You’ve noticed brown patches on your face. Maybe they appeared gradually over years. Maybe they showed up suddenly after pregnancy or starting birth control. You’ve tried brightening creams and serums. The dark areas aren’t budging.
But here’s what makes treatment tricky. Not all brown spots are the same. Melasma behaves completely differently than regular dark spots. The wrong treatment can actually make melasma worse.
Understanding which type of pigmentation you’re dealing with determines everything about your treatment plan. Let’s break down the real differences and which laser treatments actually work for each condition.
| Characteristic | Melasma | Dark Spots |
| Appearance | Large patches, blurry edges | Small spots, defined borders |
| Pattern | Symmetrical on both sides of face | Random, scattered placement |
| Color | Brown to gray-brown | Pure brown |
| Depth | Epidermal + dermal (deep) | Epidermal only (surface) |
| Main trigger | Hormones + sun | Sun damage + inflammation |
| Behavior | Chronic, relapsing | Stable once treated |
| Treatment difficulty | Very challenging | Straightforward |
Melasma creates brown or gray-brown patches on your face. The discoloration appears symmetrically, meaning both sides of your face develop similar patterns.
Hormonal triggers:
Environmental triggers:
Genetic factors:
Melasma runs deeper than surface pigmentation. It involves both epidermal melanin (surface layer) and dermal melanin (deeper layer). The depth makes it stubborn and prone to returning.
This condition is chronic and relapsing. You can clear it with treatment. But it wants to come back. Ongoing maintenance becomes a lifelong commitment.
Dark spots go by many names. Age spots. Sun spots. Liver spots. Post-inflammatory hyperpigmentation. They’re all forms of localized hyperpigmentation.
Sun damage spots:
Post-inflammatory hyperpigmentation (PIH):
Age spots:
Dark spots are superficial. They sit in the epidermis only. No deep dermal involvement. This makes them significantly easier to treat than melasma.
Unlike melasma, dark spots don’t have hormonal triggers. They appear from direct skin trauma or accumulated UV damage. Once you successfully treat them, they’re gone unless you create new sun damage.
Melasma indicators:
Dark spot indicators:
Melasma characteristics:
Dark spot characteristics:
Melasma timeline:
Dark spot timeline:
Test with skin lightening products:
Dark spots usually lighten somewhat with consistent use of vitamin C, niacinamide, or retinoids.
Melasma barely budges with topical products alone. It requires more aggressive intervention.
You might think you know which type you have. But professional evaluation prevents treatment mistakes.
Dermatologists use this special light to reveal pigment depth.
What it shows:
Misdiagnosing melasma as dark spots leads to:
Misdiagnosing dark spots as melasma leads to:
Regular dark spots respond well to laser treatment. The approach is relatively straightforward.
PicoWay Picosecond Laser:
IPL Photofacial:
| Stage | Timeline | What Happens |
| Initial treatment | Day 1 | Spots may darken slightly |
| Darkening phase | Days 1-7 | Treated spots get darker before clearing |
| Flaking phase | Days 7-10 | Dark spots flake off naturally |
| Clearing phase | Days 10-14 | Fresh, clear skin appears |
| Results visible | 2-3 weeks | Spot fully cleared |
What to expect:
Treatment is relatively aggressive because regular dark spots don’t rebound with inflammation like melasma does.
Melasma demands a completely different laser approach. Aggressive treatment backfires. Conservative, careful treatment provides best outcomes.
PicoWay with Ultra-Low Fluence:
Fractional Non-Ablative 1550nm:
Q-Switched Nd:YAG Laser Toning:
| Stage | Sessions | Timeline | What to Expect |
| Initial phase | 1-3 | Months 0-3 | Minimal visible change |
| Early response | 4-6 | Months 3-6 | Slight lightening begins |
| Significant fading | 7-10 | Months 6-9 | Noticeable improvement |
| Maintenance | Ongoing | Monthly-quarterly | Prevent relapse |
Aggressive treatment risks:
Conservative treatment benefits:
Laser alone rarely clears melasma long-term. Success requires multiple approaches working together.
Topical medications (foundation):
Start topicals 4-6 weeks before laser
Laser treatment (active clearing):
Sun protection (non-negotiable):
Chemical peels (complementary):
Maintenance (forever):
Typical outcomes:
Realistic outcomes:
Neither condition scars your skin with proper treatment. The pigmentation fades. Your natural skin tone returns. But melasma’s chronic nature means managing it long-term.
Texas has incredibly diverse communities. Treatment safety varies based on Fitzpatrick skin type.
Treatment approach:
Treatment approach:
Treatment approach:
PicoWay’s ultra-fast pulse duration makes it safer across all skin tones. The photoacoustic effect minimizes heat, reducing risks for darker skin patients.
Per session: $300-$600
Sessions needed: 2-4
Total investment: $600-$2,400
Frequency: One-time expense
Maintenance: None (protect from new sun damage)
Per session: $300-$500
Initial sessions: 6-10
Initial investment: $1,800-$5,000
Maintenance sessions: $300-$500 annually
Topical products: $50-$150 monthly
Total commitment: Ongoing indefinitely
The chronic nature of melasma makes it more expensive long-term. Factor in ongoing topical products and maintenance sessions.
Understanding whether you have melasma or dark spots determines your entire treatment strategy. Dark spots respond quickly to straightforward laser treatment. Melasma demands patience, conservative treatment, and long-term management.
Both conditions can be significantly improved with the right approach. The key is accurate diagnosis and treatment designed for your specific type of pigmentation.
If you’re dealing with stubborn brown patches or dark spots that won’t respond to topical products, professional evaluation determines which treatment path will actually work.
Schedule a consultation to assess your specific pigmentation concern. Our master nurse injectors will determine whether you’re dealing with melasma, dark spots, or post-inflammatory hyperpigmentation. Then we’ll recommend the laser treatment protocol that safely addresses your concern.
Clear, even-toned skin is possible. The path to get there just depends on what type of pigmentation you’re treating.
No. Melasma is a chronic condition that can be cleared but tends to relapse. Even after successful treatment, hormones, sun exposure, or heat can trigger it to return. Lifelong maintenance and sun protection are necessary.
Dark spots won’t return unless you create new sun damage or inflammation. They’re not chronic like melasma. Once cleared, they stay gone with proper sun protection.
Look for symmetry. Melasma appears on both sides of your face in similar patterns. Sun damage appears randomly. If you’re unsure, get professional Wood’s lamp examination to determine pigment depth.
The same laser (PicoWay) can treat both, but settings differ dramatically. Dark spots use higher energy for faster clearing. Melasma requires ultra-low energy to avoid rebound darkening. Approach matters more than laser type.
UV rays and even visible light trigger melanocytes to overproduce pigment in melasma-prone areas. Heat also activates melasma. Summer combines sun exposure and heat, making melasma darken seasonally.
For dark spots, topicals often work but slowly. For melasma, topicals alone rarely provide adequate clearing. Combination of topicals plus conservative laser treatment gives best melasma results.
Yes, with proper technology and conservative settings. PicoWay safely treats all skin tones including very dark skin. The key is using ultra-low fluence and avoiding aggressive approaches that trigger inflammation.
For dark spots, avoid direct sun for 2 weeks minimum. For melasma, sun avoidance is permanent, not just after treatment. Ongoing strict sun protection prevents relapse regardless of laser timing.
