Best treatment for pigmentation and flat moles on the back?

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser. Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.
Best,
Dr. Karamanoukian
Realself100 Surgeon

Thank you for your question. Treating flat moles, pigmentation, and post-procedural erythema (redness) on the back requires a tailored approach depending on the exact nature of the lesions and your skin type.

For pigmentation spots and residual redness (such as those from Morpheus8), here are a few effective options:

Topical Agents: Prescription-strength creams containing hydroquinone, tretinoin, azelaic acid, or tranexamic acid can help fade hyperpigmentation and improve overall tone.

Chemical Peels: Medium-depth peels, such as TCA or salicylic acid, can exfoliate and lighten pigmentation over time.

Laser Therapy: Devices like intense pulsed light (IPL) or fractional lasers can reduce pigmentation and residual redness effectively—particularly when redness is vascular in nature.

Microneedling with PRP: Can be useful for improving texture and diffused pigmentation, especially in areas with post-inflammatory discoloration.

As for flat moles, it’s important to distinguish them from pigmented lesions like lentigines or seborrheic keratoses. If they are true melanocytic nevi (moles), they are typically not treated unless for cosmetic reasons or concern for atypia. Options may include:

Laser removal (e.g., Q-switched lasers)

Radiofrequency ablation

Excision, if clinically indicated

A proper dermatological evaluation, ideally including dermoscopy, would help confirm whether the flat lesions are safe to treat cosmetically or need monitoring or biopsy.

Hope this information is helpful in guiding your decision!

Based on your description, I’d go with BBL HERO. It’s totally noninvasive and targets brown pigmentation as well as red skin/vessels. It does require an evaluation to make sure that it’s safe for your skin type. Great treatment for a more even skin tone