Pigmentation Is Not One Condition

All of these present as brown or grey marks on the face, and they are treated in materially different ways.

• Solar lentigines — the flat, well-defined brown spots that accumulate on sun-exposed skin with age. Sharp-edged, stable, and generally the most straightforward to treat.
• Melasma — symmetrical, blotchy patches with soft, ill-defined borders, typically across the cheeks, forehead and upper lip. Strongly associated with hormonal influences, including pregnancy and oral contraceptives, and provoked by both ultraviolet light and heat. It is chronic and relapsing by nature.
• Post-inflammatory hyperpigmentation — brown marks left where the skin was inflamed, most often after acne. It follows the shape of whatever caused it, and it fades on its own, though slowly.
• Post-inflammatory erythema — the red or pink counterpart, often confused with the above. Press a fingertip against the mark: if it blanches white and refills, it is vascular rather than pigmentary, and it needs an entirely different approach.
• Hori's nevus — more formally acquired bilateral nevus of Ota-like macules. Speckled blue-grey or brown-grey mottling across the cheekbones, sometimes the temples and nose, appearing in adulthood. It is comparatively common in East Asian skin and it is frequently mistaken for melasma, which matters enormously because the two respond in almost opposite ways to laser treatment.
• Freckles — small, genetically determined, darkening with sun and fading in winter.

Melasma and Hori's nevus can also coexist on the same face, which is one reason self-diagnosis from photographs online tends to go wrong.

Why Depth Determines the Plan

Pigment sits at different levels of the skin, and depth is what governs both what will reach it and what the collateral damage will be.

Epidermal pigment lies in the upper layer. It usually looks brown, has relatively defined edges, and is the most responsive to treatment because energy reaches it without having to travel far. Dermal pigment sits deeper, often appears greyer or bluer through the overlying tissue, and requires energy that penetrates further — which unavoidably means more disturbance to everything above it. Mixed lesions contain both, and are the reason a patch can partially clear and then look worse rather than better.

Clinics assess this with examination and magnification, and a Wood's lamp — ultraviolet illumination that makes epidermal pigment appear more sharply demarcated while dermal pigment does not change much. Many Korean clinics also use standardised photography systems that capture ultraviolet and cross-polarised images, giving a baseline that makes gradual change visible over a course of treatment. That baseline is more useful than it sounds, because pigmentation improves slowly enough that memory is an unreliable judge.

The clinical consequence is direct. A solar lentigo is epidermal and well-defined, so a pigment-targeted laser can often clear it in one or a small number of sessions. Melasma involves a hyperactive, easily provoked melanocyte population plus a vascular and inflammatory component, so treating it with the same decisiveness commonly triggers a rebound that leaves the patch darker than before. Hori's nevus is dermal and does respond to appropriately chosen laser treatment, but needs several sessions and carries its own risk of post-inflammatory darkening along the way.

What Korean Clinics Actually Do

The approach seen in most Seoul clinics is layered rather than device-led, and conservative in a specific way: for melasma in particular, the working assumption is that under-treating repeatedly is safer than treating decisively once.

Laser toning is the workhorse. Low-fluence Q-switched or picosecond laser is applied across the whole area in a series of gentle passes, repeated at intervals of a few weeks, with the intention of gradually reducing pigment without provoking the melanocytes into a rebound. It is deliberately unspectacular per session. Higher-energy, spot-targeted settings are reserved for lesions that suit them, such as solar lentigines.

Topicals do much of the work between sessions. Tyrosinase-inhibiting and anti-inflammatory agents — tranexamic acid, niacinamide, azelaic acid, arbutin, cysteamine, vitamin C, and prescription options where appropriate — are used continuously rather than as an adjunct. Retinoids support turnover but need pausing before device treatment.

Oral tranexamic acid is used for melasma in Korea and elsewhere in Asia. It is a prescription medication with real contraindications, including a history of clotting disorders, and requires medical screening before it is considered. It is not something to source independently.

Barrier and anti-inflammatory care runs alongside — soothing agents, hydration and strict avoidance of anything irritating, on the reasoning that inflammation drives pigment production.

Photoprotection is treated as part of the treatment, not as advice. Broad-spectrum sunscreen reapplied through the day, with visible light and heat both relevant for melasma — which is why tinted formulations containing iron oxides are often specified, and why physical shade, hats and avoiding hot environments including saunas are raised in consultation.

What Treatment Cannot Do

It does not cure melasma. This is the most important thing to understand before starting. Melasma is a chronic condition with hormonal and genetic components, and treatment manages it rather than resolving it. Improvement is real and worth having; permanence is not on offer. Recurrence with sun exposure, pregnancy, hormonal change or simply time is expected rather than a sign of failure, and maintenance is part of the arrangement from the beginning.

Aggressive treatment can make pigmentation worse. This is the specific risk that makes device choice a medical decision rather than a menu selection. Too much energy on melasma provokes rebound darkening; the patch returns deeper and more stubborn than it started. Anyone offering to clear melasma quickly is describing something the condition does not permit.

Deeper skin tones need more caution, not exclusion. Higher melanin content raises the risk of post-inflammatory hyperpigmentation after any treatment involving heat or injury, which is why settings are conservative, test patches are used, and pre-treatment preparation with topicals is common. This is a reason to choose a practitioner experienced with your skin type, not a reason to avoid treatment.

Nothing works without photoprotection. Sun exposure will undo a course of treatment faster than the treatment built it. If daily sunscreen and shade are not something you will realistically maintain, the money spent in the clinic will not hold.

Timelines are longer than people expect. A course typically runs several sessions spaced a few weeks apart, with change assessed over two to three months rather than session to session. Some pigmentation improves substantially; some improves partially; and mixed or dermal lesions often reach a plateau short of clearance. A clinic willing to say so at consultation is telling you something useful.

One further point that is easy to overlook: a new, changing, asymmetric or unusually coloured pigmented lesion is a reason for medical assessment rather than cosmetic treatment. Aesthetic devices should not be aimed at anything that has not been examined.