What kind of laser would be able to treat this deep of pigment? (Photos)

Question

I am interested in getting my skin tone to be even without pigment on my face and deep within. I used to tan a lot and now have freckles. I have done about 5 bbl/moxi treatments but pigment still lingers. When I did a Visia scan before these laser treatments my UV % was 9. After all of these treatments though that number has remained the same. Would picoway be the best bet or is there something else that could be a better option for me?

Nelson Lee Novick, MD · Answer

Instead of chasing the elusive and often expensive holy grail of "Which 'here-today-gone-tomorrow' 'laser or expensive energy-based gizmo is best?", you might wish to consider a couple of tried and true approaches that have proven helpful for reducing unwanted skin pigment that have been used with gratifying results for decades. These include the regular, dailyt at-home use of Rx topical retinoids, and/or glycolic acid or salicylic acid, combined with an in-office, professionally performed series of superficial peels consisting of maximal concentrations of glycolic or salicylic acid, or Jessner's Solution, or low concentrations of TCA. Hope this helps and best of luck.

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin - Winnetka & Chicago. This is a great question. I highly recommend Pico laser in your case, especially given your history of sun damage, persistent freckles, and limited results from BBL/Moxi treatments. Pico laser technology works by delivering ultra-short pulses of energy to break down pigment deep within the skin, without causing significant damage to the surface. This makes it particularly effective for targeting stubborn pigmentation and uneven skin tone that other treatments may not fully reach. The fact that your Visia UV score hasn’t improved suggests that deeper, more embedded pigment remains—something Pico is uniquely suited to address. Unlike traditional lasers, Pico can shatter pigment into finer particles that your body can clear more efficiently, leading to more noticeable improvements in both surface tone and deep discoloration. If your goal is clearer, more even-toned skin without long downtime, Pico is definitely worth considering as your next step. I hope this helps and best of luck!

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