PICO Laser for Dark Spots on Melanin-Rich Skin: What to Expect

A PICO laser is a laser that fires in pulses lasting trillionths of a second. It is used to treat unwanted pigment, including some kinds of dark spots, and it can be an option for melanin-rich skin when it is used with care. It is not usually the first step. Dermatologists start with sun protection and with treating whatever is causing the spots, and add procedures such as lasers later if they are needed.

This guide covers what a PICO laser is, what the research says about darker skin tones, the risks, and what to try first.

What is a PICO laser?

“Pico” is short for picosecond, which is one trillionth of a second. A PICO laser delivers its energy in pulses that short. The U.S. Food and Drug Administration approved the first picosecond laser in 2012 for the treatment of unwanted tattoos and pigmented lesions.

Several picosecond devices are now on the market. They differ in wavelength and settings, so the right device and settings depend on the kind of pigment being treated and on your skin tone.

Why dark spots need extra care in melanin-rich skin

The American Academy of Dermatology (AAD) explains that people with medium to dark skin tones get dark spots and patches because something triggers their skin to make extra melanin. Acne, eczema, a skin injury or an irritating product can all do it. The medical name is post-inflammatory hyperpigmentation.

That same tendency is why lasers need caution. A 2017 article in The Journal of Clinical and Aesthetic Dermatology notes that “laser treatments in skin of color may result in unwanted side effects, such as postinflammatory hypo- or hyperpigmentation or even scarring.” In other words, a laser used on the wrong setting can cause the problem it was meant to treat.

What the research shows about PICO laser on darker skin tones

The evidence is encouraging but small. The same article describes a retrospective analysis of 13 patients with Fitzpatrick skin types III and IV who were treated with a 755-nm picosecond laser for pigmented lesions. Results ranged from fair to complete clearing. Temporary lightening of the skin was reported in a small number of cases, and no post-inflammatory hyperpigmentation was reported.

Keep the limits in mind:

The study was small and looked back at existing records.
It involved skin types III and IV. Evidence for the darkest skin tones is thinner.
The authors themselves say larger clinical studies are needed.

For melasma, the AAD says a few studies have found that adding a laser or light treatment can improve results for patients who are already applying medication and protecting their skin from the sun. That puts lasers in a supporting role, not a starting one.

What dermatologists recommend first

According to the AAD, treatment for dark spots in darker skin tones follows this order:

Find and stop the cause. If acne or eczema is behind the spots, that condition has to be treated first.
Use sunscreen every day. The AAD recommends a tinted sunscreen that contains iron oxide, with SPF 30 or higher, broad-spectrum protection and water resistance. Iron oxide helps protect against visible light, which is a cause of dark spots.
Add a product that evens out skin tone. The AAD lists azelaic acid, glycolic acid, kojic acid, retinoids and vitamin C.

Fading takes time. The AAD says a spot a few shades darker than your natural skin colour usually fades within 6 to 12 months once the cause is stopped, and pigment that lies deep in the skin can take years. Treatment can speed this up.

Risks of PICO laser treatment

The risks named in the research are darkening of the skin, lightening of the skin and scarring. Sun exposure after treatment raises the chance of new dark spots, so daily sun protection matters before and after any laser session.

Questions to ask before PICO laser treatment

What is causing my dark spots, and has that cause been treated?
How many PICO laser treatments have you performed on skin like mine?
Which device and wavelength will you use, and why?
Will you treat a small test area first?
What are my options if I would prefer not to have a laser?

Frequently asked questions

Is PICO laser safe for dark skin?

It can be used on darker skin tones, but any laser carries a risk of darkening, lightening or scarring in melanin-rich skin. The published evidence is limited to small studies, so the provider’s experience with your skin tone matters.

Will my dark spots come back?

They can. The AAD notes that new spots can form even after existing ones clear, which is why sun protection and treating the underlying cause continue after treatment.

How many sessions will I need?

It depends on the type and depth of the pigment and on the device. Ask for an estimate at your consultation, along with what happens if the first sessions do not help.

Next step

If dark spots are bothering you, start with a skin assessment. You can read more about hyperpigmentation and melasma, or book a consultation to talk through whether a PICO laser or another approach suits your skin.