Guide · Pico laser for melasma
Pico laser for melasma in Singapore: what it can do, why melasma returns, and what comes first
Melasma is a long-term pigment condition, not a stain that a laser can lift out in one go. Here is where pico laser fits in a melasma plan, why sun protection and prescription treatment come first, how a low-energy approach lowers the risk of rebound darkening, and when to see a dermatologist.
Written & medically reviewed by Dr Sin Yong · 9 October 2026
Quick answer
- Pico laser for melasma can lighten patches as part of a plan, but it does not cure melasma. In a meta-analysis of randomised trials, 1064 nm picosecond laser reduced melasma severity without significant side effects, while 755 nm picosecond laser was no better than lightening creams and caused post-inflammatory hyperpigmentation in some people.
- Melasma is chronic and tends to relapse: sun, visible light, heat and hormones keep stimulating pigment cells. Daily broad-spectrum, tinted sunscreen and prescription creams come first; oral tranexamic acid is a prescription option for some people after screening for clot risk.
- Too much laser energy can make melasma darker (rebound hyperpigmentation) or leave pale, mottled patches. That is why doctors use low energy, spaced sessions and a laser only as an add-on, and why a clinic promising to remove melasma permanently should make you cautious.
- At SkinRev Lab, CityLink Mall, and IN Eternity Clinic, Pacific Plaza, Dr Sin Yong diagnoses melasma first, then plans sun protection, prescription treatment where suitable and, for some people, low-energy Laser Toning or Pico Laser on the DEKA TORO. Medical treatment is priced at consultation.
Watch · Dr Sin Yong explains
The condition
What melasma is, and why it keeps coming back
Melasma shows as symmetrical, soft-edged brown or grey-brown patches, usually on the cheeks, forehead, upper lip or bridge of the nose. It is common in Asian women in Singapore, and it darkens with sun, heat and hormonal change, including pregnancy and the contraceptive pill. A family history makes it more likely.
The pigment can sit in the upper skin (epidermal), deeper in the dermis, or both, and many patches also have extra small blood vessels. Pigment in the upper skin usually responds faster; deeper or mixed melasma is slower and less predictable.
The American Academy of Dermatology notes that melasma may fade when a trigger such as pregnancy or a medicine ends, but it can also last for years. Treatment fades the patches; it does not switch off the tendency. Keep that in mind when you read about any laser.
Diagnosis first
Is it melasma? The look-alikes that change the plan
Several kinds of dark patch look similar in a mirror. Sun spots (solar lentigines) are smaller, defined and scattered where the sun hits. Post-inflammatory marks sit exactly where a breakout, eczema patch or injury was. Hori's naevus, a deeper blue-grey pigment, often appears as speckled patches on the cheekbones and can be mistaken for melasma. Many faces have more than one of these at the same time.
The distinction matters because the tools differ. A targeted pico laser setting that clears a sun spot can inflame melasma right next to it. A doctor examines the pigment, often under magnification, before any laser is chosen.
A single dark spot that is new, changing, irregular, raised or bleeding is not something to laser. It needs a skin check, and if there is any doubt, a dermatologist.
The foundation
Melasma treatment in Singapore: what comes before any laser
Every melasma plan starts with protection from light. Ultraviolet and visible light both stimulate pigment, so a broad-spectrum sunscreen of SPF 30 or higher is used every day, and the AAD notes that dermatologists often suggest sunscreens containing zinc oxide, titanium dioxide or iron oxide. In a randomised trial, a sunscreen with iron oxide, which blocks visible light, improved the results of hydroquinone more than a UV-only sunscreen.
Prescription creams are the next layer. In a Cochrane review of 20 randomised trials with 2,125 participants, triple-combination cream (hydroquinone, tretinoin and a mild steroid) lightened melasma more often than hydroquinone alone or two-ingredient combinations, and 20% azelaic acid was more effective than 2% hydroquinone. In Singapore, hydroquinone is a prescription ingredient, prohibited in cosmetic skincare, and is used under a doctor's supervision.
Results take time: the AAD says it usually takes three to 12 months to see results from a melasma treatment plan. Once patches lighten, the work shifts to maintenance rather than stopping.
Singapore's UV index is high all year, and melasma darkens with visible light and heat as well as UV, so reapply sunscreen when outdoors, add a hat or shade from late morning to mid-afternoon, and limit long spells in hot places such as saunas. If melasma started with the contraceptive pill, discuss it with your doctor rather than stopping a medicine on your own. Flares are easier to settle when treated early.
Prescription tablets
Tranexamic acid: a prescription option, not a supplement
Tranexamic acid is a medicine used to reduce bleeding that also dampens some of the signals that drive melasma pigment. Its use for melasma is off-label. It can be applied to the skin, injected in tiny amounts, or taken as tablets; tablets are prescribed only by a doctor after assessment. This section is educational, not a recommendation to take it.
The largest study comes from Singapore. In a retrospective analysis of 561 patients at the National Skin Centre, about nine in ten improved, usually within two months, but 27.2% of those who improved relapsed. Adverse events occurred in 7.1%; one patient developed a deep vein thrombosis and was later found to have an inherited clotting disorder, which is why careful screening for personal and family clot risk comes first.
Oral tranexamic acid is not for people with a history of blood clots, stroke or a clotting disorder, and it needs extra caution with the combined contraceptive pill, smoking, kidney problems and pregnancy. It is often combined with sunscreen, creams and, for some people, gentle laser.
The device
How a pico laser works on pigment
A picosecond laser fires pulses measured in trillionths of a second. At that speed, pigment granules are fractured mainly by a pressure wave rather than by heat, so less heat spreads into the surrounding skin. The fragments are then cleared gradually by the skin's own clean-up cells.
At SkinRev Lab, Pico Laser is performed by Dr Sin Yong using the T2 Frax Radiance protocol on the DEKA TORO platform, which combines a 785 nm picosecond wavelength with 532 nm and 1064 nm nanosecond (Q-switched) outputs. The 1064 nm wavelength passes through the skin surface with less absorption, which is why it is usually preferred for darker skin. Which output and energy suit melasma-prone skin is decided after examining the pigment and your skin type.
The word 'pico' is not a melasma treatment in itself. What matters is the wavelength, the energy, how often sessions are given, and whether the rest of the plan, sunscreen and prescription treatment, is in place.
The evidence
Pico laser and melasma: what the evidence shows
A 2023 meta-analysis of six randomised trials found that picosecond laser reduced melasma severity scores overall, but the results varied widely between studies. In the subgroup analysis, 1064 nm picosecond laser reduced severity with no significant side effects, whereas 755 nm picosecond laser was not significantly better than topical lightening agents and caused post-inflammatory hyperpigmentation in some patients. Other wavelengths had too few patients to judge.
A broader systematic review of picosecond lasers graded the evidence for melasma at level II, below tattoo removal, and concluded that picosecond lasers are safe and effective for a growing range of uses. In plain terms: there are reasonable trials, but they are small and short, and follow-up long enough to measure relapse is limited.
So a realistic expectation is lightening, not clearance, with the patches likely to drift back if sun protection and maintenance lapse. Results vary between people.
Low energy
Why a low-fluence approach, and what laser toning adds
Low-fluence laser toning uses a Q-switched Nd:YAG laser at 1064 nm with low energy and a wide, even beam, passed over the face across a series of visits. A systematic review of 42 studies found it generally effective and safe for melasma, especially in Asia, but it flagged two risks: mottled hypopigmentation, linked to high accumulated energy, and hyperpigmentation from unwanted inflammation when used aggressively, especially in darker skin. Recurrence was common and long-term follow-up was lacking.
One split-face trial in Asian patients shows the trade-off clearly. Five weekly low-fluence sessions improved melasma far more than cream alone at first, but three of 22 patients developed mottled hypopigmentation, four developed rebound hyperpigmentation, and melasma recurred in all of them during follow-up.
The lesson is to do a little, repeatedly, and not more than the skin tolerates. Sessions are spaced, energy is kept low, total energy over the course is watched, and any new lightening or darkening is a reason to pause rather than push on.
Risks
When laser makes melasma worse: rebound and PIH
Rebound hyperpigmentation is melasma coming back darker after laser, and post-inflammatory hyperpigmentation (PIH) is darkening triggered by inflammation in the skin. Both are commoner in Asian and darker skin, both can appear weeks after a session, and both are the reason heat-heavy settings are avoided. Pale, mottled patches from repeated high-energy toning can be slow to recover.
Laser is usually deferred while the skin is tanned or sunburnt, in pregnancy, with medicines that make the skin sensitive to light, over irritated or broken skin, and over any changing mole. If melasma is actively flaring after a holiday or a hormonal change, settling it first with sunscreen and prescription treatment is safer than adding laser as well.
After a session, expect pinkness for a few hours with gentle settings. Use a bland moisturiser and daily sunscreen, pause strong acids and retinoids if advised, and report any unusual darkening or lightening early so that the plan can change.
Another opinion
When to see a dermatologist
An aesthetic doctor can diagnose and manage typical facial melasma, but some situations call for a dermatologist. See one if the diagnosis is unclear, if a patch is changing, irregular, raised, itchy or bleeding, or if pigment is appearing in unusual places. A dermatologist can examine it closely and arrange further tests if needed.
It is also sensible if melasma has not improved after several months of consistent sunscreen and prescription treatment, if laser has already made it worse, or if you are pregnant or breastfeeding and want to know which treatments are safe. If you have a personal or family history of blood clots, oral tranexamic acid should only be discussed with a doctor who knows your full history.
Choosing no treatment is also reasonable. Melasma does not harm health, and many people manage it with sunscreen and camouflage make-up alone.
At SkinRev Lab
Melasma care at SkinRev Lab: consultation and pricing
Melasma is assessed and treated by Dr Sin Yong (MBBS Singapore, MRCS Edinburgh, MSc Practical Dermatology Cardiff). At consultation he examines the pigment, confirms whether it is melasma, sun spots, Hori's naevus or post-acne marks, and asks about sun habits, hormones, pregnancy plans, medicines and clot history.
He then explains the options: sun protection, prescription topical treatment and, where suitable, oral tranexamic acid, with low-energy Laser Toning or Pico Laser added for some people and not for others. No treatment is always one of the options. SkinRev Lab's facials can support comfort and overall tone, but they do not treat melasma. Medical treatment is priced at consultation, and results vary.
Consultations are at SkinRev Lab, #B1-28 CityLink Mall, 1 Raffles Link, Singapore 039393, linked underground to City Hall and Esplanade MRT, open daily 11am to 8pm (WhatsApp +65 8266 9585), and at IN Eternity Clinic, 9 Scotts Road, #12-01 Pacific Plaza, beside Orchard MRT, Monday to Saturday (WhatsApp SkinRev Lab on +65 8266 9585 or IN Eternity Clinic on +65 8815 3008).
Sources
References & sources
- Feng J, Shen S, Song X, Xiang W. Efficacy and safety of picosecond laser for the treatment of melasma: a systematic review and meta-analysis. Lasers Med Sci. 2023;38(1):84.
- Wu DC, Goldman MP, Wat H, Chan HHL. A systematic review of picosecond laser in dermatology: evidence and recommendations. Lasers Surg Med. 2021;53(1):9-49.
- Lee YS, Lee YJ, Lee JM, et al. The low-fluence Q-switched Nd:YAG laser treatment for melasma: a systematic review. Medicina (Kaunas). 2022;58(7):936.
- Wattanakrai P, Mornchan R, Eimpunth S. Low-fluence Q-switched neodymium-doped yttrium aluminum garnet (1,064 nm) laser for the treatment of facial melasma in Asians. Dermatol Surg. 2010;36(1):76-87.
- Rajaratnam R, Halpern J, Salim A, Emmett C. Interventions for melasma. Cochrane Database Syst Rev. 2010;(7):CD003583.
- Lee HC, Thng TG, Goh CL. Oral tranexamic acid (TA) in the treatment of melasma: a retrospective analysis. J Am Acad Dermatol. 2016;75(2):385-392.
- Castanedo-Cázares JP, Hernández-Blanco D, Carlos-Ortega B, et al. Near-visible light and UV photoprotection in the treatment of melasma: a double-blind randomized trial. Photodermatol Photoimmunol Photomed. 2014;30(1):35-42.
- American Academy of Dermatology. Melasma: diagnosis and treatment. AAD public website.
Common questions
Your questions,
answered
Can pico laser remove melasma permanently?
No. Melasma is chronic and tends to return, because sun, visible light, heat and hormones keep stimulating pigment. Pico laser can lighten it as part of a plan with daily sunscreen and prescription treatment, and maintenance is part of that plan.
Which pico laser wavelength is used for melasma?
In a meta-analysis of randomised trials, 1064 nm picosecond laser reduced melasma without significant side effects, while 755 nm was no better than creams and caused darkening in some people. The wavelength and energy are chosen by the doctor after examining your pigment.
Can laser make melasma worse?
Yes. Too much energy can cause rebound darkening or post-inflammatory hyperpigmentation, and repeated high-energy toning can leave pale, mottled patches. That is why low energy, spaced sessions and early reporting of any change matter.
How many sessions of pico laser does melasma need?
There is no fixed number. Melasma is treated over a course, with sessions spaced weeks apart and progress reviewed, and laser is stopped or paused if the skin reacts. The plan is set at consultation.
Is pico laser better than laser toning for melasma?
Neither is simply better. Both 1064 nm picosecond laser and low-fluence 1064 nm Q-switched toning have trial evidence in melasma, and both carry rebound risk if used aggressively. The choice depends on your pigment, skin type and response.
Should I use creams before laser for melasma?
Usually, yes. Daily tinted sunscreen and prescription creams are the foundation, and many people improve with these alone. Laser is an add-on for some, not a replacement.
Can I take tranexamic acid for melasma in Singapore?
Oral tranexamic acid is a prescription medicine, used off-label for melasma by a doctor after screening for clot risk. It is not suitable for people with a history of blood clots, stroke or a clotting disorder.
Can I have pico laser for melasma during pregnancy?
Laser is usually deferred during pregnancy. Melasma that starts in pregnancy may fade after delivery; gentle sun protection is the main step meanwhile, and a doctor can advise which creams are safe.
What is the downtime after pico laser for melasma?
With gentle settings, usually mild pinkness for a few hours. Darkening can still appear weeks later in some people, so strict sun protection and follow-up continue between sessions.
How much does pico laser for melasma cost at SkinRev Lab?
It is a medical treatment by Dr Sin Yong and is priced at consultation, because the plan depends on the type of pigment, how many sessions are sensible and what else the plan includes.