The advancements in laser therapy have created several treatment options for individuals with pigmentation concerns. Some of these options are geared for specific skin tones while others target specific pigmentation disorders (i.e. melasma). In this post, I will highlight the various laser treatments available for hyperpigmentation, and which ones are best suitable for different skin types.
Best Laser Treatments for Hyperpigmentation
Laser therapy for hyperpigmentation is based on targeting melanin as the central chromophore (a specific target in the skin that absorbs wavelength). Since laser causes cutaneous injury, there is a risk for post-inflammatory hyperpigmentation to develop. This risk is especially high in darker-skinned individuals, since there is a greater amount of melanin.
To determine which skin tones are suitable for specific laser treatments, dermatologists refer to the Fitzpatrick Scale (skin type classification). This categorizes various skin tones by their relation to UV exposure. Here are the skin types classified:
Skin Type I: Pale white skin, always burns and never tans
Skin Type II: White skin, burns easily and tans minimally
Skin Type III: White skin, burns minimally and tans easily
Skin Type IV: Moderate brown skin, burns minimally and tans well
Skin Type V: Dark brown skin, rarely burns and tans very well
Skin Type VI: Black skin, does not burn, tans deeply
With laser therapy options, there are 2 subsets: ablative and non-ablative. In general, non-ablative treatments are ideal for hyperpigmentation, especially in darker-skinned individuals. Non-ablative lasers use less aggressive forms of energy to travel deep into the skin and stimulate tissues. There is less wound care and downtime involved with non-ablative treatments, especially when compared to ablative treatments, which are more invasive and require a longer recovery period.
Lasers also have different wavelengths in which they penetrate the skin. Shorter wavelengths have less penetration through the skin, but are excellent at absorbing melanin. Longer wavelengths penetrate deeper into the skin, and are ideal for treating deeper tissue concerns.
Below are some of the best laser treatment options for hyperpigmentation (recommended skin types included):
ND:YAG
Example Brand: Laser Genesis
A non-ablative laser (does not remove top layer of the skin) which easily absorbs melanin chromophores, resulting in damage to hyerpigmented cells and subsequent clearing of excess pigmentation. It has a wavelength of 1064 nm (namometres) to reach deep layers of skin tissue. When Q-switched (technique of creating short pulses with high intensity), the ND:YAG laser can have a wavelength of 532 nm, which is excellent at treating superficial legions. It can successfully treat various forms of hyperpigmentation including age spots, freckles, and melasma.
Spectra, a Q-switched ND:YAG laser is favorable among skin types IV, V, and VI, particularly for the treatment of melasma.
Ruby
Example Brand: RUBY
Ruby laser utilizes synthetic ruby crystals as its medium. It offers a high energy output at a wavelength of 694 nm. Due to its short wavelength, it can readily absorb melanin. It is available in Q-switched mode, which has been shown to effectively treat various types of hyperpigmentation (acne marks, age spots, freckles). It has not been shown to be effective for treating melasma on its own.
Treatment with ruby laser is recommended for skin types I, II, and III. Darker skin types run the risk of post-inflammatory hyperpigmentation as well as hypopigmentation.
Alexandrite
Example Brand: Ta2 Eraser
Alexandrite laser uses alexandrite crystals as its laser medium. It produces an infrared wavelength of 755 nm. It is available in Q-switched mode as well. It targets melanin chromophores, but doesn’t penetrate deeply into the skin.
Alexandrite laser is used to treat age spots, freckles, café au lait spots, and medication-induced hyperpigmentation. It is ideal for lighter skin types. Darker skin types such as type V and VI should avoid Alexandrite laser, as it has been shown to produce complications such as epidermal burns and post-inflammatory hyperpigmentation.
Er:YAG
Example Brand: AVVIO Er:YAG Laser
Er:YAG laser is an ablative laser (removes top layer of the skin) that uses erbium-doped yttrium aluminum garnet as its medium. It emits an infrared light with a wavelength of 2940 nm. It is strongly absorbed by water (plentiful in tissues) which mitigates excessive thermal damage.
While it is more tolerable than other ablative options such as CO2 laser (burns less surrounding tissue), it still carries many risks such as swelling, bruising, and redness.
Er:YAG can treat hyperpigmentation and melasma. In skin types VI and V, melasma can be effectively reduced with a moderate risk of post-inflammatory hyperpigmentation. Fortunately in most cases, it can be resolved in a timely manner with postoperative care (sunscreen, skin lightening products etc.).
Fraxel
Example Brand: Fraxel Re:store Dual
There are 2 main types of fraxel laser – fractional CO2 (Carbon Dioxide) and fractional Erbium. Fractional Erbium is non-ablative so it’s less aggressive than fractional CO2, which requires lengthy downtime and higher risks for bruising and swelling. However fractional CO2 is better at targeting deeper tissue concerns such as deep wrinkles and acne scarring.
Fraxel laser works by creating thousands of microscopic treatment zones within the skin, which eventually get replaced by fresher, less damaged skin. The results are often quick and progressive, with healing times much shorter than other types of laser.
A specific type of Fraxel laser, known as Fraxel Dual is excellent at treating hyperpigmentation – particularly large surface areas like the back, chest, arms, and legs. Fraxel Dual combines the deeper penetrating 1550 nm fractional Erbium laser with the unique, superficial 1927 nm Thulium Fibre laser (more effective at targeting superficial pigmentation). It can effectively treat various forms of hyperpigmentation, including melasma in types I, II, III, and IV.
Bottom Line
Laser therapy can be an effective treatment option for individuals with hyperpigmentation. It’s important to seek a trained professional when considering laser treatment, since there are often pre-treatment and post-treatment protocols involved. These include sunscreen and specific skin lightening products which can enhance results and mitigate complications (post-inflammatory hyperpigmentation).
As with most skin lightening treatments, lasers are not a quick fix. They often require several treatments to achieve specific goals and ongoing maintenance.