Concern · Pigmentation & uneven tone
Why does my skin look uneven, blotchy or darker in certain areas?
What you may be noticing
Patches of skin that look darker than the rest. Spots that keep returning after they seem to fade. An overall tone that reads as uneven rather than clear, even where nothing is actively inflamed. Patients tend to describe all of this the same way — as "pigmentation" — but the description is the starting observation, not the diagnosis.
One concern, different causes
Pigmentation is not one diagnosis.
Visible discoloration can have different patterns, depths and triggers. Previous inflammation, sun exposure, hormonal influences and other pigmentary processes may all create appearances that look similar from across a room but behave very differently under treatment.
What Dr. Lancho assesses
- Pattern and distribution
- Apparent depth and type of pigment
- Skin characteristics
- History and triggers
- Previous treatments and response
- Risk of post-treatment pigment change
- Presence of vascular or textural components
Clinical reasoning
Four dimensions decide the answer, not the color alone.
Pattern & distribution
Where the pigment sits and how it's distributed across the face changes what it's likely to represent — and which approach can reach it.
Depth
Pigment sitting at different depths in the skin responds differently to energy-based treatment; depth is assessed before a wavelength is chosen, not after.
Trigger & history
What preceded the discoloration — inflammation, sun exposure, a hormonal change — informs both the likely mechanism and the risk of it returning.
Overlap
Pigment rarely sits in isolation. Redness or textural change occurring in the same area can be part of the same picture, or a separate problem entirely.
Treatment approaches
The wavelength follows the target — not the other way around.
The same laser or energy setting is not appropriate for every form of pigmentation. Correct identification and patient selection come before technology is chosen. Depending on what the assessment finds, an approach may draw on picosecond, multi-wavelength laser treatment, a broader light-based platform capable of addressing pigment alongside vascular or textural components, or a chemical peel selected for the right depth.
When combination treatment makes sense
When more than one factor is contributing — pigment alongside redness or surface texture, for example — Dr. Lancho may consider a staged approach where each treatment is given a defined role. The purpose is not to add more treatment; it's to avoid asking one procedure to solve a problem it wasn't designed to treat.
What treatment can — and cannot — change
Results depend on the underlying pattern, the treatment selected, individual biology and the treatment course. During consultation, the objective is to define what improvement is realistic and which components may not respond to the proposed treatment. Deeper or trigger-driven pigment can also recur if the underlying trigger is not addressed — treatment changes what's visible, not necessarily the tendency that produced it.
Related treatments
Picosecond, multi-wavelength pigment treatment — The treatment decision begins with identifying the target — pattern and depth — rather than simply selecting a laser.
PicoWay
Multi-application light & fractional platform — Useful when pigment coexists with redness or textural change — one component of the platform, or a sequence, depending on what's actually present.
Nordlys
Depth-selected chemical resurfacing — A peel selected for depth and the problem, not defaulted to as a first step.
Chemical peels
Depending on additional components identified during assessment, a dual-wavelength laser platform or RF microneedling may also be considered.
Before your consultation
Bring the observation, not a device name.
You don't need to arrive knowing which laser or wavelength you need. The consultation is where pattern, depth and history are assessed, so the treatment strategy can be built around what's actually there.