Medically reviewed by Dr Bhavin Garara, GMC 7155707 · Last reviewed: 28 April 2026
Pigmentation conditions including melasma and post-inflammatory hyperpigmentation are recognised medical conditions, and more than one cause can look similar. Some pigmented lesions can indicate skin cancer or other medical conditions. This page is general information, not a diagnosis. Dr Garara will assess your skin and history in person; any suspicious, changing, or asymmetric lesion warrants GP or dermatology review before aesthetic treatment.
The pigment that gives skin its colour is melanin, produced by cells called melanocytes within the epidermis. Pigmentation conditions involve melanocytes producing excess melanin, depositing it in unusual patterns, or melanin spilling into the deeper dermis. Understanding where the pigment sits (epidermal vs dermal) and what is driving its production shapes treatment.
Dr Bhavin Garara’s approach is to identify which form of pigmentation is present, treat it with the appropriate combination of devices and topicals, and — critically — protect the result with daily SPF and skin-of-colour-aware protocols.
Discrete, flat brown spots caused by cumulative UV exposure. Sit mainly in the epidermis. Most responsive to picosecond laser. See also age spots.
Chronic, hormonally and genetically driven symmetrical brown or grey patches, often on the cheeks, forehead, and upper lip. Sits at variable depths and is sensitive to heat — aggressive heat-based devices can worsen it. Needs a careful, conservative approach.
Darker marks left after acne, injury, or skin inflammation. More common and longer-lasting in skin of colour. Responds to topical and gentle laser approaches.
Smaller, lighter, often genetically determined spots that darken with sun and fade with avoidance.
The dominant trigger for sun spots and a major aggravator of melasma and PIH.
Pregnancy, oral contraception, and hormonal fluctuations are common triggers for melasma. Hormonal IUDs can also be implicated.
Family history matters; darker Fitzpatrick types are more prone to melasma and PIH.
A less well-known driver. Hot environments, saunas, and aggressive heat-based laser can worsen melasma specifically.
Acne, eczema, allergic reactions, and skin injury can leave post-inflammatory marks.
Some medications cause photosensitivity. Some perfumes and cosmetics produce a photosensitised pigmentation pattern.
At the clinics in London, Dr Garara uses diagnostic lighting at consultation to determine whether pigment is epidermal or dermal, identifies which type of pigmentation is present, and identifies any indication for medical review.
The plan is tailored: discrete sun spots typically respond well to picosecond laser; melasma needs a particularly cautious approach (often combining low-fluence acoustic laser with topical management and strict sun protection); PIH usually responds to topical management plus very gentle laser only when the skin is in a calm state. Aggressive heat-based devices are avoided in melasma.
Prevention
The single most important thing you can do for any pigmentation is daily sun protection. A consistent home regimen amplifies clinical results.
Prevention
The single most important thing you can do for any pigmentation is daily sun protection. A consistent home regimen amplifies clinical results.
Features
Picosecond laser, vascular laser, non-ablative resurfacing, regenerative, and a medical-grade topical regimen — chosen by pigmentation type and skin type.
Treatment is tailored to the type of pigmentation identified, with daily SPF and a topical regimen as the daily foundation. Aggressive heat-based devices are avoided in melasma.
For sun spots and selected melasma presentations, PicoSure Pro delivers very short pulses of light energy designed to break down melanin clusters with reduced thermal effect compared to longer-pulse lasers. Reduced heat is particularly important in melasma. Multiple sessions are typically needed.
For pigmentation with an underlying vascular component, Derma V can address visible vessels and reduce background redness that feeds chronic pigmentation.
MultiFrax (a 1927nm non-ablative laser) refines diffuse mottling and superficial pigment with limited downtime.
For barrier repair and to support normal melanocyte function, polynucleotides (Rejuran®), PDRN, multi-ingredient skinboosters (Profhilo, klardie, NCTF), and autologous PRP / platelet-derived exosomes can be useful, particularly alongside laser.
For melasma and PIH especially, a structured topical regimen — niacinamide, vitamin C, tranexamic acid, retinoids, and where prescribed by your GP or dermatologist, hydroquinone or its alternatives — is the daily foundation. Treatment takes months.
Treatment for higher Fitzpatrick skin types (IV–VI) requires careful device selection and conservative settings to reduce the risk of post-inflammatory hyperpigmentation or, in some cases, keloid scarring. Dr Garara has particular experience in aesthetic medicine for skin of colour and tailors device choice, energy levels, and treatment intervals accordingly.
For sun spots and selected melasma presentations, PicoSure Pro delivers very short pulses of light energy designed to break down melanin clusters with reduced thermal effect compared to longer-pulse lasers. Reduced heat is particularly important in melasma. Multiple sessions are typically needed.
See full treatment page: PicoSure ProBook a consultation with Dr Bhavin Garara.
Book a Consultation| Treatment | Best suited for | Typical downtime | How long results last | What it does |
|---|---|---|---|---|
| Picosecond laser | Sun spots, selected melasma, PIH | 1–3 days of mild redness | Long-lasting with daily SPF | Breaks down melanin clusters with reduced thermal effect |
| Vascular laser | Pigmentation with underlying vascular component | 1–3 days of mild swelling or redness | Long-lasting | Targets visible vessels feeding chronic pigment |
| Non-ablative laser resurfacing | Diffuse mottling and surface dullness | A few days of mild flaking | Long-lasting; results develop over months | Resurfaces the top layer |
| Regenerative skin treatments | Barrier repair, supporting laser results | 1–2 days of mild bumps | Around 6–12 months with a course | Supports skin quality and resilience |
| Medical-grade topical regimen | Foundation of all pigmentation care | None | Ongoing with consistent use | Manages pigment production over months |
Downtime and duration figures are typical averages only. Individual results vary considerably. Dr Garara will give you a more personalised picture at consultation.
Pigmentation treatments are widely performed but treating pigment is one of the higher-risk areas in aesthetic medicine for worsening the condition if the wrong approach is used — particularly in melasma and in skin of colour. Aggressive heat-based devices can flare melasma; over-treatment can produce post-inflammatory hyperpigmentation. Conservative settings, careful test patches, longer intervals between sessions, and strict daily SPF are essential.
We share this not to alarm you but because patients deserve full information. Dr Garara is happy to discuss specific risks at consultation. Suspicious lesions warrant GP / dermatology review before aesthetic treatment.
Common questions about pigmentation treatment.
Facial pigmentation connects to other skin concerns. You may also want to read about:
For an overview of all the facial concerns we treat, visit our Skin treatments hub.
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This page is for general information and does not constitute medical advice. All treatments require a personal consultation. Suitability, risks, and expected outcomes will be discussed with you in detail before any treatment is carried out.
