Pigmentation and Laser in London 2026. Why Sun Spots Respond and Melasma Often Does Not

Take the free laser suitability check and a doctor will tell you within one working day which of these your pigmentation looks like.

The distinction the market glosses over

Type pigmentation removal London into a search bar and the results treat all brown marks as one problem with one solution. They are not. The two commonest reasons someone books a pigmentation consultation behave in almost opposite ways under a laser, and telling them apart is the whole game.

Solar lentigines, sometimes called sun spots, age spots or liver spots, are discrete, flat, well-defined brown marks that appear on skin that has had a lot of sun. Face, hands, forearms, chest, shoulders. They sit in the upper layers, they have clear edges, and they respond well to a laser tuned to melanin.

Melasma is different in kind. It presents as larger, less defined, often symmetrical patches, typically across the cheeks, forehead, upper lip and jawline. It is driven by hormones and by light, it is common in pregnancy and with the combined pill, it sits deeper and more diffusely, and its defining behaviour is that it comes back. Heat and light are among the things that provoke it, which is an awkward property in something you were planning to treat with heat and light.

A doctor tells them apart by pattern, distribution, edge definition, history and examination under magnification. It is a diagnosis, and it is the single most valuable thing an assessment produces for anyone with brown marks.

Where laser is genuinely strong

Mardani and colleagues published a systematic review of clinical trials for solar lentigines in the Journal of Cosmetic Dermatology in 2025, covering 41 trials and 3,234 patients through December 2023. Laser therapy, including Q-switched, picosecond and intense pulsed light approaches, outperformed topical agents, cryotherapy and chemical peels. Picosecond platforms showed the highest success rates at 68 to 93 percent, with an acceptable safety profile.

That is a solid evidence base by the standards of aesthetic dermatology, and it is why a doctor will often be quite positive about treating sun spots. Many respond substantially in one to three sessions. The marks darken briefly, then flake away over one to two weeks, and the skin underneath is clearer.

The caveats are real but manageable. Response varies with device and skin type. New marks will form if photoprotection stops, because the sun that caused the first lot has not gone anywhere. And any pigmented lesion that is changing, growing, irregular in colour or asymmetric needs examining before it is treated, because a laser aimed at a melanoma destroys the evidence and delays the diagnosis. That alone is a reason not to have pigment treated by anyone who cannot assess a mole.

Where laser is not the answer, and can make things worse

For melasma, two recent bodies of work point the same way. Ma and colleagues reviewed the field in the Journal of Cosmetic Dermatology in 2023, and Chehrara and colleagues pooled 16 randomised trials in 2025, most using low-fluence Q-switched Nd:YAG. The conclusion in the stronger reviews is consistent. Laser achieves short-term lightening at best, recurrence rates are high, and there is a real risk of post-inflammatory hyperpigmentation, particularly in darker skin. Follow up in most of those trials ran only two to six months, which is too short to say much about durability in a condition defined by returning.

So the current position is that laser belongs as an adjunct alongside strict photoprotection and topical depigmenting treatment, and not as a treatment on its own. What actually moves melasma is unglamorous. Daily broad-spectrum sun protection used properly and reapplied. Topical agents, which may include a triple combination cream or tranexamic acid where a doctor judges them appropriate. Time. Attention to the hormonal driver where there is one. A laser fired into that picture without the rest of it in place will often leave the patch darker than it started.

This is the sentence that will cost us a booking a month, and it is the one that earns the rest of the page. If your pigmentation is melasma, a doctor here will usually tell you laser is not first for you.

Ask which kind of pigmentation you have, or email team@thewellnesslondon.com.

The third picture, post-inflammatory pigmentation

There is a third pattern worth naming, because it changes the plan. Some people mark after any inflammation. A spot, a scratch, an insect bite or a treatment leaves a brown mark that lasts months. That tendency, post-inflammatory hyperpigmentation, is more common in darker skin.

If that describes you, it is the most important thing on your form, because it predicts how your skin will respond to laser generally, not just to pigment treatment. Settings come down, intervals lengthen, some platforms come off the table, and for some people the honest answer is a topical route. Being asked about this and having it recorded is a marker of a careful clinic.

What it costs in London

Centre for Surgery lists pigmentation treatment at £150 for a single lesion or small area, £350 for a half face and £500 for a full face, with courses of three at £400, £900 and £1,250, and melasma laser from £500. sk:n lists treatment for age and sun spots at £375. London Premier Laser lists PicoSure Pro at £1,390 for a full face and £599 for the periocular area. The Skin to Love Clinic starts Regenlite from £250 for a full area with individual lesions averaging £75.

At The Wellness, redness and pigmentation programmes start from £950 for one area in a single session, £2,250 for the full face across a course of three with a doctor review, and £4,250 for face and neck across a full course with combined vascular and pigment treatment where indicated. The consultation, £250 on video or £350 in person, is credited in full against whichever you go on to have, and if the conclusion is that laser is not right for your pigmentation, it is credited against the treatment that is.

Frequently asked questions

Does laser work on melasma? Usually not as a first treatment. Melasma resists laser and laser can provoke it, particularly in darker skin. Chehrara and colleagues pooled 16 randomised trials in 2025 and concluded that laser belongs alongside strict photoprotection and topical agents rather than in place of them, and noted that follow up in most trials ran only two to six months. Laser does not clear melasma.

Does laser work on sun spots and age spots? Yes, and this is where the evidence is strongest. Mardani and colleagues reviewed 41 clinical trials covering 3,234 patients in 2025 and found laser outperformed topical agents, cryotherapy and peels for solar lentigines, with picosecond platforms reaching success rates of 68 to 93 percent. Many respond substantially in one to three sessions.

How do I know whether I have melasma or sun spots? By examination. Sun spots are discrete, flat and well defined, on sun-exposed areas. Melasma is larger, less defined, often symmetrical across the cheeks, forehead or upper lip, and is driven by hormones as well as light. Pattern, distribution, edge definition and history separate them, and it is a diagnosis rather than something to judge from a photograph.

Will the pigmentation come back? Sun spots will not return in the same place once fully cleared, but new ones will form if photoprotection stops, because the cause has not changed. Melasma is defined by recurrence, which is why it is managed with a long-term plan rather than treated once.

Can pigmentation laser be used on darker skin? Yes, with the platform and settings chosen for the skin type, because the risk of post-inflammatory hyperpigmentation is higher and some platforms are ruled out. If your skin marks readily after inflammation, that is the most important thing to tell the doctor.

Should a mole be treated with laser? No, not without assessment first. Any pigmented lesion that is changing, growing, irregular in colour or asymmetric must be examined before anything is done to it, because treating it with laser destroys the evidence and delays a diagnosis that may matter a great deal.

Start with the diagnosis, not the laser

Take the free laser suitability check and a doctor will read it and reply within one working day. Or book a consultation with a doctor at The Wellness in Marylebone, minutes from Baker Street, £250 on video or £350 in person, credited in full against whatever you go on to have.

Email team@thewellnesslondon.com or call +44 20 3951 3429.

This article is for information and does not constitute medical advice or a diagnosis. Light-based treatment of pigmentation carries risks including post-inflammatory hyperpigmentation, loss of pigment and, rarely, scarring. Any changing or irregular pigmented lesion should be assessed by a doctor before any treatment. Every laser treatment at The Wellness follows an assessment by a GMC registered doctor, who discusses the treatment with you and takes your consent personally. Individual results vary. Please speak to a doctor before any cosmetic treatment.