Non-Ablative Laser · Pigmentation · Melasma

Laser Toning

How this page was made
This page was written with AI assistance and reviewed against the sources listed under References below. It is general information only, not medical advice. See our full disclaimer for how SHEA creates and reviews treatment information.
01

What it is

Laser toning usually refers to repeated treatment with a low-fluence Q-switched 1064 nm Nd:YAG laser. The laser is passed across a larger area of skin using relatively low energy rather than targeting individual pigment spots with a single high-energy treatment.

The approach became particularly popular in Asia for melasma and general facial pigmentation. Treatment protocols vary in fluence, spot size, number of passes, treatment interval, and total number of sessions, so “laser toning” does not describe one standardized protocol.

See the Pico Laser page for picosecond lasers, which use much shorter pulse durations and should not be treated as the same technology.

02

Why people consider it

  • They are considering a laser-based treatment for melasma
  • They are considering treatment for diffuse or uneven facial pigmentation
  • They want to compare low-fluence laser toning with other approaches to pigmentation
  • They are looking at a treatment that is often performed as a course of repeated sessions rather than a single intensive treatment
03

What the experience is like

The laser is passed repeatedly across the treatment area using relatively low fluence. Treatment settings and the number of passes vary between clinics and devices.

Temporary warmth, redness, or other mild treatment-site reactions can occur. Because laser toning is commonly delivered as a series rather than a single treatment, ask how many sessions the clinic is proposing and why that schedule is being recommended.

For melasma, improvement does not necessarily mean the condition has been permanently cleared. Recurrence after treatment is well documented, so ongoing sun protection and longer-term management may still be important.

04

Limitations & considerations

Mottled hypopigmentation is a documented complication
Repeated low-fluence Q-switched 1064 nm Nd:YAG treatment can cause mottled hypopigmentation, including small pale or white areas that may persist. A 2010 case series described 14 women who developed facial depigmentation after laser toning; they had received between 6 and 50 sessions. A 2022 systematic review also identified persistent mottled hypopigmentation as an occasional adverse effect and suggested that higher accumulated laser energy may contribute to the risk. This does not provide a precise complication rate, but it is a documented risk of the treatment category.
  • Melasma frequently recurs after treatment. In one randomized split-face study, all 22 participants experienced recurrence during follow-up despite improvement during the treatment course
  • Mottled hypopigmentation can occur after repeated treatment and may be persistent; published reports include cases appearing after relatively few sessions as well as after long treatment courses
  • Aggressive treatment can also produce inflammation and hyperpigmentation, particularly in darker skin
  • Studies use different fluences, spot sizes, numbers of passes, session intervals, and combination treatments, which makes it difficult to define one standard laser-toning protocol
  • Evidence supporting treatment of melasma should not automatically be transferred to every type of pigmentation or to general “brightening” claims
  • Device-specific contraindications and precautions should be checked for the actual laser being used
  • No specific degree or duration of pigment improvement can be guaranteed
Evidence note
A randomized split-face study of 22 Asian participants with dermal or mixed-type melasma compared five weekly low-fluence Q-switched 1064 nm Nd:YAG treatments plus 2% hydroquinone with hydroquinone alone. The laser-treated side improved more during treatment, but the study also reported mottled hypopigmentation in three participants, rebound hyperpigmentation in four, and recurrence of melasma in all 22 participants during follow-up. The findings therefore show both short-term efficacy and meaningful limitations.
A 2022 systematic review included 42 publications on low-fluence Q-switched Nd:YAG treatment for melasma. The authors found the literature too heterogeneous to summarize with a single treatment effect. They concluded that the approach appeared generally effective in the published studies but emphasized recurrence, the limited amount of long-term follow-up, and occasional persistent mottled hypopigmentation. They also noted that aggressive treatment can induce hyperpigmentation through inflammation, particularly in darker skin.
Safety reports are important because repeated treatment can extend well beyond the shorter courses used in many efficacy studies. A 2010 case series described 14 Chinese women with laser-toning-associated facial depigmentation after between 6 and 50 treatments, with a mean of approximately 22 sessions. A separate 2012 case report documented punctate leucoderma after low-fluence 1064 nm Q-switched Nd:YAG treatment. These reports establish that persistent loss of pigment can occur, but they do not tell us how frequently it occurs across all patients receiving laser toning.

References

Peer-reviewed literature.

1. 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. Dermatologic Surgery, 2010;36(1):76–87.
Peer-reviewed · Randomized split-face study (n=22) · Melasma · Recurrence and pigment complications reported
2. Lee YS, Lee YJ, Lee JM, Han TY, Lee JH, Choi JE. The Low-Fluence Q-Switched Nd:YAG Laser Treatment for Melasma: A Systematic Review. Medicina, 2022;58(7):936.
Peer-reviewed · Systematic review · 42 publications · Heterogeneous evidence
3. Chan NPY, Ho SGY, Shek SYN, Yeung CK, Chan HH. A case series of facial depigmentation associated with low fluence Q-switched 1,064 nm Nd:YAG laser for skin rejuvenation and melasma. Lasers in Surgery and Medicine, 2010;42(8):712–719.
Peer-reviewed · Case series (n=14) · Laser-toning-associated facial depigmentation
4. Kim HS, Jung HD, Kim HO, Lee JY, Park YM. Punctate leucoderma after low-fluence 1064-nm Q-switched neodymium-doped yttrium aluminum garnet laser therapy successfully managed using a 308-nm excimer laser. Dermatologic Surgery, 2012;38(5):821–823.
Peer-reviewed · Case report · Punctate leucoderma
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