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

• Hyperpigmentation stems from a variety of factors
• Laser treatments can reduce hyperpigmentation
• The new generation of lasers can safely be applied to dark skin
• Most at-home laser treatments are not powerful enough to help with hyperpigmentation.

Hyperpigmentation is a common condition that occurs when the body overproduces melanin, resulting in sporadic dark patches appearing on the skin. Laser treatments for hyperpigmentation can reduce the intensity of these dark spots, with several different types of laser available to help with different forms of the condition based on each patient’s specific skin tone. 

What Is Hyperpigmentation? 

Hyperpigmentation is a condition defined by dark patches on the skin that are inconsistent with the affected individuals natural skin tone. It results when the body overproduces melanin, with hormonal changes, inflammation, and sun exposure being the most common factors leading to the condition.

There are different forms of hyperpigmentation; melasma, solar lentigo and post-inflammatory hyperpigmentation (PIH) are the most ubiquitous varieties, although in some people it can also be brought on by certain medications, a form of hyperpigmentation called Medication-induced cutaneous pigmentation (MIP). Hyperpigmentation can sometimes be a sign of a more serious underlying health condition such as Addison’s disease or hyperthyroidism.

While hyperpigmentation can appear anywhere on the body, most forms of the condition usually develop on the face, neck, shoulders and hands, areas that are most frequently exposed to the sun.

Can Laser Treatments Remove Hyperpigmentation?

A variety of laser treatments have been shown to reduce hyperpigmentation. Most do so by targeting beams of light on to the affected area of skin. With ablative lasers this process rejuvenates the skin by resurfacing its upper layers, enabling new skin to form while simultaneously stimulating the development of collagen. Most laser treatments work in varying degrees to improve the appearance of lentigines and rhytids, eliminate photoaging, and treat post-inflammatory hyperpigmentation (PIH) by softening and depigmenting the scarring caused by acne.

Best Laser Treatments for Hyperpigmentation 

The dermatologic lasers most commonly in use to reduce hyperpigmentation include ablative and non-ablative lasers in both fractionated and unfractionated forms, along with lasers that employ radiofrequency technologies.

Nonfractionated lasers act on the entire projected surface area of the treated skin, whereas fractionated lasers target an equally distributed portion of the projected area.

Non-ablative lasers are gentler and allow for a quicker recovery time, while the ablative variety are harsher, but typically work faster and can produce more dramatic results. The primary difference in treatment modalities is that non-ablative lasers target the dermis to promote collagen growth and tightening, whereas ablative lasers vaporize the top layers of skin to enable new skin cells to grow back tighter with an improved tone.

Non-ablative resurfacing lasers

These lasers are most appropriate for melasma, PIH, and solar lentigines and work to rejuvenate the skin by building new collagen, helping to smoothen the skin and partially eliminate hyperpigmentation arising from sun damage and other factors.

These are often fractional lasers that are considered suitable for most skin types. Fractional lasers use a diffractive lens, which breaks up the beams of light, hitting the skin in a pixelated pattern so some columns receive light while others go untouched. These lasers are so designed to be gentle on the skin and minimize post-treatment downtime.

They range in strength, with a unit like the Fraxel Clear + Brilliant laser, for example, transmitting just enough energy to increase the skin’s radiance and offer subtle textural improvements that should lessen mild hyperpigmentation stemming from melasma.

Picosecond lasers are stronger fractional lasers that penetrate deeper levels of the dermis and are more appropriate for lightening minor scars and PIH than the Fraxel Clear + Brilliant laser referenced above.

The most powerful fractional lasers, such as the Fraxel Dual, employ wavelengths that go deep enough into the dermis to correct significant UV damage and the hyperpigmentation that results from it. These lasers can operate on different wavelengths, with it’s 1927 wavelength setting suitable to lighten melasma, while it’s 1550 wavelength can address more serious hyperpigmentation, such as dark patches of skin stemming from scars.

Pigment-seeking lasers:

These lasers fall into two basic categories: Q-switched and Picosecond.

Q-switched lasers are frequently used for tattoo removal, but are capable of addressing natural hyperpigmentation issues as well. These devices release energy in extremely short bursts (one-billionth of a second) so pigment clusters deeper within the dermis can absorb heat without compromising surface skin.

Picosecond lasers release energy in even shorter bursts than the Q-switched variety, so fast that the skin doesn’t even register the heat. They work by generating a powerful acoustic wave that physically shatters pigment particles, effectively lightening areas of hyperpigmentation such as sunspots.

Ablative fractional lasers

This variety of laser acts on water, employing a more powerful beam of light than with non-ablative lasers. Ablative fractional lasers heat water molecules in the skin tissue. When the water becomes a gas, the skin cells are vaporized..

Due to how light is absorbed by the skin with ablative fractional lasers, they’re able to generate more heat, creating wounds on the skin’s surface that are more intense than with non-ablative lasers, with the considerable ablation and resultant injuries they create translating into more collagen renewal. At the same time, because of their comparative intensity, addressing hyperpigmentation with ablative fractional lasers requires more downtime than other laser treatments. They are most suitable for severe sun damage and to lighten post-inflammatory hyperpigmentation (PIH).

At-home laser treatments

While there are many at-home laser treatments on the market, it’s important to recognize that none of these products actually use laser technology like you’d find at a dermatologist’s office. At-home laser treatments typically employ intense pulsed light (IPL) and light-emitting diodes (LED), which are less accurate than professional grade lasers and far less powerful.

Consequently, their efficacy is questionable, and while even professional treatments typically require multiple sessions to reduce hyperpigmentation, most at-home devices are too weak to make any significant improvements to the skin regardless of how many times the devices are used.

Laser Treatments for Dark Skin Tones 

In recent years laser technology has evolved to the point where people with dark skin can be safely treated with some devices, something that was less assured only a decade ago. In the past the main concern for dark-skinned individuals was that because certain lasers target pigment, they could confuse a person’s natural skin tone for the hyper-pigmented area of skin being treated, resulting in burns or further hyperpigmentation.

To this end, most resurfacing lasers should be avoided for anyone registering five or six on the Fitzpatrick scale. These lasers remove top layers of the skin, which when applied to dark skin can result in permanent hyperpigmentation.

As such, people with dark skin tones should avoid ablative lasers unless their dermatologist recommends otherwise.

Fractionated lasers are an option for all skin tones because they trigger inflammation in selected spots throughout the skin, rather than evenly covering the entire surface area.

Many of the newer non-ablative fractional lasers such as the PicoWay or PicoGenesis can be used on darker skin tones.  

Because their pulses are exponentially faster and less heat-generating than lasers of the past, these newer pico-second lasers should no longer cause scarring on darker skin tones and are considered safe to use for all skin types.

Another new non-ablative laser considered safe for dark skin is the 1064-nanometer Nd:YAG. These lasers still target melanin but zero in on the hair follicle instead of pigment on the surface skin, stimulating the production of new collagen. Because they penetrate the skin at a specific depth, these lasers are considered to be safe for people of all skin colors.

People with darker skin should be aware that they will probably need more laser treatments than people with paler skin tones. That’s because it’s safest to deliver light energy to dark skin at slower, less traumatic speeds, hence requiring more time and sessions to address hyperpigmentation.

If you have dark skin your dermatologist will assess your discoloration and overall skin tone to select the best laser options for your skin type.

Cost of Laser Treatments for Hyperpigmentation   

In the United States the cost of laser treatments to treat hyperpigmentation varies greatly depending on how much skin needs to be treated, the type of laser used, the individual performing the procedure, and geographic location.

According to the American Society of Plastic Surgeons (ASPS), the average non-ablative laser treatment costs approximately $1000 per session, whereas ablative treatments are roughly $2,330 per session.

The cost of one Nd:YAG laser treatment typically costs between $600 and $800. 

One PicoWay session costs approximately between $400-$600.

Most hyperpigmentation laser treatments require multiple sessions.

Takeaway

Hyperpigmentation stems from a variety of factors, with different causes spawning different forms of the condition. Laser treatments can reduce hyperpigmentation, with the newest lasers now being safe to use on darker skin, which wasn’t the case only a few years ago. 

There are several different kinds of lasers used to treat hyperpigmentation. Determining which type is the most suitable for any one patient is based on their skin type, tone, and the type of hyperpigmentation being treated. The dermatologist providing the laser therapy will determine the correct course of action based on these factors.