Melasma Laser or Toning? Research Starts With Topicals

Melasma laser and toning are not really a head-to-head choice. A 2024 review in the American Journal of Clinical Dermatology places laser after topical treatment has already been tried, not beside it, and when a laser is used, the evidence favors low-fluence Q-switched Nd:YAG (what patients usually call toning) or picosecond devices. The real starting question is how much sunscreen and topical treatment you have already done.

Hello, I'm Dr. Kim Yeonjin, director of UH CELL Clinic's Gangnam branch.

Patients often ask me which gives a better result, laser or toning. Before I can answer that, two things need to be straight: toning is itself a type of laser, and laser has a specific place in melasma treatment, not the first place.

Toning Is a Way of Using a Laser, Not a Separate Treatment

Toning delivers low energy evenly across the skin using a laser device. Christian Gan of St Vincent's Hospital Melbourne and Michelle Rodrigues of the Royal Children's Hospital, in a 2024 review published in the American Journal of Clinical Dermatology, concluded that if a laser is used for melasma, the supporting evidence sits with low-fluence Q-switched Nd:YAG or picosecond lasers. The same review did not treat laser as a first-line melasma treatment. Its position is to consider laser for patients who have not improved on topical treatment, weighed against cost and the high relapse risk after stopping treatment.

A Trial That Put Picosecond Lasers Next to a Topical Treatment

A team at Beijing Friendship Hospital, Capital Medical University, led by Surong Liang, published a randomized controlled trial in Frontiers in Medicine in 2023. Sixty melasma patients with Fitzpatrick skin types III-IV were split into three groups. The picosecond Nd:YAG (1,064 nm) group and the picosecond alexandrite (755 nm) group each received three sessions four weeks apart, while the comparison group applied 2% hydroquinone cream twice daily for 12 weeks.

• Over 24 weeks, all three groups showed improvement in melasma severity scores (MASI).
• The picosecond Nd:YAG group showed the largest reduction.
• The picosecond alexandrite group performed similarly to the hydroquinone cream group.
• Safety profiles were similar across all three groups.

The same researchers still described hydroquinone as a first-line melasma treatment in their paper.

Whichever Laser You Choose, Plan for Recurrence

A 2024 randomized split-face study in Lasers in Surgery and Medicine compared a picosecond alexandrite laser with a Q-switched Nd:YAG laser. At the two-year follow-up, 10 patients (58.82%) reported recurrence or worsening, with no statistically significant difference between the two lasers. Before choosing a device, settle how sunscreen use and maintenance treatment will continue afterward. That plan matters as much as the device itself.

What to Have Ready Before Your Consultation

• How much sunscreen and topical brightening treatment you have already tried, and in what way.
• Whether freckles or other pigmented spots are mixed in with the melasma. This is confirmed through diagnosis, and it can change the treatment plan.
• Your schedule in Seoul after treatment and your return date.

Our Gangnam branch has Japanese, Chinese, and English-speaking interpreting staff on site.

Skin response and recovery time vary between individuals. Please discuss your diagnosis and treatment plan directly with your physician.