Picosure Laser for Pih?

You have a difficult problem, but your best bet is with the best technology.  Picosure represents state of the art technology for this difficult problem.  I would approach your problem with this technology.

Dark pigmentation on the skin can be caused by genetics, hormones,
and sun exposure. I would use a carefully curated protocol of laser
therapy, fractional ablation, Covalent peels, and topical creams. The
most important step is first starting Melarase creams for at least 6 to 8
weeks. 
AM: Melaclenz, Melapads, Melarase AMPM: Melaclenz, Melapads, Melarase PMBest, 
Dr. Karamanoukian
Realself100 Surgeon

We are presently doing a study at our practice to determine if the picosure will work for melasma.  If one has type V or VI skin I would still be very cautious as this is a 755nm wavelength that can target pigment very effectively.  Hopefully a picosecond 1064nm laser will allow us to treat types IV-VI more safely in the future without such a great risk of targeting their normal pigment.

The PicoSure laser is FDA approved for a variety of pigmented lesions.  At Hall Plastic Surgery & Rejuvenation Center in Austin, TX we may perform a test spot in an inconspicuous area to determine a patient’s reaction to the treatment.  Picosecond technology differs greatly from older Q-switched lasers and it may be worth your while to get a consult and have a test spot performed.

PIH and melasma are the most difficult cosmetic skin conditions we deal with.  I wish there was any laser that would make a permanent difference but so far, no luck.  Aggressive sun protection, mild chemical peels, and regular use of effective topical products continue to be our best ways to minimize and control discoloration on the face.  We look forward to better solutions in the future!

The PicoSure laser can be helpful for post inflammatory hyperpigmentation in people with lighter skin. In most situations, however, the Clear& Brilliant Permea laser is a better choice in most patients and can to a better outcome.
 

The Picosure is working on pigemented lesions and freckles very well, with pigmented lesions resolving in 100% of those treated in the studies done with just two treatments.  Melasma may respond, but has not been studied yet.  A test spot of the area will let you know if it would be effective.

Good Luck!