Pigmentation is one of the most common skin concerns in Singapore, and one of the most frequently mismanaged.
Dark spots, melasma, post-inflammatory hyperpigmentation, and deep dermal pigmentation like Hori's naevus each behave differently and respond to different treatments. Applying the wrong laser at the wrong setting can make pigmentation worse, not better.
At 1Aesthetics, Dr Wan takes a diagnosis-first approach to pigmentation removal. Before any treatment begins, he assesses the type, depth, and likely cause of your pigmentation, then builds a plan around that assessment. The goal is meaningful, lasting improvement with the lowest possible risk of complications.
Dr Wan uses a triple-wavelength picosecond laser (a laser that delivers energy in ultra-short pulses, reducing heat damage to surrounding tissue) as his primary tool for pigmentation removal.
Its three wavelengths (532nm, 694nm, and 1064nm) allow him to match the laser setting to the specific pigmentation type and the patient's skin tone.
The 694nm ruby wavelength is particularly well suited to melanin-rich pigmentation and carries a lower risk of triggering post-inflammatory hyperpigmentation than many other laser settings, making it a more appropriate choice for Asian skin types.
The photoacoustic effect (the use of light energy to generate pressure waves that shatter pigment particles) produced by the picosecond pulse duration means pigmentation can be broken down with less thermal damage to the surrounding skin compared with older nanosecond laser technology.
The fractional mode of the pico laser uses a microlens array (a specialised attachment that splits the laser beam into numerous focused micro-beams) to concentrate energy approximately 2mm beneath the skin surface.
By leaving a proportion of skin untreated in each session, the fractional approach reduces the risk of complications and supports faster recovery. This makes it particularly suitable for patients with more sensitive skin or those who have previously experienced PIH from laser treatment.
Q-switched nanosecond lasers (lasers that deliver energy in longer pulses than picosecond technology) were the standard of care for pigmentation removal before picosecond lasers became widely available. They remain useful in specific clinical situations, particularly for certain deeper pigmentation conditions or as part of a combination protocol where the longer pulse duration produces a different tissue response.
They require careful application on Asian skin tones. Prolonged or aggressive use in full-field mode carries a higher risk of white spot formation compared with the fractional approaches Dr Wan typically prefers. Where a Q-switched laser is appropriate, it is used at conservative settings and always as part of a broader treatment plan.
The fractional thulium laser operates at a wavelength of 1927nm and selectively targets the superficial layer of the skin, where surface pigmentation such as freckles, sun damage, and mild melasma tends to concentrate.
Applied fractionally, it removes pigmented skin cells while stimulating collagen production (encouraging the skin to produce the structural protein that keeps it firm and even-toned), with minimal downtime compared with fully ablative laser approaches.
It is suitable for a range of skin tones and is particularly useful for diffuse pigmentation that does not respond well to spot laser treatment.
Chemical peels use carefully selected acids to remove the outer layers of the skin and reduce the concentration of pigment at the surface.
They are a useful adjunct to laser treatment, particularly for freckles, mild melasma, and post-acne pigmentation. Dr Wan selects peel strength and formulation according to skin type and sensitivity, with Asian skin tones requiring a more conservative approach to avoid triggering PIH.
Prescription medications play a central role in Dr Wan's pigmentation treatment plans, particularly for hormonally driven conditions like melasma.
Topical agents may include melanin-inhibiting creams that slow down pigment production in the skin, while oral medications can address pigmentation from within. These are not standalone treatments but are used alongside laser sessions to improve outcomes and reduce the risk of recurrence.
The most common mistake in pigmentation treatment is applying a laser before understanding what type of pigmentation is being treated. Different pigmentation conditions sit at different depths, respond to different wavelengths, and carry different risks of rebound or worsening with aggressive treatment.
Dr Wan's approach begins with a thorough assessment of the patient's history, skin tone, and pigmentation type before any treatment decision is made.
He does not use a standardised laser toning protocol applied to every patient. Indiscriminate laser toning, particularly with older nanosecond technology, can lead to slow results at best and serious complications, including PIH and white spot formation, at worst.
Instead, he selects and combines treatment modalities based on each patient's specific diagnosis, skin colour, and observed response to previous treatment.
In Dr Wan's view, the harder part of treating pigmentation is not the initial removal but preventing it from returning. Aftercare, including consistent sun protection and prescription medication where indicated, is as important as the laser sessions themselves. Pigmentation treatment is a programme, not a single procedure.
Dr Wan regularly treats the following pigmentation conditions. Each requires a different clinical approach, and many respond best to a combination of treatments rather than a single modality.
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Melasma is a complex, hormonally influenced pigmentation condition that is worsened by sun exposure and tends to recur. It is one of the most frequently treated conditions at 1Aesthetics, and one of the most misunderstood.
Unlike surface pigmentation such as freckles, melasma often sits at multiple depths in the skin and has an uneven response to treatment. Using high-energy lasers aggressively on melasma can trigger a rebound effect, making it temporarily or permanently darker. This is why Dr Wan avoids indiscriminate laser toning and instead uses lower-risk approaches tailored to the patient's skin tone and hormonal profile.
There is currently no treatment that eliminates melasma permanently. The realistic goal is significant lightening and long-term suppression through a combination of laser treatment and ongoing medication.
Dr Wan's preferred approach combines fractional thulium laser, which carries a lower risk of white spot formation than traditional nanosecond lasers, with the fractional microlens array handpiece from the pico laser, which targets melanin with greater specificity. Where appropriate, fractional microneedle radiofrequency is added to improve the effectiveness of laser treatment and help stabilise melasma activity over time.
Topical and oral medication are not optional extras in a melasma treatment plan. They are essential to suppress pigmentation production between sessions and reduce the risk of recurrence.
Freckles and age spots are among the more straightforward pigmentation conditions to treat. Both typically respond well to the pico laser using the 694nm ruby wavelength, which targets melanin with high specificity and generally produces visible improvement within a small number of sessions.
Very faint or diffuse age spots may respond better to fractional thulium laser, which removes the superficial layer of skin where this type of pigmentation tends to concentrate. With consistent sun protection and appropriate aftercare, including pigmentation creams and oral supplements, recurrence is generally slow in most patients.
Cafe au lait macules (flat, light-brown patches that are typically present from birth or early childhood) generally respond well to the pico laser using the 694nm ruby wavelength. However, they are prone to recurrence and may require repeat sessions or a combination approach with fractional thulium laser for more durable results.
Nevus of Ota and Hori's naevus are types of deep dermal pigmentation (pigmentation situated in the deeper layers of the skin rather than the surface) that appear as bluish or greyish patches, typically on the face. Because they sit deeper than surface pigmentation, they require more sessions and higher energy levels to treat effectively.
Both conditions respond to the pico laser, with the 694nm ruby wavelength used for most patients and the 1064nm wavelength reserved for darker skin types or particularly deep pigmentation. Treatment takes longer than for surface conditions, but in Dr Wan's experience, the outcomes are often the most visible of any pigmentation type, and recurrence following successful treatment tends to be low.
Post-inflammatory hyperpigmentation (PIH) is darkening of the skin that occurs in response to inflammation, whether from acne, insect bites, wounds, or, critically, from laser treatment itself. It is one of the most common concerns patients raise when considering pigmentation treatment, particularly those with medium to darker skin tones.
Dr Wan's approach to minimising PIH risk is built into his treatment selection process. By using lasers with high melanin specificity, lower thermal damage profiles, and fractional delivery methods, he reduces the likelihood of the treatment triggering the very condition it is meant to address.
For Asian skin types in particular, this means avoiding aggressive full-field laser settings and preferring approaches such as the fractional microlens array or fractional thulium laser that leave a proportion of skin untreated to support recovery.
For patients already dealing with PIH, facial skin tends to respond well to the pico laser using the 694nm ruby wavelength, or the 1064nm wavelength for darker or more sensitive skin tones. PIH on the upper limbs and legs is more challenging to treat and may require longer treatment courses and oral medication in addition to laser sessions.
This is one of the most common concerns Dr Wan hears from patients who have researched pigmentation treatment online or who have previously experienced a negative reaction to laser elsewhere. It is a legitimate question, and it deserves a direct answer.
Yes, laser treatment can make pigmentation worse if the wrong laser is used, the settings are too aggressive, or the patient's skin tone is not properly accounted for. This is not a reason to avoid laser treatment altogether, but it is a reason to choose a practitioner who understands the risk and actively designs treatment to minimise it.
Patients who have already experienced worsening after laser treatment elsewhere are a specific group that Dr Wan sees regularly. The first step in a consultation is to identify what type of pigmentation is now present, whether that is the original condition, a PIH response, or a combination of both.
From there, Dr Wan will advise on whether treatment is appropriate, how long any inflammatory response needs to settle before further laser work is safe, and which approach carries the lowest risk given the current state of the skin. In some cases, a period of topical treatment and sun avoidance is recommended before any laser session is considered.
If your pigmentation has worsened after a previous laser session, or if you are concerned about PIH risk before starting treatment for the first time, a consultation with Dr Wan is the most reliable way to understand your options.
Address:
1Aesthetics, Medical & Surgery
#14-90 The Central Tower 1
8 Eu Tong Sen Street
Singapore 059818
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