Laser treatment to remove dark spots on face

Age spots, sun spots, freckles, post-acne blemishes and melasma all fall under a condition known as hyperpigmentation, in which patches of skin become darker than the surrounding skin. It is common, and it can happen to women and men of all ages and skin types. 

According to Dr Isaac Wong, medical director of The Artisan Clinic, hyperpigmentation is triggered by two factors – prolonged exposure to the sun without protection and inflammation, which can occur from an acne breakout or when strong laser treatment is used on the skin. 

Treating hyperpigmentation is not always straightforward. Pigmentation spots and patches can be found near the skin’s surface or in the skin’s deeper layers or both. While pigments that occur at the top-most layer of the skin respond well to lasers and other medical treatments, the pigments that are found in the deeper skin layers, or found in multiple layers of the skin, present more difficulties. 

“The deeper the pigment, the tougher it is to treat”, says Dr Wong.

Melasma: one of the most difficult types of hyperpigmentation to treat 

Melasma, which appears as brownish patches, is one of the more difficult types of hyperpigmentation to treat. 

“Melasma is a very common skin disorder. Loosely translated, it means ‘black spot’,” says Dr Wong. It frequently occurs on the cheeks, upper lips and forehead. It is also known as the “mask of pregnancy” as it is commonly seen in women between the ages of 30 and 40, pregnant women and women who are on oral contraceptives or on hormone therapy, he adds.  

Melasma gained a reputation for being difficult to treat because it often occurs in the deeper layers of the skin, which makes it difficult to target through treatment, and it also recurs easily. 

Dr Wong adds that he’s seeing more patients – a 50 per cent increase – coming in to seek help for melasma in the last two years.

Laser skin care treatments have come a long way since their dermatological debut in 1963, treating everything from hair and tattoo removal to hyperpigmentation, acne scars, skin tightening, and fine lines and wrinkles. The trends in recent years have consistently gravitated towards the use of gentler laser treatments with minimal downtime that can still offer prejuvenation via boosted collagen production and skin tightening. Many laser treatments for dark spots and other skin concerns are also administered in once-monthly series that patients can fit into their busy schedules — no reason to struggle with dark spots or rough skin texture if there’s an in-office treatment that can help.

The short recovery times associated with these treatments are in stark opposition to the ablative options of years past, which often left patients with a week of redness and flaking. But in today’s busy world (especially since millions of workers are heading back to the office this fall) few people want to commit to a lengthy recovery period.

Board-certified dermatologist Dr. Jason Emer, who practices in Beverly Hills, elaborates, stating that, "The trend right now is [for] low-downtime procedures that improve your skin over time, without having to look like a burn or having scaling, peeling faces for too long of a time.” He explains that modern lasers deliver ultra-controlled damage that “stimulates the dermis to remodel itself without damage.” The end result? “Radiance, smooth and clear skin with reduced pimples, pores, and scars,” he says.

For comparison, Fraxel teatments take approximately five to ten days to recover, the CO2 laser is quoted at seven-to-ten days of healing time, and the heavy-duty, ablative RENUVION Plasma requires an intimidating six weeks for your skin’s full recovery, according to Dr. Emer.

Lower-intensity lasers are also more universally viable as they are safe to use on darker skin tones that are more risk of post-inflammatory hyper-pigmentation. Birmingham, Alabama-based, board-certified dermatologist Dr. Corey L. Hartman notes that patients with darker skin tones should steer clear of pulsed light treatments such as BBL and IPL, or more intensive lasers than Fraxel. But when it comes to gentler, low-downtime laser treatments, virtually all skin tones and concerns have an option to choose from. Plus, as Los Angeles-based, celebrity aesthetician Joshua Ross, founder of SkinLab, points out, laser treatments have different settings that an experienced provider can customize to suit your needs. “All lasers can be considered low downtime — the important thing is that you communicate with your provider [so they] adjust the settings accordingly.”

Below are the best low-downtime lasers and in-office skin treatments to consider to target dark spots, uneven skin texture, lack of radiance, and more. All feature less than five days of redness and peeling — the amount of healing time associated with Fraxel — allowing them to be completed over the window of a weekend with proper timing.

Clear + Brilliant For Dark Spots & Texture

Sometimes referred to as “Baby Fraxel,” the Clear + Brilliant laser comes in two varieties: the Original and the Permea. “Clear + Brilliant delivers the energy of Fraxel with no downtime. After topical numbing, the procedure is painless and provides the effects of a chemical peel,” says Dr. Hartman. While the original model is ideal for treating pore size and texture, you will want to opt for the Permea if you would like to clear up pigmentation and/or sun spots. Best results are typically visible after a series of three treatments spaced four weeks apart, with one-to-three days of a sandpaper-like texture, redness, and flaking.

If you are interested in layering your treatments, Dr. Emer offers a treatment called the Laser Vampire Facial. "Our ‘go-to’ lower downtime treatment for younger patients [and those looking for prejuvenation] was Clear and Brilliant combined with microneedling or Morpheus [which is deep microneedling with radiofrequency for skin tightening] and platelet-rich plasma, or PRP,” says Dr. Emer. “Patients can expect 1-2 days of light redness and peeling and significant changes in pigmentation, pores, wrinkles, and discoloration. It wasn’t heavy enough to treat scars but good enough to give people glow, radiance, and complexion blending, without having to take off work."

Due to the incorporation of growth factor-rich PRP — which is created by drawing the patient’s blood and spinning it in a centrifuge — there is reduction in inflammation and expedited healing that allows more treatments to be layered without drastically extending downtime.

MOXI Low Density by Sciton For Dark Spots & Texture

“The MOXI by Sciton falls into the non-ablative, fractional laser category,” explains double board-certified dermatologist Dr. Elizabeth Bahar Houshmand, who is based in Dallas, Texas. “These devices are great for skin tone and texture without the recovery or downtime associated with more aggressive laser procedures.” Dr. Emer advises that the MOXI Low Density Laser by Sciton falls somewhere between the Clear + Brilliant Permea and the Fraxel, but with downtime that lasts only one-to-three days. She adds that the higher-intensity settings make it versatile for the treatment of pores and wrinkles. “MOXI improves skin texture, appearance of pores, pigment, and helps prevent premature aging by stimulating collagen,” says board-certified dermatologist Robyn Siperstein, who practices in Boynton Beach and Boca Raton, Florida. “I recommend a series of three MOXI treatments one month apart, and then regular maintenance treatments every four months... One of MOXI’s strengths is its ability to be treat all skin types.”

Dr. Emer performs bespoke treatments featuring the MOXI Low Density by Sciton called the Advanced Tight and Bright Treatment. "The newest combination includes Morpheus microneedling RF with PRP, but uses BBL HERO light therapy and MOXI laser combined to [achieve] substantial changes in color, texture, and tone — without having to take off work but still getting major changes in results,” Dr. Emer says.

Intense Pulsed Light (IPL) or Broad Band Light (BBL) HERO by Sciton For Dark Spots

Board-certified plastic surgeon Dean Vistnes, medical director and co-founder of SkinSpirit MedSpas, recommends intense pulsed light (IPL) and broad band light (BBL) treatments for the removal of brown-hued hyper-pigmentation and sun spots. “These treatments are incredibly effective at reducing all the signs of sun damage — pigmentation, spots, redness, and uneven skin tone,” he says. However, he warns that while these are great for lifting skin pigmentation, they do less for skin texture and tightening, and are not recommended for patients with more melanated skin tones or a history of post-inflammatory hyperpigmentation.

Patients receive no numbing prior to these treatments, as your feedback is an important indicator for the provider to ensure that the setting is not too high. The sensation feels like having a rubber band snapping on your face, passing instantly as your provider moves the device from one section of your face to the next. After treatment, the areas of pigment will temporarily darken before flaking away over the course of three-to-five days. Many esthetic nurses, dermatologists, and plastic surgeons will also recommend these treatments for being preventative anti-aging services.

PicoSure For Dark Spots

Another great option for laser dark spot removal is PicoSure. “We’ve used Picosure for years to treat pigment problems of all types in all skin tones, but it’s nice that it recently gained FDA-clearance to treat melasma, making it the only device on the market approved to do so,” explains Dr. Hartman. PicoSure delivers energy, not heat, allowing it to target pigmentation due to myriad causes, whether sun exposure, melasma, acne scars, or even an unwanted tattoo. Like the other featured treatments, it promotes the production of collagen and elastin, making it a great preventative treatment. It is often recommended in a series of three to four treatments spaced at two- to four-week intervals and boasts no downtime beyond appearing flushed, red, or temporarily swollen for up to an hour.

Post-Laser Treatments to Reduce Downtime

As mentioned, PRP creams or serums can be applied topically post-laser treatment and are often recommended to help expedite the healing process. “The main benefit to adding PRP to a laser or microneedling treatment is to expedite the healing process,” Ross confirms. “This is really great for patients that need as minimal downtime as possible.” That being said, if expedited downtime is not your concern, note that when PRP is microneedled into the skin or even injected, it boosts collagen production.

There are other in-office treatments that your doctor may recommend post-laser — namely, PRP without microneedling, oxygen, and red light therapy — to reduce inflammation and redness while expediting healing. This allows you to reap the benefits of multiple treatments into single office visits without risking as extensive downtime.

“In my opinion everyone [should do] post laser ACell and PRP applied topically,” says Dr. Emer, referencing both bio-derived stem cells and platelet-rich plasma that is applied in part of his post-laser protocol. As he points out, this allows patients to maximize their results and receive stronger treatments while still healing relatively quickly. For instance, the AuraSpa, a Beverly Hills-based, holistic healing center created by plastic surgeon Dr. Ben Talei, recommends a hyperbaric oxygen treatment (to reduce inflammation, help with discomfort, and promote healing) with the LightStim LED bed (to reduce inflammation and to ‘charge up’ the skin cells’ mitochondria to super-power its innate healing functions). Dr. Emer’s practice offers these treatments in conjunction with an enzymatic facial which helps with flaking, and his at-home AERIFY skincare regimen to enhance results.

There are so many options to consider when it comes to skin pre- and rejuvenation. If the beauty trends can speak for themselves, a series of low downtime lasers, with all their fancy add-ons — from topical PRP to radiofrequency and microneedling adjuncts — are the next iteration of achieving smoother, clearer, more even skin tone, with a plumping boost in collagen and promoted elasticity to boot. Still, there are some trade-offs when opting for a low-downtime treatment, as opposed to a more aggressive treatment with longer recovery. “Typically, the more downtime, the greater the results,” explains Dr. Hartman. “But there is something to be said for slow and steady as well. Devices these days can deliver results over time and fit conveniently into a busy lifestyle.”

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