Fotona Laser Resurfacing for Dark Spots: Sun Spots, Melasma, and When to Get Checked

Ashley Harwyn, PA-C, ABAAHP  |  Published October 24, 2025  |  Last updated October 6, 2026  |  19 min read

Brown sun spots can respond well to a laser, once you are sure they are sun spots and not melasma or something that needs a dermatologist.

Three different things often get filed under “dark spots.” There are sun spots (doctors call them solar lentigines), there is melasma, which behaves very differently and needs its own plan, and there is the occasional spot that could be a skin cancer and needs a dermatologist.[1] This guide walks through how to tell them apart, what the laser actually does to a sun spot, what the studies found, and how to keep new spots from forming. If you already know your spots need attention, our hyperpigmentation treatment page explains why sun spots, melasma, and marks left after acne get different plans.

• Sun spots, also called age spots, liver spots, or solar lentigines, are flat, painless, light brown to black spots that appear most often on skin with the greatest sun exposure. They have nothing to do with your liver.[2]
• Melasma is not a sun spot. It forms blotchy patches, mainly on the face and on both cheeks when it appears there, and pregnancy hormones and some medicines may trigger it.[4][5]
• Before any spot is lightened, it should be examined. The AAD warns that a skin cancer can look like an age spot, and fading it can give the cancer time to grow.[1]
• In a 2023 review of 48 studies, laser treatment fully cleared lentigines in 43% of cases, and combination treatment did better. The included studies differed widely in design, patients, and methods.[7]
• Dark marks after treatment are a real risk. In one randomized trial, they appeared in more than half of laser-treated sun spots in the group that used only a moisturizer afterward.[10]
• Treated spots can return. The AAD says protecting your skin from the sun prevents this: shade, sun-protective clothing, and a broad-spectrum, water-resistant sunscreen of SPF 30 or higher.[1]

What is a sun spot, and why does it show up after years outdoors?

A sun spot is a flat area of color change on skin that is exposed to the sun. MedlinePlus describes these spots as flat, painless, and light brown to black, and says the coloring may be due to aging, sun or other ultraviolet light, or causes that are not known.[2] You will hear them called age spots, liver spots, or solar lentigines (one is a lentigo). MedlinePlus lists these as alternative names for the same thing, and the spots have nothing to do with the liver or how it works.[2]

They are very common after age 50, and they occur most often where sun exposure has been greatest: the backs of the hands, the face, the forearms, the forehead, and the shoulders.[2] That map is one clue, not a diagnosis. A brown patch that appears on both cheeks during pregnancy, for example, fits the pattern the AAD describes for melasma, covered in the next section.[4][5]

MedlinePlus says liver spots are not dangerous to your health, that they are permanent skin changes that affect how your skin looks, and that most of the time no treatment is needed.[2] So treating a confirmed sun spot is a choice about appearance. That is worth keeping in mind when anyone pushes you toward a package of sessions.

Ordinary outdoor time counts as sun exposure, whether it is a boat day, a beach walk, a round of golf, or a string of errands. MedlinePlus lists ultraviolet light from the sun or other sources among the possible causes of the coloring.[2]

Sun spot or melasma: how can you tell them apart?

Melasma and sun spots both look brown, so they are easy to confuse. The pattern on your face is one useful clue. The AAD describes melasma as blotchy patches and spots, mostly on the cheeks, chin, forehead, nose, and above the upper lip, and if it is on your cheeks, it shows up on both of them.[4] The patches can merge into larger areas.[4] Sun spots, by contrast, are described as flat spots on areas the sun's rays often hit, such as the face and hands.[1][2]

The backstory differs too. The AAD lists pregnancy, birth control pills, some anti-seizure medicines, tanning beds, thyroid disease, and possibly stress among the triggers for melasma, along with sunlight.[5] The AAD says melasma is much more common in women than men, and names women between 20 and 40 and people with medium or dark skin tones as being at higher risk.[5] In darker skin, melasma can even look bluish gray.[4]

Why does this matter for a laser plan? The AAD says any treatment plan for melasma will include sun protection,[4] and on our hyperpigmentation page, melasma care starts with daily sun protection and prescription creams, with procedures added carefully and only if needed. If the pattern on your face sounds more like melasma, read our guide to laser treatment for melasma and dark marks after acne, which covers why lasers can backfire on that kind of pigment.

There is a third look-alike worth knowing. Seborrheic keratoses are common, harmless growths that most people get in middle age or later. Most are tan or brown, and some look like a dab of brown candle wax on the skin.[6] Some grow quite thick with a warty surface, while a sun spot is flat.[2][6] Because they can look like a wart, a precancerous growth, or skin cancer, and because the AAD names them among the spots a dermatologist can tell apart from age spots, they also deserve a look before anyone treats them.[1][6]

Which dark spots need a dermatologist before any laser?

Some spots should never go straight to a laser. The AAD puts it plainly: what looks like an age spot could be skin cancer, so a skin exam comes before treatment.[1] Its warning is that using an age spot treatment to fade a skin cancer can give the cancer time to grow and possibly spread.[1] The AAD also notes that when skin cancer is caught early, it is highly treatable.[1]

Dermatologists teach the ABCDEs of melanoma as a quick screen for moles and pigmented spots.[3]

• A, asymmetry: one half of the spot does not match the other half.[3]
• B, border: the edge is irregular, scalloped, or poorly defined.[3]
• C, color: the color varies from one area to the next, with shades of tan, brown, or black, or patches of white, red, or blue.[3]
• D, diameter: melanomas are usually larger than 6 millimeters, about the size of a pencil eraser, when found, though they can be smaller.[3]
• E, evolving: the spot looks different from the rest or is changing in size, shape, or color.[3]

The AAD adds a broader rule that is easy to remember: any new spot, any spot that looks different from your others, and any spot that is changing, itching, or bleeding is a reason to see a board-certified dermatologist.[3] MedlinePlus notes that a biopsy may be needed when a liver spot looks irregular or unusual, partly to check for melanoma.[2]

Here is how that works at our practice. Before we treat, a clinician looks at every spot you want treated. As our hyperpigmentation page describes, a spot that is new, growing, bleeding, irregular, or simply unlike its neighbors is referred for a dermatology exam or biopsy first, and treatment waits.

How does a laser clear a sun spot?

Start with what a sun spot is under the microscope. A 2025 review describes it as a local increase in pigment cells (melanocytes) and in melanin production within the top layer of skin, often in response to chronic UV exposure.[8] The same review explains that Q-switched lasers are used often for sun spots because they target melanin effectively, delivering high-intensity pulses in the nanosecond range, which it ties to how quickly the tiny pigment packets in skin cells shed heat.[8] The AAD lists crusting and temporary darkening of the treated spots as side effects of laser treatment for age spots, and notes that they tend to fade quickly.[1]

At our Mount Pleasant and downtown Charleston offices, our laser services page describes the laser treatments we offer as done on a Fotona platform combining an erbium (Er:YAG) laser and a neodymium (Nd:YAG) laser and lists some pigment among the concerns treated. The erbium laser is the one our skin resurfacing page describes for removing thin layers of surface skin. Our skin rejuvenation page covers 1064 nm Nd:YAG laser treatment for brown spots, small red vessels, and texture. As our laser services page puts it, the right laser depends on the spot, and that choice is made at your visit, not in advance.

Both kinds of laser have been studied on sun spots, though not necessarily in the form or settings any one clinic uses. In a small split-face trial, 15 Asian patients with light-colored facial lentigines had a Q-switched Nd:YAG laser on one side of the face and an Er:YAG micropeel on the other.[9] Pigment was reduced on both sides. The Nd:YAG side showed more pigment reduction at two weeks, but by one month the two sides were similar, which the authors attributed to more dark marks after inflammation on the Nd:YAG side.[9] The authors concluded there is no perfect therapy for light lentigines and suggested the two could be used in turns or together.[9]

That study is small and short, with one month of follow-up after a single session. Within those limits, it shows a trade-off worth knowing: in that trial, the faster early result came with more dark marks afterward, and by one month the difference between the two lasers had narrowed.[9]

What does the research say about laser results for sun spots?

The most useful evidence here comes from systematic reviews, which gather many studies and compare them. A 2023 review in Dermatologic Surgery pulled together 48 studies covering 1,763 patients.[7] Lasers fully cleared lentigines in 43% of cases. Combination treatments did better at 65%, while topical retinoids reached 21%, freezing (cryotherapy) 15%, and peels 6%.[7] Side effects showed up in 23% of laser-treated cases in that review.[7]

A 2025 review of 41 clinical trials and 3,234 patients reached a similar conclusion: laser therapy appears more effective than other approaches, with an acceptable safety profile.[8] It reported success ranges that ran from 36% to about 77% for Q-switched lasers and from about 68% to 93% for picosecond lasers, with most side effects mild and short-lived.[8] It also found that pulsed dye lasers and intense pulsed light were less often linked to dark marks after treatment.[8]

Read those numbers with care. Both reviews flagged real limits. The 2023 authors noted that the studies varied in design, patients, treatment schedules, and how they measured success.[7] The 2025 authors called for larger randomized trials to confirm the findings.[8] So the fair summary is that the 2023 review ranked combination and laser treatments as the most effective options for lentigines,[7] but no single percentage predicts how your spots will respond.

For anyone weighing treatment, these reviews describe a real chance of complete clearing, not a guarantee, and the 2025 review suggests that combining lasers with certain topical agents may further improve outcomes.[7][8]

What about the risk of dark marks after laser treatment?

One common setback after treating a sun spot is post-inflammatory hyperpigmentation (PIH), a new dark mark that appears where the skin was inflamed. The authors of the trial below call it a common adverse event after laser procedures, and note that studies evaluating its risk remain limited.[10]

A 2024 randomized trial measured this risk directly in 28 patients with 67 solar lentigines, treated with a 532 nm Q-switched Nd:YAG laser.[10] In the group that used only a plain moisturizer afterward, PIH appeared in 55.3% of treated spots.[10] Two things predicted it: more redness at two weeks and outdoor activity between 1 and 5 pm.[10] Starting a prescription triple combination cream two weeks after the laser cut the rate to 31.0%.[10]

Those numbers come from one Korean center using one laser, so they do not transfer directly to every skin type or device. The authors concluded that the cream could be considered for preventing PIH in high-risk patients, which makes aftercare a topic worth settling before treatment.[10] At Solcara, a history of dark marks after bug bites, waxing, burns, or earlier treatments is part of the skin history our hyperpigmentation page describes, and our laser pages describe gentler settings and sometimes a small test area first for darker skin.

Not sure what your spots are? Call 843-981-0870. Each spot you want treated is examined before any laser session, and any spot that needs a dermatologist's exam is referred before anything is treated.

Is a laser your only option, and how do you keep spots from coming back?

No. The AAD groups age spot treatments into creams and lotions on one side and procedures on the other. Procedures, including lasers and chemical peels, tend to work faster, but they cost more and carry a higher risk of side effects.[1] Creams ask for discipline instead: once or twice a day for weeks or months before you see a change.[1] Some people need a prescription-strength cream.[1]

Among procedures, freezing (cryosurgery) is a common choice. It is quick but can hurt, and possible lasting effects include a darker spot, a lighter ring around it, or a scar, although the AAD says those are rare in a board-certified dermatologist's hands.[1] Chemical peels can work on the hands: in one study the AAD cites, 47% of peel patients saw their spots fade by half, and cryosurgery did slightly better, though peeled skin healed faster.[1] A chemical peel is a nonlaser option we offer, and ZO Skin Health is the medical-grade home care line we use to support pigment treatment.

Whatever you choose, the spots can come back. The AAD is direct that age spots can return no matter which treatment you choose, and that protecting your skin from the sun prevents this.[1] Its advice is specific: seek shade, wear sun-protective clothing (long sleeves, pants, a wide-brimmed hat, UV-blocking sunglasses, ideally with a UPF label), and put sunscreen on all uncovered skin before you head outside.[1] That sunscreen should be broad-spectrum, SPF 30 or higher, and water-resistant.[1]

MedlinePlus adds practical timing. Try to avoid the midday sun, when it is strongest, apply sunscreen at least 30 minutes before going out, reapply often, and keep using it on cloudy days and in winter.[2] That last point applies in Charleston and Mount Pleasant as much as anywhere.

A first skin visit is about sorting the spots, not booking a series. At Solcara, care is led by Ashley Harwyn, PA-C, who is board certified in anti-aging and functional medicine through A4M (ABAAHP). Your clinician looks at each spot, asks about sun exposure, hormones, medicines, and skin history, and sorts out which type of pigment you are dealing with, and any spot that needs a dermatologist's exam is referred before anything is treated.

Visits are available at our Mount Pleasant office on Bramson Court and at The Longevity Club on Rutledge Avenue in downtown Charleston, and you can book a skin visit online. For a broader look at which laser fits which concern, see our guide to laser skin treatments in Mount Pleasant, and if you are new to lasers, read what to expect from your first laser treatment.

Ashley Harwyn, PA-C PA-C, ABAAHP · Founder, Solcara Health Online

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