Why lasers alone can't fix pigmentation: PIH mechanism, wavelength approach, case-by-case order.
Please check this before reading
Q. Brown marks after treatment,
will they fade faster if I get more laser?
A. In fact, they often get darker.
If you apply more energy while inflammation remains,
the melanocytes get even more stimulated.
Q. Then what's the cause?
A. Most of the time, it's not the 'pigment itself,'
but the 'inflammation' underneath.
You have to calm the inflammation first for the pigment to fade.
Among the people coming into the clinic these days,
"I had laser five times somewhere else,
but it seems to have gotten darker instead"
there are suddenly many people saying this.
Honestly, when I was a resident,
when I saw hyperpigmentation, I used to think of laser first.
But only after doing a few hundred cases
did I learn something.
Hyperpigmentation is not really a pigment problem,
it's much more often an inflammation problem.
What makes them different is this:
Hyperpigmentation refers to brown to gray-brown marks
caused by abnormal buildup of melanin in the skin.
Unlike melasma, hyperpigmentation
is mostly caused by 'acquired irritation.'
Marks left after popping acne, post-laser marks,
and darkened areas after a wound heals.
All of these are post-inflammatory hyperpigmentation (PIH).
If melasma is based on 'hormones and genetics,'
PIH is based on 'inflammation.'
The approach is completely different.
Director Wi Youngjin's
Key Insight
Post-procedure hyperpigmentation, brown marks that won't go away
— the director explains the causes and solutions.
A client in their mid-30s who came last month
had received 10 toning sessions at another clinic,
but the borders of the hyperpigmentation had become even more distinct.
When I looked closely at the skin, beneath the pigment
there was very faint micro-inflammation left.
If inflammation remains, melanocytes
keep receiving stimulation signals.
If you hit it with laser again here
the pigment can get even darker.
Especially when toning is repeated at low energy,
this 'rebound hyperpigmentation' often occurs.
In Korean patients,
this has been reported in about 15–20%.
Director Wi Youngjin's Key Summary
The reason hyperpigmentation doesn't fade,
is mostly not the 'pigment'
but because the 'inflammation' underneath is still there.
You need to control the inflammation first, then choose the wavelength.
Just changing the order can change the outcome.
Clinic classification guide by pigment type
Type | Features | First-line approach |
Post-inflammatory hyperpigmentation (PIH) | Brown marks after acne or wounds | Laser after 4–6 weeks of medication |
Melasma-associated type | Symmetrical on both cheeks and the forehead | Low-intensity toning + tranexamic acid |
Deep (dermal) pigment | Gray-brown, bluish, flat | 1064 nm laser, long intervals |
With residual redness | Brown + faint redness coexist | Vascular laser first, then pigment treatment |
Treatment for hyperpigmentation can take as few as 2–3 sessions,
but most cases require 4–6 or more.
If you get the sequence right, what didn't improve even after 10 sessions
often becomes noticeably lighter.
The three questions I get most often in the clinic
Q1. Does the at-home
brightening cream alone not work?
If it's epidermal, it may fade over several months,
but pigment that has gone into the dermis has its limits.
If there's no change after 6 to 8 weeks,
I recommend a consultation.
Q2. How much does it cost and how many sessions
should I plan for?
For PIH, usually about 3 to 5 sessions,
done at 2- to 3-week intervals.
If you don't protect against UV, it can come back within 6 months.
Q3. Are there side effects or precautions?
Excessive energy and short intervals
cause rebound hyperpigmentation.
Sunscreen is essential, and
don't forcibly peel off dead skin.
KakaoTalk consultation before visiting is also available.
That was Wi Youngjin.
Read more
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