Before either treatment is the question that decides both: what kind of pigmentation is it?
A dark mark left behind after a spot cleared is post-inflammatory hyperpigmentation. It is a finished event, and it fades on its own eventually. Melasma is not a finished event. It is an ongoing process with a vascular and hormonal component, it recurs, and treating it like a stain to be removed is the most common way it is made worse. Sun damage that has accumulated over decades is a third thing again.
These respond differently, and the same treatment can help one and aggravate another. That is why this is examined rather than decided from a description.
Scroll the table sideways to compare
| Aerolase Neo Elite | VI Peel | |
|---|---|---|
| How it works | 1064 nm energy absorbed by pigment and vessels | A chemical solution that resurfaces the upper layers |
| Reaches | Deeper, and the vascular component with it | The surface and the epidermal pigment in it |
| Best for | Melasma with a vascular component, redness, deeper pigment | Post-inflammatory marks, surface unevenness, texture with it |
| Preparation | Photosensitizing medication reviewed beforehand | Four weeks of preparation in deeper skin |
| In the chair | 15 to 30 minutes, no numbing needed | 30 minutes, tingling and heat |
| Afterwards | Warmth and mild redness, hours | Peeling from about day 3 to day 7 |
| Visible downtime | Effectively none | Yes, and it is not subtle |
| Course | Usually a series, spaced weeks apart | Usually a series, spaced 4 to 6 weeks apart |
The one risk both share
In richly pigmented skin, the thing most likely to go wrong with either treatment is that it causes the exact problem it was meant to treat. Inflammation triggers pigment. A laser set too aggressively and a peel taken too deep both end in post-inflammatory hyperpigmentation, and that outcome is worse than the original complaint because it is larger and more diffuse than what you came in with.
This is the reason the settings, the depth and the interval between sessions matter more here than the choice of device. It is also why the answer is often a conservative course of several sessions rather than one strong treatment, and why anyone promising to clear pigment in a single visit is describing a risk rather than a plan.
Why the wavelength is not incidental
A 1064 nm Nd:YAG is the wavelength with the least melanin absorption of those used in aesthetics, which is what makes it usable across all six Fitzpatrick types. Devices that rely on being absorbed by pigment cannot distinguish the pigment you want gone from the pigment in the surrounding skin. That is the whole reason most laser treatments were not designed for deeper skin, and it is why this is the first laser in this practice.
When the peel is the better answer
Post-inflammatory marks sitting in the upper layers respond well to resurfacing, and a peel resurfaces the whole field rather than chasing individual spots. If the complaint is general unevenness across an area, with texture alongside it, the peel treats both at once.
The catch is the four weeks beforehand. In deeper skin the preparation determines the outcome more than the peel itself does, and skipping it is how peels earn their reputation for causing pigmentation. If you cannot commit to that preparation, or to a week of visible peeling afterwards, the peel is the wrong choice for you regardless of what your skin needs.
When the laser is the better answer
Melasma with a visible vascular component, redness that comes with the pigment, or pigment that sits deeper than a surface treatment can reach. It also wins on practicality: effectively no visible downtime means it fits around work in a way a peel does not.
Melasma deserves a caution of its own. It is a chronic condition and no treatment cures it. What treatment does is control it, and holding that control depends on daily sun protection and on the hormonal drivers being understood rather than ignored. Anyone treating melasma as a one-off removal will be treating it again in six months.
What we recommend
Combination therapy, sequenced. Pigment is the area where relying on a single modality most often disappoints, and the plan that holds is usually a course of one treatment for what dominates, then the other for what is left: a peel course for surface pigment and texture, laser for the vascular and deeper component, or the reverse depending on what the examination finds.
Underneath both of them, and doing more work than either, are the parts nobody sells you. Daily broad-spectrum sunscreen and the right topical regimen are not the supporting act here. They are the treatment that runs continuously, and without them the procedures are money spent on a result that will not hold.
The one thing that does not work is stacking the two procedures close together. Each is an inflammatory event, and in richly pigmented skin inflammation is what causes the pigment in the first place. The interval between sessions is not caution, it is what stops the treatment becoming the cause. That is also why the plan is a sequence rather than a package, and why it is built after examination rather than sold in advance.
Common questions
How do I know if I have melasma or post-inflammatory marks?
By history and examination, and it is worth getting right because they respond differently. Post-inflammatory marks appear where something happened first, a spot, a scratch, an ingrown hair, and each mark has a story. Melasma appears symmetrically, usually across the cheeks, forehead or upper lip, without a preceding injury, and it fluctuates with sun and hormones. Imaging helps by showing pigment below the surface that a mirror does not.
Will either of these get rid of it permanently?
Post-inflammatory pigmentation, yes, in the sense that once a mark has cleared it is gone unless the skin is injured again. Melasma, no. It is a chronic condition that is controlled rather than cured, and it returns with sun exposure and hormonal change. Being told otherwise is a reason to be careful about who is treating you.
Is one safer for darker skin?
Both are used across the full range of skin tones here, which is why these two are the ones offered. The 1064 nm wavelength is the safest laser option in richly pigmented skin because melanin absorbs it least. The peel is safe in deeper skin when the four weeks of preparation are done and the depth is appropriate, and considerably less safe when they are not. Neither is inherently safe or unsafe. How it is performed decides that.
Why do my spots look darker straight after treatment?
With the laser this is expected and it is a sign the pigment absorbed the energy. Spots darken, then flake away over the following days. It is not the treatment making the pigmentation worse, though it looks alarming the first time. What is not expected is new darkening in skin that was clear, spreading beyond the treated spots, or appearing weeks later, and that should be reported.
Can I do anything at home instead?
Daily broad-spectrum sunscreen does more for pigmentation than any single treatment, and without it neither of these holds. Topical agents have a real role and are usually part of the plan rather than an alternative to it. What is worth avoiding is unsupervised strong actives and anything sold as a fast lightening product, since irritation is the thing that drives pigment in the first place.
What about microneedling for pigmentation?
It has a role, particularly where texture and pigment occur together, and the protocol here is deliberately conservative in deeper skin for the same inflammatory reason. It is generally not the first choice for pigment alone. Which of the three fits, and in what order, is what the consultation decides.
This page is for general education and is not medical advice. It does not establish a physician-patient relationship, and it cannot account for your individual history, medications or skin. Suitability for treatment is decided at consultation following examination.