Melasma, Hori's naevus, sunspots — why each requires a different approach.
Many clinics offer 'laser toning' as a one-size-fits-all solution for any dark spot. This approach works adequately for superficial sunspots but fails for deeper pigmentation — and can worsen conditions like post-inflammatory hyperpigmentation through inappropriate stimulation.
Epidermal pigmentation (superficial: sunspots, freckles, superficial melasma) responds to shorter wavelengths and lower energy. Dermal pigmentation (deeper: Hori's naevus, deep melasma) requires longer wavelengths (1064nm or Ruby 694nm) to reach the pigment depth.
PIH requires the gentlest approach of all — aggressive laser energy on inflamed skin triggers more inflammation and more pigmentation. Conservative settings and topical management between sessions are essential.
Dr. Park identifies your pigmentation type at consultation — epidermal or dermal, the triggering mechanism, and your skin's response tendency — before selecting any laser protocol. This specificity is what 20 years of managing pigmentation produces.
Yes — for patients with both epidermal and dermal pigmentation, a combination protocol using different wavelengths at different sessions produces better results than a single wavelength approach.
Truly refractory melasma often has both epidermal and dermal components, plus ongoing hormonal stimulation. Dr. Park's combined approach (laser + prescription topical + SPF) addresses all three factors simultaneously.