Best Laser Treatments for Hyperpigmentation: Costs, Before and After, and More

• Hyperpigmentation is characterized by patches or spots of skin that are darker than the surrounding area
• This pigmentation is caused by sun damage, hormonal fluctuations, skin injuries and inflammation 
• Laser therapy has been shown to effectively treat hyperpigmentation for all skin types and tones
• At-home laser treatments are not powerful enough to produce noticeable results

When your body overproduces melanin, the pigment responsible for skin’s color, the outcome is scattered, irregular dark spots on the skin called hyperpigmentation. Laser treatments are an effective solution to fade hyperpigmented spots and brighten the complexion, either as a standalone treatment or alongside topical creams that contain depigmentation agents.

What Is Hyperpigmentation? 

Hyperpigmentation refers to flat, irregular spots or patches of skin that are darker than the surrounding skin. Depending on your skin tone, this discoloration can range from pink or red to gray, brown or black.

Pigmented spots are triggered by a number of causes. They occur when melanocytes, the cells that determine pigmentation in the skin overproduce melanin. The most common causes are sun exposure, fluctuating hormones, skin injury and inflammation. 

Some skin conditions such as acne and melasma also cause dark spots and patches to form. 

While hyperpigmented lesions can develop anywhere on the body, it occurs most often on the face, neck, shoulders and hands –  the areas most frequently exposed to the sun. It’s also more common among people with dark skin tones, as this group has skin that is rich in melanin pigments.

Common forms of hyperpigmentation include the following:

• Age spots, liver spots and sun spots; and senile lentigines, the most common component of photoaged skin 
• Cafe-au-lait marks, common birthmarks that can also develop early in childhood
• Freckles, small brown spots that are either present at birth or develop due to sun exposure 
• Melasma, a chronic skin disorder that is characterized by dark brown or blue-gray patches of skin
• Postinflammatory hyperpigmentation (PIH), is caused by skin injuries including cuts, burns, scrapes, insect bites and healed wounds

Can Laser Treatments Remove Hyperpigmentation?

Several types of lasers can effectively and safely eliminate or greatly reduce the appearance of hyperpigmented spots.

Of note is that the correct diagnosis is key for a successful outcome, otherwise lasers may exacerbate the condition. As well, skin type and severity are important considerations. 

These factors will influence the number of treatments required and the choice of laser.

Best Laser Treatments for Hyperpigmentation 

Ablative and nonablative lasers in both fractional and nonfractional forms are used to treat hyperpigmentation. In some cases, more than one laser may be used to more effectively target melanin by using two mechanisms of action for greater results. 

Ablative resurfacing lasers

Ablative lasers heat water molecules in tissue which vaporizes the top layers of skin and promotes the growth of a fresh layer of undamaged skin. While these lasers are harsher than nonablative lasers, they typically work faster and can produce more dramatic results.

Nonfractional ablative lasers

Nonfractional lasers affect the entire projected surface area of the treated skin. Because of their intensity, ablative fractional lasers require the most downtime of any laser treatment. They are most suitable for severe sun damage and to lighten PIH.

Fractional ablative lasers

These lasers have a diffractive lens that breaks up the beams of light into a pixelated pattern, so some areas of skin receive light while others go untouched. They’re gentle on the skin and minimize post-treatment downtime; however, they require more sessions than nonfractional lasers.

Nonablative resurfacing lasers

Nonablative lasers deliver heat deep within the dermis without damaging the outermost layer of skin. Over time and with multiple sessions melanin clusters will break apart and dark spots will fade.

Fractional nonablative lasers

These lasers range in strength: the Fraxel Clear + Brilliant laser, for example, transmits just enough energy to lighten mild hyperpigmentation, while more powerful lasers such as the Fraxel Dual can correct significant hyperpigmented cells created by UV damage. 

These lasers can operate at different wavelengths, depending on the type of hyperpigmentation being addressed.

Q-switched lasers

A type of nonablative laser, Q-switched lasers target pigment clusters deep within the dermis. They work by generating a powerful acoustic wave that physically shatters melanin, effectively lightening areas of discoloration. 

The laser releases energy in extremely short bursts (one-billionth of a second) so the melanin can absorb heat without compromising surface skin. Q-switched lasers can treat most forms of hyperpigmentation and have been shown to be an ideal choice for treating darker skin tones. 

Picosecond lasers

Picosecond lasers release energy in even shorter bursts than the Q-switched laser. This laser is so fast it doesn’t burn skin tissue which allows for effective depigmentation and less damage to the surrounding normal tissue. 

These lasers therefore offer shorter healing times and typically require fewer sessions; they can also be fractional or nonfractional.

IPL treatments

Although not strictly a laser, intense pulsed light (IPL) has been shown to effectively treat pigmented lesions as well as signs of photoaging such as liver spots, sun spots, senile lentigines and freckles.

IPL devices emit a wide array of light wavelengths to target these pigmented spots as well as patches associated with melasma. 

At-home laser treatments

While there are many at-home laser treatments on the market, these products are not comparable to those found in a dermatologist’s office. 

At-home laser treatments typically use IPL and light-emitting diodes (LED), which are far less powerful and accurate than professional grade lasers and IPL devices. As a result, these devices are not able to make any significant improvements to the skin regardless of how many times the devices are used. 

Adjunctive therapy

You can enhance the effectiveness of laser treatments by using over-the-counter topical treatments that target hyperpigmentation in different ways.

Gentle chemical peels and skin care products that contain proven brightening agents such as azelaic acid, glycolic acid or salicylic acid. These are all chemical exfoliants that speed up skin cell turnover to gradually lighten hyperpigmented spots and brighten and smooth skin. 

Niacinamide is another ideal choice, as it not only inhibits melanin production to allow for gradual lightening of discolored skin but it has oxidative effects to help repair and protect skin from environmental damage, including sun damage.

Hydroquinone cream has also been proven effective; it is considered the standard in depigmentation and skin lightening. 

Lastly, apply sunscreen every day, with an SPF of at least 30 to protect your skin from the sun’s damaging rays. This will help prevent dark spots from forming as well as lines and wrinkles that occur due to premature aging.

Laser Treatments for Dark Skin Tones

In recent years, laser technology has evolved to the point where hyperpigmentation on dark skin can be treated safely. 

In the past, pigment-seeking lasers could not distinguish between a person’s natural skin tone and the hyperpigmented area, sometimes resulting in burns or worsened symptoms. Now, several modern lasers are safe for people with Fitzpatrick skin types V and VI. 

The best options are nonablative fractional lasers such as the PicoWay or PicoGenesis. Their pulses are exponentially faster and generate less heat than lasers of the past, and being fractionated, the laser targets and treats selected areas only, which results in less inflammation, reduced risk of side effects and faster healing. 

Treatment options to avoid include all ablative lasers, which can cause permanent hyperpigmentation in darker skin tones.

Cost of Laser Treatments for Hyperpigmentation   

In the United States, the cost of laser treatments to treat hyperpigmentation varies greatly depending on the size of the treatment area, the type of laser used, your provider and geographic location.

According to the American Society of Plastic Surgeons (ASPS), the average nonablative laser treatment cost $1,445 per session in 2020, whereas ablative treatments were $2,509 per session.

Takeaway

Hyperpigmentation is characterized by spots and flat patches of skin that are darker than the surrounding area. It’s caused by several factors including fluctuating hormones, sun damage, skin injuries and inflammation; as well as acne and melasma.

Laser therapy has been shown to be an effective treatment to eliminate pigmented areas altogether or to greatly reduce its appearance depending on the severity of the issue.

Several different lasers are currently in use; ablative, nonablative, fractional and nonfractional lasers are all potential treatment options. The right one for you will be based on your skin type, tone, the type of hyperpigmentation being treated and how quickly you want to see results. 

Discuss your options with a dermatologist to help you decide what course of action is best for you.