Hyperpigmentation and Dark Spots: Causes and Med Spa Treatments

Hyperpigmentation is the general name for spots and patches that are darker than the skin around them.

The American Academy of Dermatology (AAD) describes the mild end as an area a few shades darker than your natural skin color and the deep end as color that sits down in the skin, where it can read slate-blue to gray.

The dark spots people bring to med spas fall into a few recognizable groups: sun spots (also called age spots), post-inflammatory hyperpigmentation (PIH) and melasma.

They start differently and respond to treatment differently, which is why the type matters before any treatment does.

Where a dark spot comes from depends on the type.

In medium-to-dark skin, the AAD says dark spots usually come from post-inflammatory hyperpigmentation — the mark left after acne, psoriasis, an injury, an irritating product, a medication or a hormonal change — and it calls dark spots one of the most common reasons people with darker skin tones see a dermatologist.

Sun damage is the other source behind the spots on this page.

It builds up over years and shows as freckles, age spots and wrinkles, and some people develop precancerous growths (actinic keratoses) or skin cancer, per the AAD.

Treatment cannot undo years of sun damage, but it can even out skin tone.

Two pieces of context from the AAD frame everything on this page.

Once whatever caused a spot stops, a spot a few shades darker usually fades in 6 to 12 months, while deep color can take years.

And any fading treatment has to be used with caution, because irritation can itself worsen post-inflammatory hyperpigmentation.

That last point is why the AAD's own starting line-up for dark spots is not a device.

It is a daily tinted sunscreen with iron oxide — SPF 30 or higher, broad-spectrum — plus fading ingredients such as azelaic acid, glycolic acid, kojic acid, retinoids or vitamin C.

For melasma, the AAD adds that visible light can worsen it, especially in darker skin tones, which is where the tinted formula comes in.

The three types differ in where they come from, and the difference drives which treatment makes sense for which spot.

Sun spots (age spots). These appear on sun-exposed areas such as the face and hands.

The AAD recommends a dermatologist exam before treating them, because what looks like an age spot could be skin cancer, and fading a cancer gives it time to grow.

Post-inflammatory hyperpigmentation (PIH). Flat red, pink, brown or bluish-gray marks that appear after acne clears are usually PIH, not scars, and PIH usually fades over time, per the AAD.

The triggers run from acne and psoriasis to injuries, irritating products, medications and hormonal changes.

Melasma. A skin condition that causes patches and spots, usually on the face, that are darker than the person's natural skin tone; it is not contagious.

The exact cause is not fully understood — the pigment cells (melanocytes) are more active — and the AAD's list of possible triggers includes sunlight, pregnancy hormones, some medications, stress (which it flags as controversial), tanning beds and thyroid disease.

Melasma has its own pages on this site: our guide to melasma covers what it looks like, who gets it and what treatment can honestly achieve, and melasma treatment walks through the options in detail.

The short version for this page: the AAD lists chemical peels, microneedling, laser and light treatments and PRP as add-ons when sun protection and topical medication are not enough, and says only a board-certified dermatologist should perform them — the AAD's professional recommendation, not a legal rule.

It is equally blunt about the course — treatments fade it, but it can come back, commonly after unprotected sun exposure, and no laser, peel or light treatment makes it go away forever.

The AAD's prescription topicals for melasma include hydroquinone, tretinoin plus a mild corticosteroid and triple combination cream, with azelaic acid, kojic acid and vitamin C as gentler options.

One practical note — hydroquinone is no longer sold in non-prescription products in the US.

Chemical peels are one of the med spa treatments aimed at dark spots: the AAD lists sun-damaged skin, age spots, freckles, melasma, uneven tone, fine lines and some acne among what a chemical peel treats.

Peels are grouped by how deep they go, and the depth sets the recovery.

A light "lunchtime" peel heals in 1 to 7 days, with redness followed by 3 to 7 days of scaling; makeup can usually go back on the same or next day, and a series is common — often 3 to 5 peels, every 2 to 5 weeks.

A medium peel heals in 7 to 14 days, with swelling, blisters and crusting, and makeup after 5 to 7 days.

A deep peel heals in 14 to 21 days, needs 2 to 3 weeks at home and 3 to 6 months of total sun avoidance afterward — and it is done under general anesthesia in a surgical setting, with a person able to have only one deep peel.

Money follows the same structure.

Insurance does not cover chemical peels, per the AAD, so a series of light peels is a series of out-of-pocket sessions, and depth buys downtime as well as reach into the skin.

On darker skin, peels are the treatment with the sharpest warning on this page — it is covered in full under what to avoid — and the variable the AAD names is the provider's experience with darker skin.

Names first, because the marketing blurs them.

Intense pulsed light (IPL) is not a laser: the American Society of Plastic Surgeons defines it as a non-laser light treatment that emits many wavelengths, absorbed and converted to heat, targeting pigment, blood vessels and hair follicles.

BBL (broadband light) is a type of IPL, not a laser either.

Pico lasers are lasers — PicoSure (Cynosure) is a 755 nm Alexandrite picosecond device.

An IPL photofacial or BBL photofacial is cleared by the FDA device by device.

In one example, pigment is named in the cleared indications: an IPL system cleared in 2020 (Lumenis Stellar M22) is cleared for benign pigmented lesions, with dyschromia, hyperpigmentation, melasma and freckles named. "Photofacial" itself is a marketing term rather than an FDA indication — cleared uses belong to specific devices, so the device label is the document that matters.

For sun spots, there is a specific published record: a 2025 systematic review of solar lentigines collected 41 trials covering 3,234 patients and reported success ranging from 74.6% to 90% for IPL, 67.9% to 93.02% for picosecond lasers, 36.36% to 76.6% for Q-switched lasers and 37% to 71.4% for cryotherapy.

Those ranges come from separate trials with different designs, not from one head-to-head comparison.

In the same review, IPL and pulsed-dye laser were the options less associated with post-inflammatory hyperpigmentation, while cryotherapy came with more severe side effects.

The AAD's practical read on age spots runs the same way: one or two laser treatments can treat age spots quickly, with longer-lasting results than a fading cream.

Crusting or temporary darkening is possible, and spots can return without sun protection.

Pico lasers carry melasma in their cleared indications too: PicoSure's cleared 755 nm indication explicitly includes it (along with tattoo and benign pigmented lesion removal), and PicoWay's clearance covers its 532 nm and 1064 nm wavelengths for melasma in Fitzpatrick types I to IV.

The pico laser trial record for melasma is more cautious than the clearance list: a 2022 meta-analysis of 22 laser studies (694 patients) found low-fluence Q-switched Nd:YAG, fractional CO2 and fractional Er:YAG lasers reduced melasma scores, while picosecond lasers did not reach a significant reduction, and darker skin carried a risk of post-inflammatory hyper- and hypopigmentation.

IPL's melasma record is genuinely two-sided: a 2020 meta-analysis of 8 studies (215 patients) found IPL-based combination therapy lowered melasma scores, yet in a series of 675 patients (skin types III to IV) treated with IPL, 2.96% developed melasma-like hyperpigmentation within 3 months.

Microneedling holds a particular place in the dark-spot conversation because of who it may be safer for.

A 2016 review in the Journal of the American Academy of Dermatology found that in darker skin — Fitzpatrick types IV to VI — traditional resurfacing (dermabrasion, peels, lasers) carries a higher risk of pigment change and scarring, and concluded that microneedling may offer a more advantageous safety profile in that population.

For melasma specifically, a 2022 systematic review of 12 small studies found microneedling combined with topical depigmenting agents more effective than topicals alone, with few side effects — while noting that the evidence base is small and mostly low-quality (pilot trials, case series, split-face studies).

Microneedling is the treatment on this list carrying that favorable darker-skin finding, which is one reason it comes up in pigment conversations.

Facials are a different story.

For med spa facials, we did not find controlled-trial evidence in the research reviewed for this page that they fade dark spots — anyone selling one as a hyperpigmentation treatment is ahead of the published record we reviewed.

The facial-adjacent treatment with an actual number behind it is microdermabrasion: in one 16-week study the AAD cites, it cleared about 40% of age spots, with better results when a peel was added.

The caution in the studies is that on darker skin the same tools can trigger the very pigment change they are being used to fade.

The Fitzpatrick scale, which classifies skin by its reaction to sun, runs from type I (always burns, never tans) to type VI (never burns), and the pigment cautions on this page cluster in types IV to VI.

Peels without experience in darker skin. The AAD's warning is specific: without expertise in darker skin, people with skin of color can develop permanent pigment problems from chemical peels.

The same guidance says people with skin of color can safely have peels with an experienced dermatologist — the variable is the provider's experience.

Lasers as a first step for PIH. A 2023 review puts lasers second line to topical agents for post-inflammatory hyperpigmentation in skin of color, because of variable response, cost and the risk of complications; Nd:YAG and fractional lasers can be adjuncts when appropriate settings are used.

A 2026 systematic review of facial laser complications (13 studies, 2,010 cases) found post-inflammatory hyperpigmentation was the most common complication, particularly in Fitzpatrick IV to VI.

Assuming every device covers every skin tone. Clearances and maker guidance set their own limits: Sciton says its BBL HEROic treats skin types I to V — not VI — for pigment, and describes only its infrared SkinTyte mode as usable on types V and VI.

That is the manufacturer's own statement, and it is exactly the kind of question to ask about whichever device a practice would use on you.

Irritating the skin into new pigment. Researchers caution that hyperpigmentation treatments must be used cautiously, because irritation itself can worsen post-inflammatory hyperpigmentation.

The AAD makes the same point for melasma: some melasma treatments can irritate darker skin, which can worsen and darken it, and results usually take longer in darker skin tones.

Imported lighteners and liquid bleach. The AAD warns that skin products imported from other countries have been found to contain steroids or mercury that were not listed on the label.

Its advice on liquid bleach is shorter: never use it.

For dark spots, vetting is not a formality: provider experience runs through several of the risks above — with your skin tone, with the device's settings and with the exact treatment you would be getting.

The AAD publishes a list of questions to ask before any cosmetic procedure, and they map directly onto pigment: Are you board-certified?

How many times have you done this exact procedure?

How often do you treat patients with my skin tone and type?

What results can I realistically expect — it suggests asking for before-and-after photos of patients with similar skin tones — and what are the risks, recovery time, number of treatments and cost?

Who may perform a given treatment varies by state.

AmSpa, the trade association, describes injecting botulinum toxin as the practice of medicine, which must be done by a physician, an independent-practice NP or another licensed professional acting within their scope, under rules that vary by state — and our med spa laws by state guide collects who can inject and who must supervise.

This page is one entry in our guide to skin and body concerns, which pairs concerns with the treatments that address them, and our 10-point checklist for choosing a med spa walks the full vetting list.

A consultation at the practice itself is where the rest of your questions get answered: who would perform each treatment, what it would cost in that office, and how they treat skin like yours.