"I came in to get rid of melasma, so why are you telling me toning alone won't do it?"
"Aren't blemishes and melasma the same thing? Just take it all off in one go, please."
These are the kinds of things people who come in for pigmentation say all the time.
This is Director Kwon Si-jin of DA Clinic Myeongdong.
We're getting ready to open our doors in Myeongdong soon, and since so many people have been asking about pigmentation treatment ahead of our opening, we wanted to put together this overview for your information first.
If you erase pigment hard and blindly without telling the types apart, it can end up darker instead.
If you don't tell melasma from blemishes from lentigines, the irritation itself can bring post-inflammatory pigment up. That's why the 'diagnosis that tells which pigment it is' comes before the device — let me unpack it from here, step by step.
Wherever you have it done, let's go through the standards worth keeping.
Pigmentation Isn't Just One Type
Melasma, blemishes, freckles, age spots, lentigines.We tend to lump them all together under the single word 'pigmentation', but they're really different kinds of stains.
A stain on your clothes needs a different washing method depending on whether it's coffee or oil, right? Pigment works the same way ㅎㅎ
Blemishes that sit shallowly in the epidermis fade relatively quickly, but melasma, which spans both the epidermis and the dermis in a complex way, is a concern of a different nature.
So even on the same face, even for the same 'thing that looks like melasma', working out what it actually is needs to come before deciding which device to use.
First — melasma is 'management', not 'clearing it in one go'
Many people arrive hoping that "a few laser sessions will make the melasma go away."
But melasma is chronic pigment bound up with sun, hormones and constitution, so it's closer to lightening it in stages than to removing it at a stroke.
The laser toning at DA Clinic Myeongdong delivers a 1064nm Q-switched Nd:YAG evenly at relatively low output, breaking melanin down slowly across several sessions rather than strongly in one.
The change generally becomes clear as five to ten sessions build up at two to four week intervals, and afterwards care such as sun protection shapes the result.(it differs from case to case)
Second, More Power Isn't Always Better
You think, since you're having it done anyway, it'd be nice to fire it hard once and get it out quickly.
But pigment lasers aren't a treatment where the effect improves in proportion to how much you crank up the power.
Too low and the pigment doesn't come out well, but too high and you can actually get more pigment — what we call post-inflammatory hyperpigmentation (PIH).
So what matters isn't unconditionally high intensity, but finely adjusting the output at each session to match the depth of the pigment and the thickness and sensitivity of the skin. This is exactly the point where the results diverge even when the same device is used.
Third, Toning and Pico Have Different Roles
People often ask whether toning is better or pico is better.But these two aren't about which is superior — they have different uses.
Toning, with its nanosecond (ns) pulse, is strong at gradually refining pigment, while the pico laser breaks pigment down into finer particles with an even shorter pulse of one trillionth of a second (picosecond, ps).
When the pulse is short, there's less thermal damage to surrounding tissue, so pico is often the better fit for dark or deep pigment and tattoos.
It's like grinding a stain down into fine grains like sand so the body can clean it up naturally — and in the end, the key is a design that first works out which pigment it is, then blends toning and pico appropriately.
Pigment devices divide into families
Pigment lasers aren't one thing either. They divide in character by how short a time the energy goes in over and at what wavelength, and the pigment they suit changes with it.
- Picosecond familydelivers over an extremely short time to break pigment into fine particles. Because heat has less time to spread, it's spoken of as lowering the risk of pigment rebounding after treatment
- Q-switched familylong used for toning, building up across multiple low-output passes
- Combined-wavelength familycomes up where pigment and vessels are considered together
Wavelength differs in character too.Shorter wavelengths are described as reaching surface pigment, longer ones as reaching deeper.
At our Myeongdong clinic we have PicoSure Pro and PicoPlus on the pico side, Hollywood Spectra for toning, and Clarity II and V-Laser where pigment and vessels are considered together.
It isn't about showing off a device count. You can only say "this method doesn't suit this pigment" if there are alternatives. With one device, whatever pigment walks in converges on that one device.
Honestly, We Don't Recommend It for These Cases
A pigment laser isn't the answer for every stain.
In particular, if you try to remove lentigines (the age-spot family) with a strong laser when melasma was actually present alongside them, the pigment can end up rising even more.
So even when something looks like lentigines, you first have to work out whether melasma is mixed in, and in that case we think it's right to shift direction toward toning or melasma management rather than a strong treatment.
Those who are pregnant or breastfeeding, or taking photosensitizing medication, are also safer to postpone the treatment and consult first.Rather than reaching for the laser no matter what, knowing what your pigment actually is comes first.
- Pigment is sorted by type first
- Higher output is not better
- Toning and pico lasers play different roles
Frequently Asked Questions
Q. Can melasma be completely removed with laser?
A. Melasma is less a pigment you remove completely in one go, and more one you manage gradually in stages.Since it's a chronic change tangled up with UV exposure, hormones, and constitution, we approach it by breaking melanin down slowly over several sessions with laser toning. Usually the change becomes clearer when you build up 5–10 sessions at intervals of 2–4 weeks, and the effect accumulates when you use a brightening agent along with UV protection. That said, it can rise again if you stop the care, so please understand it as a treatment that also involves ongoing maintenance. Do keep in mind that how much you notice differs from person to person.
Q. Between toning and pico, which is better?
A. Toning and pico aren't about better or worse — they're treatments with different roles.Toning, with its nanosecond pulse, is strong at gradually refining pigment, while the pico laser breaks pigment down into finer particles with an even shorter picosecond pulse, so it's often the better fit for dark or deep pigment and tattoos. So it's not about which is better, but about designing how to divide the two appropriately depending on what type your pigment is and how deep it sits.DA Clinic Myeongdong is equipped with both toning and pico, and we plan to choose and guide you to the suitable method after diagnosis.
Q. Can I go back to daily life right after a pigmentation treatment?
A. If the pigment laser is a treatment received at lowered output like toning, there's almost no downtime — even if there's slight redness right after the treatment, it usually settles within an hour or two and light makeup is possible too.That said, treatments that strongly remove blemishes or age spots go through a process where a scab forms for a few days and then falls off naturally.In either case, applying sunscreen thoroughly after the treatment, and for a few days postponing activities that apply a lot of heat such as saunas and jjimjilbangs, helps reduce pigmentation.Even if flaking occurs, please don't force it off and keep it well moisturized.
Q. How is it assessed?
A. The eye alone often struggles to separate them, so we start by dividing them by depth with Eve-V's pigment mode. Then we keep records with Photo Manager at the same angle under the same lighting, for comparison at your next visit.
Q. Why keep photographs?
A. Pigment changes gradually, and memory alone won't hold it. The same skin looks different under different light, so standardising the conditions is itself part of the judgement.
Q. Can it not be done in summer?
A. The measure isn't the season so much as how well you can keep sun exposure off. If it's a period with a lot of outdoor activity, protection is hard and postponing may be better.
Which pigment is it
It's long, but the conclusion is simple.
With pigmentation, it's the 'diagnosis that works out which pigment it is' and the 'appropriate output and staged management' that make the result — more than 'which device'.
Going back to the question I opened with, the answer is here.
DA Clinic Myeongdong is set to open soon.We'll share news of our opening and treatment information first on our blog and Instagram ^^
Thank you for reading to the end.This was Director Kwon Si-jin at DA Clinic Myeongdong.
This column is an informational article intended to provide general medical information; the effects and side effects of treatments may vary by individual. DA Clinic Myeongdong is set to open soon. (Medical Service Act Art. 56)