravating factors and skin type of the pigmentation together, and designs an appropriate treatment.
Second, skin type and barrier condition
Asian skin often has a relatively active pigment response.
As a result, post-inflammatory hyperpigmentation can easily develop from laser irritation.
In particular, if a laser is applied while the skin barrier is weak, redness and stinging can occur, and the melanocytes can also become unstable.
A treatment the skin can tolerate, set at exactly the right intensity — that is the know-how of a board-certified dermatologist.
Third, energy intensity and intervals
What if the intensity is too weak?
Naturally, there may not be enough change.
I consider cost-effectiveness very important.
To deliver more effect without damaging the skin, treatment needs to be customized based on extensive clinical experience.
It is best to assess the skin accurately at every session — why redness has appeared, whether dryness has worsened, whether the pigment is fading — and continue treatment accordingly.
Thank you for reading this long post.
This has been Dr. Tae Hoon Kim, board-certified dermatologist.
The medical information on this website is general guidance only. Diagnosis and treatment may differ depending on your individual condition — please obtain an accurate diagnosis through an in-person consultation.