Key takeaways
- Pigmentation isn't one condition – sun spots, melasma, and post-acne marks each have different causes, different depths, and require very different approaches.
- Laser and physical treatments for melasma carry a genuine risk of making it worse or more resistant to treatment if not carefully calibrated – expert assessment first is essential.
- Both UV and visible light trigger melasma; a sunscreen containing iron oxide (not just SPF50+) provides meaningfully better protection for melasma-prone skin.
- Treating pigmentation without repairing the skin barrier first is one of the most common reasons results don't hold.
- Melasma is a chronic condition that requires long-term management, not a one-time fix.
You've tried the brightening serums. You've been diligent with SPF. You may have had a laser session or two. For a few weeks, your skin looks clearer – and then, slowly, the patches creep back. If this sounds familiar, you're not imagining things, and you haven't done anything wrong.
Pigmentation is one of the most common concerns I hear about at Lapeau. It's also one of the most misunderstood – because what looks like "pigmentation" on the surface can have several very different causes underneath, each sitting at a different depth in the skin, each requiring a different approach. Treating them all the same way is exactly why so many people find themselves going in circles.
In this article, I want to share what I've learned from treating hundreds of clients with pigmentation concerns – what's really happening in the skin, what common mistakes set people back, and how we approach treatment at Lapeau in a way that's safe, gradual, and built to last.
What is pigmentation – and why does it happen?
Pigmentation occurs when the skin produces excess melanin – the pigment that gives your skin its colour – in certain areas. The result is patches, spots, or areas of uneven tone that are noticeably darker than the surrounding skin. The trigger, however, varies enormously from person to person.
In our clinic, we see three main types, and knowing the difference is fundamental to choosing the right treatment. Using the wrong approach for a given type of pigmentation doesn't just fail to help – it can actively make things worse.
Sun damage and age spots (solar lentigines)
This is the most straightforward type. Cumulative UV exposure over the years causes melanocytes – the pigment-producing cells in your skin – to overreact in certain areas, creating the flat, well-defined brown spots commonly called sun spots or age spots. They typically appear on the face, hands, décolletage, and shoulders – wherever your skin has been regularly exposed to the sun. The good news is that surface-level sun damage, where the excess melanin sits in the outer layers of the skin, generally responds well to the right laser treatment when the skin barrier is healthy.
Melasma – and why it's different from everything else
Melasma is a fundamentally different condition. It presents as larger, irregular, brownish-grey patches – most commonly across the cheeks, forehead, upper lip, and chin – and it has a complex, multi-factorial cause that sets it apart from simple sun damage.
Clinically, melasma is described as a photoageing disorder in genetically predisposed individuals. Around 60% of people with melasma have a family history of it. Hormones are a well-documented trigger – melasma is common during pregnancy, when starting or stopping oral contraceptives, with certain intrauterine devices, and around perimenopause. Thyroid disorders are also associated with melasma.
Here's something most people don't know: it's not just UV light that triggers melasma. Visible light can also stimulate melanin production in melasma-prone skin. This is why a standard mineral SPF50+ alone may not be enough – sunscreens formulated with iron oxide provide meaningful additional protection against visible light, and we specifically recommend these for clients managing melasma.
Melasma also exists at three different depths: epidermal (surface layers, well-defined border, dark brown in colour), dermal (deeper layers, ill-defined border, light brown to blue-grey, significantly harder to treat), and mixed (the most common type – a combination of both). Understanding which type a client has changes the entire treatment approach.
Post-inflammatory hyperpigmentation (PIH)
Post-inflammatory hyperpigmentation is the dark mark that remains after a pimple, an ingrown hair, a rash, eczema, or any inflammation or injury to the skin. When the skin is inflamed, melanocytes are stimulated to produce more melanin and transfer it to the surrounding skin cells as part of the healing response. Once the original inflammation resolves, the dark mark can persist for months.
PIH tends to be more noticeable and more persistent in medium-to-deeper skin tones, where melanocytes are more reactive. Importantly, PIH also exists at two depths: epidermal (responsive to treatment) and dermal (not effectively treated by laser or most physical treatments, and may actually be aggravated by them). This distinction is why a proper assessment before treatment is so important.
Why does pigmentation keep coming back?
This is the question I hear most often – "I had treatment, it improved, and now it's back." There are a few common patterns behind this.
The trigger is still active
If the underlying driver of pigmentation hasn't changed, treatment can only ever be temporary. Hormonal melasma that's still being triggered by a contraceptive or a thyroid imbalance will return regardless of how well it was treated. Ongoing sun exposure without adequate protection will keep creating new pigmentation. The most effective treatment plans address the root trigger alongside the pigmentation itself – which is why we discuss your full history during a consultation rather than just looking at the skin.
SPF alone isn't always enough for melasma
For general sun damage, a broad-spectrum SPF50+ applied daily is the essential foundation. But for melasma specifically, UV is not the only culprit – visible light (the light we can actually see) can also stimulate melanin overproduction. This is why clients managing melasma often benefit from a tinted mineral sunscreen containing iron oxide, which blocks a broader spectrum including the visible range. Even then, SPF50+ must be applied every morning without exception and reapplied when spending time outdoors. For melasma, sun protection is genuinely lifelong.
The skin barrier was compromised
A healthy skin barrier doesn't just protect against moisture loss – it also regulates the skin's inflammatory response. When the barrier is weakened through over-exfoliation, harsh actives, or poorly timed aggressive treatments, the skin becomes chronically inflamed. That inflammation signals melanocytes to produce more pigment – and so the pigmentation worsens precisely because of the steps taken to treat it. This cycle is extremely common in clients who have tried many products and treatments without lasting improvement.
Pigmentation was treated without being properly typed
Dermal PIH and dermal melasma do not respond to laser or most physical treatments the way epidermal pigmentation does. In some cases, applying laser energy to dermal pigmentation can cause further inflammation, triggering more melanin production and making the condition more resistant to future treatment. Correct typing before treatment isn't just best practice – it's what determines whether treatment will help or harm.
Common mistakes that make pigmentation worse
Over the years, I've seen patterns in what holds people back. These are the mistakes I encounter most often.
Aggressive laser treatment for melasma
This is worth being direct about: Q-switched Nd:YAG, picosecond, and fractional laser treatments used at high intensities or without careful patient selection carry a well-documented risk of causing melasma to relapse or become more resistant to future treatment. This is recognised across the clinical literature – these are powerful tools, but for melasma they require expert, conservative use. At Lapeau, when we use laser for melasma it is low-fluence laser toning with carefully calibrated settings, not aggressive pigmentation clearance. There is a meaningful difference between the two.
Layering too many active ingredients at once
Vitamin C, niacinamide, AHAs, retinoids, kojic acid, azelaic acid, tranexamic acid – all of these have evidence for pigmentation management. But layering multiple actives simultaneously is a common way to overwhelm and sensitise the skin. A simpler, consistent routine using one or two targeted actives tends to produce steadier improvement with less risk of barrier disruption than an ambitious multi-active stack.
Skipping SPF on cloudy days or when indoors
UV radiation penetrates cloud cover, and visible light passes through glass. For melasma in particular, the habit of applying SPF only on sunny days or when going outdoors is not adequate. Incidental exposure – sitting near a window, a short walk to the car – is enough to trigger a flare. SPF is an every-day habit without exception.
Not addressing the root cause
Treating pigmentation without understanding what's driving it is like clearing water from a flooded room without closing the tap. If hormonal triggers aren't managed, if the skincare routine is continuing to damage the barrier, or if the pigmentation type hasn't been correctly assessed, treatment results will always be temporary.
How we approach pigmentation at Lapeau
Our approach is built around one principle: understand the skin first, treat second. We don't apply the same protocol to every client who presents with pigmentation – because the right treatment for epidermal sun spots is not the right treatment for dermal melasma, and getting that distinction wrong has real consequences.
Thorough skin analysis before any treatment
Every new client at Lapeau starts with a detailed consultation. We assess the type, depth, and likely cause of pigmentation; skin tone and Fitzpatrick phototype; current barrier health; previous treatments and reactions; sun exposure habits; hormonal history; and current skincare routine. Our dermatopathologist advisor, Dr Eric Song, supports our clinical protocols where more complex cases warrant it.
In many cases, the first step is not a laser session – it's barrier repair. Clients who arrive with an inflamed or barrier-compromised skin need restorative, low-stimulation care before any active treatment begins. Bypassing this step is the most direct route to the frustrating flare-and-repeat cycle that so many clients have experienced elsewhere.
A gradual, layered approach
Rather than a single intensive session, we build a plan that layers complementary treatments over a course of appointments, adjusted at each visit based on how the skin responds. Depending on the type and severity of pigmentation, this may include:
- Low-fluence laser toning (Q-switched Nd:YAG) – gentle, low-energy passes that gradually disrupt surface pigment without over-stimulating the melanocytes. Used conservatively for melasma and diffuse uneven tone, with settings calibrated specifically to avoid triggering a rebound.
- Targeted laser treatment (Pico Laser / Cynosure Synergy) – higher-precision laser energy for discrete, well-defined sun spots or stable post-acne marks, introduced only when barrier health is confirmed and the pigmentation type is appropriate for this approach.
- Skin boosters and hydration treatments – hyaluronic acid-based injectable boosters that restore deep skin hydration, improve barrier function, and support the skin's capacity to manage pigmentation more effectively between sessions.
- Targeted homecare – a simplified, evidence-based routine tailored to your pigmentation type. For melasma, we look to topical tranexamic acid, niacinamide, and azelaic acid as core actives; for PIH, vitamin C and targeted retinoids. The routine is designed to support the barrier, not overload it.
You can read more about our laser approach on the Complexion & Clarity treatment page and the Advanced Laser Solutions technology page.
Protecting the skin barrier at every stage
Every component of the treatment plan is designed to work with the skin's natural processes, not against them. We monitor barrier health at each visit, and we slow the plan down if the skin shows signs of sensitisation or irritation. This isn't caution for its own sake – it's what produces durable results without the setbacks that come from pushing the skin harder than it's ready for.
Who is a good candidate for pigmentation treatment?
Most people with pigmentation concerns are good candidates for some form of treatment. What matters most is matching the approach to the type of pigmentation, the skin tone, and the current health of the barrier.
You're likely a strong candidate if you have:
- Discrete sun spots or age spots on a stable, non-sensitised skin barrier
- Post-inflammatory marks from acne or other skin injury that have been present for several months
- Mild to moderate melasma that is stable (not in an active hormonal flare)
- Uneven skin tone that hasn't responded adequately to topical treatments alone
We take extra care with clients who have medium-to-deeper skin tones (where the risk of post-treatment PIH is higher), active hormonal triggers, current or recent pregnancy, a history of adverse reactions to laser treatment, or skin that is currently inflamed or barrier-compromised. These factors don't rule out treatment – they shape how conservatively and carefully the plan is designed.
For melasma specifically, if hormonal contraception is contributing to flares, discussing a change with your GP or specialist may meaningfully improve the long-term outcome of any in-clinic treatment. We can't address that part for you, but we can discuss it during your consultation.
The clearest way to know whether you're a good candidate – and what a realistic outcome looks like for your specific situation – is to come in for a consultation. We'll give you an honest assessment and a plan that's appropriately calibrated.
Realistic expectations: what a treatment journey looks like
I want to be direct about this, because it's the area where unrealistic expectations cause the most disappointment.
Melasma, in particular, is a chronic condition – not a one-time problem with a one-time solution. Treatment research consistently emphasises that it is slow to respond and has a genuine tendency to relapse, especially with sun exposure. The goal of treatment is not permanent clearance – it's sustained, well-managed control. Clients who understand this from the outset tend to get far better results, because they commit to the ongoing habits (especially SPF) that make the difference.
What a realistic treatment journey tends to look like:
- Sun spots (epidermal): initial improvement typically visible after 2–4 sessions; meaningful clearance often achievable in 4–6 sessions over 2–3 months, with SPF maintenance to prevent recurrence.
- Melasma (epidermal component): gradual improvement over 6–12 months of consistent treatment and homecare; maintenance sessions of 1–2 per quarter are common to hold results, particularly during higher UV months.
- Melasma (dermal component): this is the most challenging to treat. Progress is slower, and the focus shifts more towards suppression and management than clearance. Honest expectations are essential here.
- Post-inflammatory marks (epidermal): can fade considerably over 3–6 sessions combined with targeted homecare. Dermal PIH is slower and less responsive to most treatments.
Most clients find that once they understand the timeline and commit to the plan, the results are genuinely worthwhile. Individual results vary based on pigmentation type and depth, skin tone, lifestyle, and consistency with aftercare.
Aftercare and long-term prevention
The treatment room is only half the story. What happens every day in between appointments has a profound effect on how well results hold.
After each session, we'll provide specific aftercare instructions relevant to the treatment – generally including a period of careful sun avoidance, gentle cleansing, temporary suspension of active ingredients, and prescribed soothing products. Following these carefully isn't optional – it directly affects your results and your risk of PIH from treatment.
For the long term, the essentials are:
- SPF50+ every morning, every day, year-round. For melasma-prone skin, choose a mineral sunscreen with iron oxide (typically found in tinted formulations) for broader protection against visible light as well as UV.
- A simple, consistent homecare routine – one focused on barrier health and 1–2 targeted actives rather than an ambitious multi-ingredient stack. Consistency matters far more than complexity.
- Regular maintenance sessions – particularly important for melasma clients as UV increases in spring and summer.
- Protective habits – a wide-brimmed hat when outdoors, seeking shade during peak UV hours (10 am – 3 pm), and being mindful of visible light exposure (near windows, screens) if melasma is a known concern.
Managing pigmentation well is really about building long-term skin health habits. The clients who see the most lasting results aren't necessarily the ones who had the most intensive treatment – they're the ones who took the daily habits seriously.
