The short answer
Though they may look similar, melasma, freckles and seborrheic keratoses, lentigines, and nevus of Ota are distinct diagnoses that differ in depth and character. Identifying the lesion comes first and choosing the laser second — and above all, melasma is not a lesion to blast away but one to lighten and manage over time. That principle is the starting point of any treatment plan.
What kind of lesion is my pigment?
Freckles and seborrheic keratoses are epidermal lesions with relatively clear borders, and they tend to respond well to spot laser treatment. Melasma has blurred borders, spreads diffusely, and reacts sensitively to irritation — so it is managed with low-energy toning alongside lifestyle care (sun exposure, hormonal factors). Deep dermal pigment such as nevus of Ota requires a long-term plan with a high-power laser.
Why can't melasma be removed aggressively?
In melasma the melanocytes are in an overactive state, so excessive thermal stimulation can worsen the pigment or trigger rebound hyperpigmentation. That is why we manage it in multiple low-energy sessions, and decide on adjunct medication such as tranexamic acid based on the diagnosis.
Which devices does Grays use for pigment?
We use PicoWay (picosecond), StarWalker MaQX, QX MAX (nanosecond), and GentleMax Pro (long-pulse), matched to lesion depth and character. The reason we keep several devices is that each lesion calls for a different wavelength and pulse.
Pigmented lesions: characteristics and approach
| Lesion | Depth | Characteristics | Approach |
|---|---|---|---|
| Freckles / seborrheic keratoses | Epidermis | Clear borders | Spot removal, a few sessions |
| Melasma | Epidermis to dermal junction | Blurred borders, sensitive to irritation | Low-energy toning + ongoing care |
| Lentigines | Epidermis | Small, dark macules | Spot removal |
| Nevus of Ota | Dermis | Bluish tone, broad distribution | Long-term high-power laser plan |
Related treatments
PicoWay / PicoWay Resolve
PicoWay / PicoWay Resolve
A picosecond laser that shatters pigment into fine particles
- ·Widespread pigmentation such as melasma, sun spots, or freckles
- ·Those who want a tattoo or eyebrow tattoo removed
- ·Those who want to address pigment together with pores and scars
StarWalker MaQX
StarWalker MaQX
A high-power laser platform for hard-to-treat pigment
- ·A diagnosis of a difficult pigmented lesion such as nevus of Ota or cafe-au-lait macules
- ·Dense pigment that responded slowly to standard toning
- ·Those considering tattoo removal
GentleMax Pro
GentleMax Pro
Dual wavelengths, wide range: hair removal, toning, and redness
- ·Those who want medical laser hair removal (underarms, legs, and more)
- ·Sun spots and uneven tone managed with toning
- ·Those who want to address redness and pigment together
Sources
- 01A Systematic Review of Picosecond Laser in Dermatology: Evidence and RecommendationsLasers Surg Med · 2021 · PubMed 32282094
- 02Efficacy and safety of picosecond laser for the treatment of melasma: a systematic review and meta-analysisLasers Med Sci · 2023 · PubMed 36897459
- 03PicoWay Laser System 510(k) clearanceUS FDA 510(k) Premarket Notification · 2017 · US FDA 510(k) K170597
These are the general references used for this guide. They do not warrant the results of treatment at this clinic.
This guide is general medical information and does not replace an individual diagnosis. Please seek an in-person consultation for decisions about your own care.