The comparison, in one table
Brown marks are at least three problems: solar lentigines (sun spots) and freckles, post-inflammatory hyperpigmentation, and melasma. The table compares the four treatment classes across all three; the melasma column is the one that most often gets skipped.
| Option | Mechanism | What it changes | Downtime | Who it does not suit | How it is priced here | Device or medicine class |
|---|---|---|---|---|---|---|
| Picosecond laser | Pulses measured in trillionths of a second fragment pigment mechanically (a photoacoustic effect) with little heat spilling into surrounding skin. The body clears the fragments over days. | Sun spots, freckles and diffuse sun damage clear over a small number of sessions; some post-inflammatory marks. In melasma, at most a low-energy adjunct once triggers are controlled. | Mild redness for hours to a day; treated spots darken and flake over about a week. | Any pigmented mark that has not been diagnosed; active or untreated melasma; recently tanned skin; anyone expecting complete removal in one visit. | Per session, by spot count or full face | Registered medical device; lasers of the wavelengths named in the 2026 Order are designated devices requiring a permit. |
| Q-switched (nanosecond) laser | Pulses measured in billionths of a second fragment pigment with a larger thermal component than picosecond pulses. | Sun spots, freckles and tattoo pigment. Repeated low-energy passes for melasma (so-called toning) carry a risk of patchy hypopigmentation and rebound. | Similar to picosecond, with somewhat more crusting and a slightly higher chance of post-inflammatory darkening in darker skin. | Melasma treated by repeated toning courses; darker skin types at high energy; undiagnosed lesions. | Not offered at this clinic | Registered medical device; designated under the 2026 Order where the wavelength is named. |
| Intense pulsed light (IPL) | Filtered broad-spectrum light, not a laser, heats melanin and blood vessels selectively across a large treatment window. | Diffuse sun damage, redness and fine lentigines in lighter skin. Not a melasma treatment: the heat tends to make it worse. | Marks darken then flake over five to seven days; redness for a day. | Melasma; darker skin types, where the risk of post-inflammatory darkening rises; recently tanned skin. | Not offered at this clinic | Registered medical device; not a laser, and not named in the 2026 Order. |
| Prescription topicals and sun protection | Medicines that slow pigment production or speed its turnover: hydroquinone, tretinoin, azelaic acid, tranexamic acid (topical or, in selected patients, oral) and daily broad-spectrum sunscreen against the trigger. | First line for melasma and post-inflammatory marks; maintenance after any laser; slows the return of pigment that a laser has cleared. | None, though irritation and dryness are common early and are managed by adjusting the regime. | Pregnancy and breastfeeding for several of the actives; anyone unable to use them consistently; anyone expecting speed. | Per prescription, at consultation | Registered medicines; several are prescription-only under the Poisons Act 1952 (hydroquinone, tretinoin, oral tranexamic acid) and are supplied by a doctor. |
What each one actually does
A picosecond laser delivers pulses measured in trillionths of a second. At that speed the energy fragments pigment mechanically, by a photoacoustic effect, rather than heating it, so far less heat spills into the surrounding skin. That is the reason it has become the usual tool for discrete sun spots and freckles in skin types common in Malaysia, where heat is the enemy. How a picosecond laser actually works goes into the mechanism and its limits. Since 1 June 2026, medical lasers of the wavelengths named in Malaysia's Medical Device (Designated Medical Device) Order 2026 are designated devices, so the operator needs a permit as well as a registered device. A Q-switched laser is the older equivalent, with pulses measured in billionths of a second. It fragments pigment too, but with a larger thermal component, which matters most in darker skin and in melasma. The low-energy repeated passes sold as laser toning for melasma are the part of this class that deserves the most caution: they can produce patchy loss of pigment and rebound darkening. Intense pulsed light is not a laser. It is filtered broad-spectrum light delivered through a large window, and it heats melanin and blood vessels together, which makes it a reasonable tool for diffuse sun damage with redness in lighter skin and a poor one for melasma or for darker skin, where its heat raises the risk of post-inflammatory darkening. Intense pulsed light is on the Ministry of Health's list of procedures a credentialed general practitioner may perform, and it is not named in the 2026 Order. Topicals are the least glamorous option and, for melasma and post-inflammatory marks, the first-line one. Hydroquinone, tretinoin, azelaic acid and tranexamic acid slow pigment production or speed its turnover; daily broad-spectrum sunscreen removes the trigger; and the regime is adjusted over months. Several of these actives are prescription-only in Malaysia and are supplied by a doctor after assessment. They are also what keeps pigment from returning after a laser has cleared it, which is why why pigmentation comes back is mostly about triggers rather than devices.Melasma is its own chapter
Melasma is a hormonally influenced pigmentation that sits deeper, often symmetrical across the cheeks or upper lip, and it behaves less like a stain and more like a condition. It is managed, not erased. The foundation is strict daily sun protection, a prescription topical regime, and control of heat and hormonal triggers; oral tranexamic acid is an option in selected patients after the doctor has excluded the reasons it should not be used. A laser, when it is used at all, is a supporting instrument at low energy, once the triggers are under control, and never the answer on its own. Aggressive laser on melasma, and intense pulsed light on melasma, are the two ways this concern is most often made worse.
The practical consequence is that a course of sessions offered for melasma should make you ask what the topical plan is, because the sessions are not the treatment.
What none of them does
None of the four diagnoses the mark. A pigmented spot that looks atypical, has changed recently, or does not fit a benign pattern is referred for a specialist opinion before any aesthetic treatment is considered. And none of them out-works the sun: in this climate a patient who cannot commit to daily sun protection is better advised to wait, because the trigger will undo the treatment. Neither is a sales line; both are the reason the pigmentation concern page begins with the diagnosis.
Cost, and what moves it
Laser sessions are priced per session, by spot count against a full face and by the number of sessions the diagnosis calls for; a designated laser permit and the handpiece for the wavelength are part of that fee. Topicals are priced per prescription. The number for any one person is stated at consultation; how to read a laser fee, and the questions to ask any clinic, are on the cost guide. Q-switched lasers and intense pulsed light are not offered here.
How the choice is made here
The read starts with pattern and history, in proper light and often under a diagnostic lamp: when the mark appeared, what makes it worse, whether its border is clean, how deep the pigment sits. Discrete spots behind a clean border are usually laser territory. A symmetrical shadow that flares with sun and heat is managed as melasma, topicals first. A mark that maps onto an old breakout is post-inflammatory, and its cause is treated first. The device, if any, is chosen after that reading, not before it.
