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.