What it is
In nanosecond pulses it fragments dermal pigment and dark tattoo ink; in long pulses it treats larger and deeper blood vessels; at low energy repeated over a course it is one option inside a melasma plan. It is the pulse setting, more than the machine, that decides what the treatment actually does.
What this page covers
- Q-switched Nd:YAG 1064 nm for dermal pigment and dark tattoo ink
- Low-fluence 1064 nm laser toning as one component of a melasma plan
- Long-pulsed Nd:YAG 1064 nm for larger telangiectasia and deeper vessels
- Micro-pulsed 1064 nm (laser-genesis type) passes for redness, pore appearance and texture
- Long-pulsed 1064 nm hair reduction on darker skin types, including as an adjunct in acne keloidalis nuchae, pilonidal disease and hidradenitis suppurativa
Who it suits
- For dermal pigment: someone with pigment sitting in the dermis, a dark spot, or dark tattoo ink — once it has been examined and named first. The laser comes after the diagnosis here, not before it.
- For melasma: someone already on daily sun protection and a supervised topical treatment, where toning is added to a plan that already exists. Melasma is managed over years, and its treatment does not begin with a device.
- For vessels: someone with settled visible vessels that have been examined and confirmed to be vessels. Vessels also return over time with rosacea and with sun, so maintenance is part of the plan rather than a sign the treatment has failed.
- For hair reduction: someone with dark coarse hair on Fitzpatrick IV-VI skin who accepts the word reduction. Light, blond and white hair does not respond, because the laser targets the pigment inside the hair.
- Not you if you want one session that ends the matter, or want the machine named rather than the setting explained. The pulse setting, more than the machine, decides what this laser does; the same device is gentle or harmful depending on how it is set, and by whom.
When we advise delaying or not treating
- Pregnancy and breastfeeding. Elective device sessions are postponed. Pigment change that arrives with pregnancy is exactly what people come asking a laser to fix, and it is exactly what we defer: it is re-assessed after delivery rather than treated now, and breastfeeding is discussed case by case. Sun protection is the main tool in that period. Tell us if you become pregnant partway through a course.
- A spot, a mole or a red lesion that has not been examined. No laser is aimed at it — see the box at the top of this page. A mole that simply falls inside the treatment area is examined and covered before the first pulse rather than passed over because it is in the way, and the same holds for a tattoo; both absorb the energy focally and burn.
- A recent tan or recent sun exposure. We postpone. A tan also invalidates a test spot: it describes different skin from the skin that will be treated.
- The area threaded, waxed or sugared in the last few days. This is asked at every visit rather than only the first, and the skin is left to recover before any pass is made.
- An unlabeled mixed lightening cream on the area. Skin thinned under a steroid of unknown type and strength reacts unpredictably and scars. The skin is repaired first, and stopping the cream itself causes a rebound we warn you about in advance rather than let you discover alone. Bring the container with you.
- Active infection or an abscess in the treatment field, and recent isotretinoin use — timing is discussed. Where long-pulsed Nd:YAG hair reduction is used in pilonidal disease or hidradenitis suppurativa, it is an adjunct to medical management rather than a substitute for it, and an active abscess is treated before any session.
- A request to start melasma with the laser at the first visit. We decline. The order is daily sun protection and a review of triggers — heat, the kitchen, the oven, the car, light, hormones and medicines — then supervised topical treatment, and only then a device added cautiously if it has a place. Sometimes the honest answer is that it has none. And we do not begin laser work for melasma with someone who cannot commit to daily photoprotection.
- A request to keep going because the last session helped. We decline that too. Repeated low-fluence toning is itself a documented cause of mottled loss of pigment and of melasma returning darker than it started, which is why the stopping point is written into the plan at the beginning rather than after the effect has appeared.
Possible effects
Stated in full, because the decision is not sound without them. One device is doing unrelated jobs here: what applies to pigment is not what applies to vessels, and neither is what applies to hair. The risks follow the setting, not the name written on the machine:
- Redness, warmth and slight swelling around what was treated — around the follicle, or along the line of the vessel — usually settling over hours to days.
- Post-inflammatory hyperpigmentation: darkening that appears after the session, and the commonest problem in deeper skin tones. It fades with time and with sun protection, and can take months.
- Mottled loss of pigment: scattered pale areas, associated with repeated low-fluence toning on the face. Recovery is slow and may not be complete, and there is no straightforward treatment for it — which is why preventing it is the whole plan.
- Rebound of melasma: it returns darker than it was after a course. Heat and light drive it, just as rubbing and friction do, and a device is heat.
- A linear mark or a burn along a treated vessel: it happens when the energy goes above what the vessel will take, and it can leave a scar. Spot size, pulse duration and cooling are what reduce that chance.
- Blistering, an open crust, spreading redness, increasing pain or discharge: these are not a normal stage of healing and are seen the same day. Delay is what turns them into a lasting pale mark or a scar.
- A mole or a tattoo inside the treatment field absorbs the energy focally and burns; and pulsing over a mole that was never assessed destroys the lesion that should have been examined. They are identified and covered before the first pulse.
- Eye injury from a single stray pulse: immediate, and it can be lasting. That is why wavelength-specific eyewear is worn by everyone in the room for every pulse, including a short touch-up, and why shields placed under the eyelid are used for work close to the eye.
- In hair reduction: paradoxical growth — new fine or coarse hair appearing at or beside the treated site. It is reported most on the face and neck, and more often in Middle Eastern and Mediterranean skin, and a hormonal cause is looked for before the course continues.
The stopping point is written into the plan at the beginning, not after the effect has appeared. And if between sessions you see mottling, areas paler than the skin around them, or darkening that is increasing rather than settling, stop and come in before the next appointment. Do not complete the course because it is booked.
A note on darker skin
At 1064 nm the light is absorbed less by skin pigment than shorter wavelengths are, which is why it is often the wavelength chosen for Fitzpatrick IV-VI skin; and the rapid micro-pulsed passes do not rely on targeting melanin at all, which makes them among the more forgiving options for these skin types, though the change they produce is subtle and cumulative and needs a course. But "absorbed less" is not "without risk": the same wavelength runs deep and carries heat, higher energies with it on type IV-VI skin are a documented cause of mottled loss of pigment and of rebound darkening, and post-inflammatory hyperpigmentation happens here more readily than it does in lighter skin. That is why a test spot is routine rather than an extra precaution — while a normal test spot lowers the risk without removing it, and a delayed pigmentary reaction can still appear after the test looked fine. A recent tan invalidates the test, and so do threading, waxing and a mixed lightening cream, because they describe different skin from the skin that will be treated. In vascular work specifically, it is the surrounding melanin that limits which devices can safely be used on the face and near the eye. And in hair reduction this wavelength is less risky on darker skin than the alternatives but is felt more sharply, so it is run at conservative settings with continuous cooling. The honest summary: skin tone is not a barrier here, but it removes the margin for improvising.
Afterwards
- Cool the area and use only what you were given. No scrubs, no acids and no mixed cream until the skin has fully settled.
- Daily sun protection, and shade. Heat itself is a trigger in melasma, so the kitchen, the oven and a car standing in the sun all count.
- No threading, waxing or sugaring of the treated area until you are told otherwise.
- If a crust forms, do not scratch or lift it; let it come away on its own.
- Makeup according to what you are told at the session itself; it differs with the setting that was used.
- Do not judge the result the same week. Assessment happens at the review appointment and with photographs, not in the mirror two days later.
Report the same day: a blister, an open crust, a burn, redness that is spreading, pain that is increasing rather than settling, or any discharge. And between melasma sessions specifically, look in the mirror before every appointment: if you see mottling, areas paler than the skin around them, or darkening that is increasing rather than settling, stop and tell us before the next session rather than coming to it. Those are the signs that precede mottled loss of pigment and rebound, and recognizing them early is what stops both. Tell us as well if you become pregnant, and if a new spot appears, an old one changes, or a dark band shows up under a nail.
Honestly
Being the more forgiving wavelength on deeper skin does not make it risk-free: repeated low-fluence toning for melasma is a documented cause of mottled hypopigmentation and of rebound, and too much energy over a vessel can leave a linear mark, so a stopping point is agreed as part of the plan rather than after the fact.
Common questions
I was told Nd:YAG is safe on brown skin. Is that right?
Partly, and the missing part is the important one. At 1064 nm the light is absorbed less by skin pigment, so it is often the option offered on darker skin instead of the shorter wavelengths. But it runs deep and carries heat, and the problems it does cause — mottled loss of pigment, and melasma rebound — happen in darker skin specifically, and with repeated sessions. Safety here lies in the setting, in stopping at the right time, and in who is holding the device, not in the name of the device.
I want to start my melasma with the laser at the first visit. Why not?
Because that is the order reversed, and it is one of the commonest reasons melasma goes badly. Melasma is driven by heat, light and hormones, and a device is heat. The plan starts with daily sun protection and a review of triggers, then supervised topical treatment, and only then is a laser added cautiously if it has a place — and sometimes the honest answer is that it has none for you. Melasma is managed rather than finished in a session; anyone promising otherwise is not describing the condition accurately. The plan itself is set out on the melasma and pigmentation page.
The last session helped and I want to carry on. Why do you stop?
Because what helps with repetition here is the same thing that harms with repetition. Repeated low-fluence toning leaves scattered pale areas, and the melasma can come back darker than it started. That is why the stopping point is written into the plan at the beginning rather than after the effect appears. And if between sessions you notice mottling, areas paler than the skin around them, or darkening that is increasing, stop and come in before your appointment.
I have a small red thread vein on my cheek. Can it be lasered off?
After it has been examined. Most of what is brought to us like this does turn out to be an ordinary thread vein, which is a reason to have it seen quickly rather than a reason to put it off. But other things wear the same look: a red bump that grows over weeks and bleeds at the lightest touch; a pearly patch crossed by fine vessels with a sore that will not heal; a melanoma with no pigment in it, which reads as red rather than brown. A vascular laser closes the vessel and clears the lesion, and it clears away what would have made the diagnosis. So it is examined first, and treated if it is a thread vein. Note too that vessels return over time with rosacea and with sun, so maintenance is part of the plan, not evidence the treatment failed.
I am pregnant and my melasma got worse in pregnancy. Could I not have just one session?
We postpone. Elective device sessions are deferred in pregnancy, and breastfeeding is discussed case by case. Melasma that comes with pregnancy often settles after delivery, so it is re-assessed then rather than treated now. What we can do in the meantime is real and not an empty deferral: shade and daily sun protection, and a topical plan restricted to what suits pregnancy and breastfeeding. And if you become pregnant partway through a course, tell us straight away.
Does this laser remove hair, or only reduce it?
The word we use is reduction, not removal, and we use it because it is the honest one. The laser targets the pigment inside the hair, so dark coarse hair responds and light, blond and white hair does not. What remains usually comes back finer and sparser. This wavelength is less risky on darker skin than the alternatives, but it is felt more sharply, so we work at conservative settings with continuous cooling. Moles and tattoos inside the area are examined and covered before the first pulse; the device does not pass over them.