What it is
It is used for surface brown spots, deeper dermal pigment and tattoo ink, and with a focusing lens for texture, pores and shallow post-acne marks. The wavelength is chosen to match the target and the skin tone, so it is not one setting for everything.
What this page covers
- Picosecond 1064 nm for dermal pigment and dark tattoo ink
- Picosecond 532 nm for superficial brown pigment and warm-colored ink, used selectively on deeper skin
- Picosecond 755 nm or 785 nm for stubborn tattoo pigment
- Fractional picosecond with a focus or holographic lens array for texture, enlarged pores and shallow acne scars
- Picosecond treatment of nevus of Ota and Hori's nevus, once the diagnosis has been separated from melasma
- Carbon laser peel for surface oil, congested pores and dullness
Who it suits
- For a discrete brown spot: someone with a sun spot or surface pigment that has been examined and named first. The laser comes after the diagnosis here, not before it — see the box at the top of this page.
- For blue-gray pigment over the cheekbone or around the eye: nevus of Ota or Hori's nevus, once the diagnosis has been separated from melasma. This is a long, widely spaced course that carries a real risk of the area darkening before it improves, so it suits someone who accepts going through that phase.
- For texture, pores and shallow post-acne marks: with the focusing lens, for someone who accepts gradual, cumulative change over spaced sessions. Deep or sharp-edged scars take a different route — acne scar treatment.
- For melasma: someone already on daily sun protection and a supervised topical treatment, where a device is added at a late stage and cautiously if it has a place at all. Melasma is controlled rather than cured, and it relapses with sun, heat, pregnancy and travel — melasma and pigmentation.
- Not you if you are choosing the device by its name. "Pico" describes a pulse duration, not one particular machine; the wavelength is what decides the target, and the setting is what decides what happens to your skin. Not you either if you want one session that ends the matter.
When we advise delaying or not treating
- Pregnancy and breastfeeding. Elective sessions are postponed. Pigment that appears or worsens in 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 or a mole 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 tattoo you want removed has its own page and its own order of work — tattoo removal.
- A recent tan or recent sun exposure. We postpone, and 532 nm is not used on tanned skin at all. 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.
- Diabetes that is not well controlled. This treatment breaks the skin surface wherever it crusts or blisters, and skin in that state heals more slowly and picks up infection more readily while sugars are running high. We ask about control rather than assume it, and the answer can change the wavelength, the setting, or whether anything is done that day.
- Active infection in the treatment area, or an active cold sore near it. Nothing is treated over it; the session waits until the skin has cleared, and the infection itself is dealt with first. Recent isotretinoin use is a separate question, one of timing, and it is discussed. And if you get cold sores at all, tell us before any work around the mouth or on the lip line; laser to that area can set one off in someone prone to them, and that changes what we do and when.
- Active post-inflammatory pigmentation over the area. Lasering it while it is active usually deepens it, so it is treated first — post-inflammatory pigmentation.
- 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.
- A request to keep going because the last session helped. We decline that too. Over-treating melasma with devices is a known cause of it returning darker than it started and of mottled loss of pigment, which is why the stopping point is written into the plan at the beginning rather than after the effect has appeared.
- A request to treat the whole area before the test spot has been read. We decline, and particularly where the treatment is 532 nm on deeper skin.
- A request to have it finished before a date — a wedding, travel, a photograph. We decline: the sessions are spaced by nature, and the crusting and darkening that follow a session are more conspicuous in the mirror than the spot was beforehand.
- A request for the carbon peel — the "Hollywood peel" — to clear deep pigment or acne scarring. We correct the expectation before we book anything: the carbon peel is a surface treatment for surface oil, congested pores and dullness, and its change is gradual and gentle. It does not treat deep pigment and it does not treat scarring, and anyone selling it to you as though it does is not being straight with you.
Possible effects
Stated in full, because the decision is not sound without them. And the first thing usually left out here is not a rare complication but the ordinary course of the treatment on skin like most of ours: the spot looks worse before it looks better.
- Redness, warmth and slight swelling around what was treated, and pinpoint darkening right after the pulse. This usually settles over hours to days.
- The crusting and darkening phase: with 532 nm on deeper skin in particular, the spot crusts and looks darker than it did before it starts to improve. That is an expected course rather than a burn, but it is exactly what drives people to scratch, lift, scrub and reach for a lightening cream — and that is what turns a passing stage into a mark that stays.
- Post-inflammatory hyperpigmentation: darkening that appears after the session. The shorter pulse reduces its likelihood in Fitzpatrick IV-VI without removing it. It fades with time and with sun protection, and can take months.
- Mottled loss of pigment: scattered pale areas, more likely with higher energy, with stacked passes and with sessions booked too close together, and a meaningful risk on deeper skin with any wavelength that melanin absorbs. It also shows more on deeper skin, because a pale patch sits further from the color around it. Recovery is slow and may not be complete, and there is no straightforward treatment for it.
- Rebound of melasma: it returns darker than it was after a course. Heat and light drive it, just as rubbing does, and a device is heat. This is set out on the Nd:YAG laser page, and it is the same problem here.
- 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 scar or a lasting pale mark.
- 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 work around the eyelid — as in nevus of Ota — uses internal metal shields placed onto the eye after anesthetic drops.
- Incomplete or uneven clearance, and some pigment returning later. Becker's nevus and cafe-au-lait patches in particular are known for recurrence and for partial results, and that is said before starting rather than afterward.
- Textural change and scarring: most likely with stacked passes, and over skin that has already scarred.
And the test spot: a small area treated first at the proposed setting, then left and read after an interval — not on the same day, because what matters is what your skin does once the inflammation has settled: did its color darken, did it lighten, did a blister appear, did it heal as it should. The reading can change the wavelength or the energy, and it can end the plan altogether. A session is not canceled as a penalty; it is canceled because your skin answered, and an answer that comes from a small area is far easier to live with than one that comes from a whole face. A normal test spot lowers the risk without removing it, since 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.
A note on darker skin
Most of the people treated here are Fitzpatrick III-VI, and on this page skin tone is not a detail added at the end: it is what decides the wavelength. A shorter pulse — one measured in picoseconds — delivers less heat into the skin around the target, and that reduces the risk of post-inflammatory hyperpigmentation in Fitzpatrick IV-VI without removing it — which is the sentence the advertising stops halfway through. In practice: 1064 nm is absorbed least by skin pigment, so it is the wavelength most often chosen here for dermal pigment and for dark ink. 532 nm is strongly absorbed by pigment, so it is used selectively and sparingly on deeper skin; and where it is used, crusting and a period in which the spot looks darker than it did are the expected course rather than a sign of error, the risk of blistering and of pigmentation afterward rises sharply the deeper the skin tone, and it is not used on tanned skin. 755 nm and 785 nm are absorbed by pigment too, so they are run at lower energy and with more caution. The fractional picosecond lens is widely marketed as suiting every skin tone; in practice deeper skin needs lower energy with it, wider intervals, and daily sun protection in between, and stacked passes are what wake the pigment up. So a test spot is routine rather than an extra precaution, and it is read after an interval before a full session is booked. And the honest summary: at the deeper end of this range the safe treatment is not necessarily a lower setting — it may be a different plan, a topical program, or no device at all — and being told so is the result of an examination, not a service withheld.
Afterwards
- Leave the crust alone. Do not scratch it, lift it or scrub it; let it come away on its own. Picking and scratching are what make the scar, not the laser itself.
- The spot may look darker before it fades. Do not answer that with a scrub, an acid, a lightening cream or an early extra session. Tell us about it instead of treating it yourself.
- Daily sun protection and shade, and cover the treated site with clothing where you can. An area that tans becomes harder to treat at the next session, not easier.
- No hot water, sauna, pool, sea or strenuous exercise until the skin has settled — and where a crust has formed, until it has come away on its own. With the focusing lens and with the carbon peel there may be no crust to wait for, so ask at the session what marks the end of this for you.
- No threading, waxing or hair-removal cream over the area, and no scrubs or acids, until the skin has fully settled.
- Makeup according to what you are told at the session itself; it differs with the wavelength and the setting that were used.
- Photograph the site on your phone in the same light before each session. Assessment rests on the photographs rather than on an impression; memory does not hold the difference between one session and the next.
- Keep the settings record from every session. The next session is planned from it, and it is the first thing any other doctor will ask for if something goes wrong.
And report the same day — not at the next appointment — a blister, an open crust, redness that is spreading, pain that is increasing rather than settling, discharge, or a fever. Look in the mirror before every appointment: if you see darkening that is increasing rather than settling after it had begun to fade, or areas paler than the skin around them, stop and tell us before the next session rather than coming to it. 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.
And after any work near the eyelid: if your vision changes at all — blurring, a dark patch, or loss of sight in the treated eye — do not wait and do not message us first: go to the nearest emergency department the same hour. Eye pain, or a foreign-body sensation that has not settled within a few hours of the shields coming out, is told to us the same day and the eye is examined the same day, not left until the review appointment. The drops used before the shields go in numb the surface of the eye, so a scratch there can go unfelt at the time and only make itself known hours later — which is why this one is not judged by how it feels while you are still in the clinic.
Honestly
Shorter pulses reduce the risk of post-inflammatory pigmentation in Fitzpatrick IV–VI without removing it, the 532 nm wavelength is strongly absorbed by skin melanin and so is used sparingly on deeper skin, and a test spot comes before a full treatment.
Common questions
I was told pico suits every skin type. Is that right?
Partly, and the missing part is the important one. First, "pico" is not one particular machine; the word describes the pulse duration and nothing else. The wavelength is what decides the target: 1064 nm for dermal pigment and dark ink, 532 nm for superficial brown spots, and 755 or 785 nm for stubborn tattoo ink. Second, a shorter pulse means less heat around the target, and that reduces the chance of post-inflammatory hyperpigmentation in Fitzpatrick IV-VI — it does not remove it. And 532 nm is strongly absorbed by skin pigment, so it is used selectively on deeper skin. Safety here lies in the wavelength, in the setting and in who is holding the device, not in the name written on it.
I have melasma. Why not start with pico?
Because starting there reverses the order, and that is one of the commonest reasons melasma goes badly. Melasma is controlled rather than cured: it settles and returns with sun, heat, pregnancy and travel, and it does not end with a session. The order we follow 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 at a late stage and cautiously if it has a place, and sometimes it has none. Over-treating here turns against you: the melasma comes back darker than it started, and it can leave scattered pale areas that have no straightforward treatment. The plan itself is set out on the melasma and pigmentation page, and the rebound on the Nd:YAG laser page.
The spot went darker after the session. Did something go wrong?
Usually not. With 532 nm in particular, and on deeper skin, the spot crusts and looks darker than it did before it begins to improve, and that is an expected course we tell you about before the session rather than after it. What matters is what you do in that phase: let the crust come away on its own, do not scratch or scrub, do not apply an exfoliant, an acid or a lightening cream, and protect the area from the sun. Picking and scratching are what turn a passing stage into a mark that stays. But tell us the same day if a blister appears, or an open crust, spreading redness, increasing pain or discharge; those are not the normal stage.
Does the Hollywood peel treat deep pigment and acne marks?
No. The carbon peel — the Hollywood peel — is a surface treatment: it works on surface oil, congested pores and dullness, and its change is gradual and gentle. It does not treat deep pigment and it does not treat scarring, and anyone offering it to you as a treatment for either is not being straight with you. Be aware too that advertising photographs of this treatment are frequently over-processed, so comparing your skin to them is not a fair comparison. If deep pigment or an acne mark is what concerns you, the route is a different one, and we will say so at the examination.
I am pregnant and my pigmentation has worsened. Could I not have just one session?
We postpone. Elective device sessions are deferred in pregnancy, and breastfeeding is discussed case by case. Pigmentation that appears or worsens in 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 — which here is the treatment, not the addition — and a topical plan restricted to what suits pregnancy and breastfeeding. And if you become pregnant partway through a course, tell us straight away.
I have been treated for melasma for years with no improvement. Could it be something else?
Possibly, and it is worth an examination that reopens the diagnosis. Blue-gray pigment over the cheekbone or around the eye may be nevus of Ota or Hori's nevus: pigment that sits in the dermis, is regularly mistaken for melasma and treated as melasma for years, and does not respond to what melasma responds to. Other things resemble it too: pigmentation caused by a medicine, pigmentation from long unsupervised use of an unlabeled lightening cream, and lichen planus pigmentosus. Dermoscopy helps separate them; a Wood's lamp adds most at the lighter end of this range and much less as the skin deepens; and where the picture stays unclear, a small skin sample is what settles it. Separating them changes the whole plan. If it does turn out to be nevus of Ota or Hori's, treatment is a long, widely spaced course that carries a real risk of the area darkening before it improves, and work around the eyelid is done with shields placed onto the eye.