Laser Treatment for Sun Spots and Pigmentation

Laser can lighten many flat, brown sun spots by breaking up excess pigment so the skin can shed or clear it. It tends to work well on true sun spots, called solar lentigines, but not every brown mark is a sun spot. Before any spot is treated, it should be assessed to make sure it is harmless, because lasering a skin cancer can delay its diagnosis.

Sun spots and other brown marks

Solar lentigines are flat, tan to dark brown patches that appear on skin that has had years of sun, such as the face, backs of the hands, forearms, chest and shoulders. They are sometimes called age spots or liver spots, although they have nothing to do with the liver. They are harmless in themselves, but they are a sign of cumulative sun exposure.

Other common types of pigment behave differently:

• Freckles are smaller and often fade in winter and darken in summer.
• Melasma forms larger, blotchy patches, often on the cheeks, forehead and upper lip, and is driven by hormones and sun. It can worsen with heat-based treatments.
• Post-inflammatory hyperpigmentation is darkening left after acne, a rash, a burn or an injury.
• Seborrheic keratoses are raised, waxy or "stuck-on" growths that may be brown but are not simple pigment.
• Moles are collections of pigment cells and should not be lasered for cosmetic reasons without medical assessment.

Telling these apart matters, because the right approach for one can make another worse. Melasma in particular needs a gentler plan, described in Melasma: Why It's Tricky and What Can Help.

Get suspicious spots checked first

Skin cancer, including melanoma, can sometimes look like an ordinary brown spot. Laser treatment can remove the surface pigment of a cancer without removing the cancer itself, which can hide warning signs and delay diagnosis. For that reason, every spot considered for treatment should be looked at carefully, and any spot that seems unusual should be assessed by your family doctor or a dermatologist before any cosmetic treatment.

See your doctor about any spot that:

• Is new and looks different from your other spots
• Is changing in size, shape or colour
• Has an irregular border or several colours
• Itches, bleeds, crusts or does not heal
• Is raised and growing

If there is any doubt about a spot, the responsible choice is not to treat it with laser until it has been properly assessed.

How laser targets pigment

Lasers for pigment rely on the fact that melanin, the brown pigment in skin, absorbs certain kinds of light. When a short pulse of energy is aimed at a pigmented spot, the extra pigment heats up and breaks apart, while surrounding lighter skin absorbs less energy.

With the Fotona system, pigment may be treated with the Nd:YAG wavelength (1064 nm), sometimes in very short pulses, or with light Er:YAG (2940 nm) resurfacing that removes the top layer of skin where much of the pigment sits. The choice depends on the depth of the pigment, your skin tone and how much recovery time you can accommodate.

What happens after treatment: darkening and flaking

One thing that surprises many people is that treated spots usually look darker for a while before they look lighter. This is expected and is part of how the treatment works.

1. Immediately: The area may be red and slightly swollen. Treated spots often turn a darker brown or greyish colour.
2. Days 2 to 7: The darkened spots form fine, coffee-ground-like crusts or flakes. On the face these often shed within about a week; on the hands, arms or chest it can take longer.
3. Weeks 2 to 6: Once the flakes come off, the skin underneath is often lighter and may be slightly pink. Colour continues to even out over the following weeks.

It is important not to pick or scrub off the flakes, because doing so increases the risk of marks and pigment changes. Gentle cleansing, a plain moisturiser and strict sun protection support healing.

How many sessions and how long results last

Some light, well-defined sun spots fade noticeably after a single session. Others need two or three treatments spaced several weeks apart. Results vary from person to person. Treated spots can return, and new ones can form, with further sun exposure. Daily broad-spectrum sunscreen, a hat and shade are the most effective ways to protect your result.

Because summer sun increases the risk of complications, many people choose to treat pigment in the fall and winter months.

Who should not have it, or should wait

Pigment laser may not be suitable, or may need to wait, if you:

• Have a spot that has not been assessed or looks unusual
• Are pregnant
• Have a current tan, sunburn or upcoming sun holiday
• Have melasma in the same area, unless a specific gentle plan is made
• Have an active infection or cold sore nearby
• Have recently taken isotretinoin or use medications that increase light sensitivity
• Have a history of keloids or significant pigment changes after skin injury

Risks and side effects

Expected effects include redness, swelling, temporary darkening and flaking. Possible complications include post-inflammatory hyperpigmentation (new darkening), hypopigmentation (light patches, which can sometimes be long-lasting), blistering, infection and, rarely, scarring. The risk of pigment problems is higher in darker skin tones and in tanned skin, which is why conservative settings and test spots are often used.

Frequently asked questions

Can I treat sun spots at home instead?

Some topical products, such as those containing retinoids, vitamin C or other brightening ingredients, may lighten spots gradually over months. They work more slowly than laser and are less effective on darker lentigines, but they are a reasonable place to start and help maintain results.

Will my skin look worse before it looks better?

Usually, yes, for about a week. Treated spots darken and then flake off. Planning treatment around work or social events helps.

Can sun spots on my hands be treated?

Yes, the hands are a common area. Healing on the hands and body is often slower than on the face, so flakes may last longer.

Before you decide

The most important first step is confirming what your spots are. Once that is clear, you can weigh laser against topical care or simply better sun protection. If you would like to discuss your pigment, HealthPark Medical Aesthetics offers medical consultations where spots are examined, options and risks are explained, and referral is arranged when a spot needs further assessment.