Treatment of pigmentation is a complex subject. Determining the type of lesion will help to establish which laser or light device to use and what parameters to set.

Hyperpigmentation is a broad descriptive term, offering us little information about etiology or pathophysiology of the lesion. Dividing this expansive category into primary versus secondary helps with treatment decision-making and predicting outcome.

Moreover, hyperpigmentation can stem from epidermal, dermal or a combination of these locations. Discrete lesions, such as lentigines, ephelides (primarily epidermal lesions) and nevus of Ito or Ota and decorative tattoos (primarily dermal lesions), show the most favorable response to laser and light-based therapies.

Postinflammatory hyperpigmentation would be the main component of the secondary hyperpigmentations. Melasma can also be considered in this category, as it generally behaves similarly to postinflammatory hyperpigmentation after laser treatments, showing the most unpredictable response to laser and light-based therapies.

Primary pigmented lesions are generally easier to treat than secondary lesions. For localized lesions on the trunk and face, the Q-switched lasers are very successful at removing pigmentation. These include Q-switched ruby (694 nm), Q-switched alexandrite (755 nm) and Q-switched Nd:YAG (both 1,064 nm and 532 nm). For darker skin types, choose the longer-wavelength Q-switched lasers, as their emissions have less absorption by melanin and hence less competition/absorption from normally pigmented skin.

To learn more about the use of IPLs, long-pulsed dye laser (LPDL) and Q-switched lasers for the treatment of solar lentigines, photoaging and flat seborrheic keratosis read The right tool: Lesion type determines which laser, light device is best choice, opinions of Joely Kaufman, M.D., assistant professor of clinical dermatology at the University of Miami Miller School of Medicine and director of lasers for the University of Miami Cosmetic Group, and Vic Narurkar, M.D., the chair of dermatology at California Pacific Medical Center and director and founder, Bay Area Laser Institute, and associate clinical professor of dermatology at University of California Davis School Of Medicine.

Just like Dr. Kaufman and Dr. Narurkar, I believe that there is a potential of further development of “do it at home” lasers:

“It remains to be seen what type of contribution the at-home devices will play in the treatment of pigmentation. The newer devices coming to the market look very promising as both preventive and adjuvant therapeutic options.”

Laser lasers and light-based devices for home use cannot be considered as a replacement of medical office treatment, but some of the products in the laser industry pipeline can be used as ancillary tools to enhance the effectiveness of a medical treatment plan.

1. It’s your body’s largest organ: an average adult’s skin spans 21 square feet, weighs 9 pounds and contains more than 11 miles of blood vessels.

2. The skin releases as much as 3 gallons of sweat a day in hot weather. The areas that don’t sweat are the nail bed, the margins of the lips, the tip of the penis and the eardrums.

3. Body odor comes from a second kind of sweat – a fatty secretion produced by the apocrine sweat glands, found mostly around the armpits, genitals and anus. The odor is caused by bacteria on the skin eating and digesting those fatty compounds.

4. Fetuses don’t develop fingerprints until three months of gestation (the period during which an embryo develops (about 266 days in humans)). Some people never develop fingerprints at all. Two rare genetic defects, known as Naegeli syndrome and dermatopathia pigmentosa reticularis, can leave carriers without any identifying ridges on their skin.

5. Globally, dead skin accounts for about a billion tons of dust in the atmosphere. Your skin sheds 50,000 cells every minute.

6. There are at least five types of receptors in the skin that respond to pain and to touch. One experiment revealed that Meissner’s corpuscles – touch receptors that are concentrated in the fingertips and palms, lips and tongue, nipples, penis and clitoris – respond to a pressure of just 20 milligrams, the weight of a fly. In blind people, the brain’s visual cortex is rewired to respond to stimuli received through touch and hearing, so they literally “see” the world by touch and sound.

7. “In the buff” became synonymous for “nude” in 17th-century England. The term derives from soldiers’ leather tunics, or “buffs,” whose light brown color apparently resembled an Anglo-Saxon backside.

8. White skin appeared just 20,000 to 50,000 years ago, as dark-skinned humans migrated to colder climes and lost much of their melanin pigment.

9. The Cleveland Public Library, Harvard Law School and Brown University all have books clad in skin stripped from executed criminals or from the poor. Hopefully, they didn’t have to reprint it: One such volume is Andreas Vesalius’s pioneering 16th-century work of anatomy, “De Humani Corporis Fabrica” (On the Fabric of the Human Body).

Still horrified by laser blasting of facial wrinkles followed by months of redness? This is so 90s!

New generation of aesthetic lasers is safer and more selective in treating just what the doctors says you need: wrinkles, age spots, broken capillaries, saggy skin, etc. The result? Faster healing, so you can get back in makeup and return to work with smoother skin in as little as 24-48 hours. Well… it depends. Here is a brief guide to different laser treatments so you can better understand your options.

Ablative Carbon Dioxide (CO2) Resurfacing

This is the skin-wounding original 1990s procedure.

Used for: hard-core lines and acne scars; can also tighten loose skin but is safe only for fair skin types only.

How it works: By blasting and burning away the skin’s top layer, this aggressive single treatment bulldozes wrinkles and everything else in it path.

How it feels: you should not feel anything during the procedure since it is performed under general anesthesia. Recovery time: you are a burn victim for several days with open wounds, which ooze and bleed, followed by 7-10 days of rawness while your obliterated epidermis regenerates, and pinkness for 4-5 months.

Price: $4,000 to $8,000

Efficacy/Results: Excellent (if done right) but in a few months after the treatment.

Ablative  Erbium Laser Resurfacing

Used for: fine to deep wrinkles and acne scars; can also tighten loose skin, doctor must be cautious with darker skin types.

How it works: By evaporizing layers of epidermis (the skin’s top layer).

How it feels: This proceudre is performed under a topical or local anesthesia and you may experience some burning discomfort. Recovery time: depending on the depth of resurfacing, you will feel from slight to mild oozing for 2-5 days, followed by 7-20 days of pinkness, which can be covered by make-up.

Price: $1,500 to $3,000

Efficacy/Results: Good to excellent depending on the depth of resurfacing.

Ablative Fractional Resurfacing

Types of lasers used: either CO2 or Erbium (Er:YAG).

Used for: Smoothing fine-to-deep lines and evening out brown spots in a single treatment. Can also help tighten lax skin and remove some small spider veins.

How it works: The laser beam strikes the skin in thousands of tiny spots, destroying tissue a millimeter deep in those microscopic spots only (think perforated paper). Surrounding skin remains intact, allowing for faster recovery than the original ablative devices but more intense results than the nonablative fractional laser. The hole-punching fires up the body’s wound-healing response, which generates collagen and smooths wrinkles. It’s ablative and therefore riskier for patients of color, but can be executed successfully at a doctor’s office.

How it feels: Typicaly performed with local anesthesia similar to what you’d get in a dentist’s office. After 15 minutes of post-treatment discomfort and an application of ice packs, pain is minimal. For 24 to 36 hours, skin oozes, bleeds and peels, followed by five days of crustiness. Once crust peels, new, pink skin emerges and makeup can be worn; complete healing within two weeks.

Price: $1,500 to $5,000

Efficacy/Results: Average to good.

Nonablative Fractional Resurfacing

Non-ablative simply means that your skin will not actually be resurfaced, i.e. top layer of the skin, aka epidermis, will remain intact.

Used for: Smoothing fine-to-moderate lines, evening out brown/age spots, and improving overall texture and glow.

Downtime: typically none, but the skin may be red for a couple of days.

How it works: The laser penetrates deep into the skin, heats and provides controlled thermal injury to the connective tissue, which stimulates collagen production. No oozing no raw skin. It’s typically performed over a course of three to five 25-minute treatments, one to two months apart. This procedure is safe for darker skin types.

How it feels: like the heat is building up in your skin, but no pins and needles. May feel like a bad sunburn for a few minutes after the procedure is over; afterward, skin is pink and sandpapery for three to five days but can be camouflaged with concealer.

Price: $600 to $1200 per treatment depending on the actual laser modality and doctor.

Efficacy/Results: Average to good depending on a number of treatments.

Intense Pulsed Light (IPL)

Used for: Eliminating brown spots and other sun-induced discoloration and spot-treating broken capillaries. No effect on wrinkles.

How it works: IPL devices are not lasers, unlike lasers they emit a broad spectrum of light. Short pulses of bright white light pinpoint brown pigment cells and redness, which are damaged when they absorb the light and the heat it creates. Safe for most skin types, but a doctor may dial down intensity for darker skin tones to avoid slim risk of de-pigmentation.

How it feels: Like a sunburn. Patients experience slight swelling and pinkness the day of the procedure, but there’s no downtime, which is why it’s often categorized as a “lunchtime” treatment.

Price: $400 to $600 per treatment.

Efficacy/Results: Average and multiple treatments are required.