Pigmentation and hyperpigmentation treatment at Dr Joney De Souza Clinic in Marylebone, London. Sun spots, melasma, age spots and post-acne marks, assessed and treated by type.
Dr Joney De Souza Clinic treats pigmentation more often than almost any other skin concern, and it is one of the most satisfying to get right. Your skin takes its colour from melanin, the pigment your body produces to shield deeper tissue from ultraviolet light. Produced evenly, melanin gives you a smooth and uniform tone. Produced in excess in one spot, it leaves a patch, a freckle or a shadow sitting darker than the skin around it. Doctors call that excess hyperpigmentation, and most people recognise it on sight long before they know its name.
A handful of culprits account for nearly all of it. Sun exposure sits at the top of the list by a wide margin, and British weather is no protection, since UVA passes through cloud and window glass on the greyest January afternoon. Hormones come next, because pregnancy, the contraceptive pill and HRT can each trigger melasma. Inflammation leaves its own mark, as acne, eczema and over enthusiastic skincare can fade to a brown stain, particularly in medium and deeper skin tones. Then there is time, as decades of accumulated light resurface as age spots, and genetics, which set your baseline. The NHS guidance on sunscreen and sun safety explains why daily protection matters, and it underpins everything we do here.
The single most useful thing to understand is this. Pigmentation is not one condition, and the treatment that clears one type can make another worse. Laser is excellent on sun spots and can aggravate melasma. That is why our clinic reads your skin before recommending anything, and it is the heart of a longevity minded approach to skin: clear what is there, then protect the result for the years ahead.
Most people arrive knowing they have “pigmentation” without knowing which kind. The six below cover almost everything we see at our Marylebone clinic, and each one responds to a different hand. Find the description that sounds like your skin, then follow it through to the treatment that suits it.
Flat, well defined brown marks
Solar lentigines, to give them their proper name, are the flat brown marks left by years of accumulated daylight. They favour the face, hands and chest, they have crisp edges, and they tend to multiply slowly through your forties and fifties. This is the type that responds fastest and most reliably, usually to laser.
Larger, soft edged, symmetrical patches
Melasma spreads in blurred, roughly symmetrical patches across the cheeks, forehead and upper lip. Hormones drive it as much as sunlight, which is why pregnancy, the contraceptive pill and HRT so often precede it. It asks for restraint rather than power, because heat and aggressive treatment can provoke it. Prescription skincare and careful peels come first.
The stain left behind after a spot
Post-inflammatory hyperpigmentation is what remains once acne, eczema or an injury has settled. It is flat rather than raised, it is more common in medium and deeper skin tones, and it fades on its own eventually. Treatment simply shortens a wait that can otherwise run to many months.
Small clusters, often genetic
Freckles are largely written into your genes and then darkened by the sun, which is why they surface every summer and retreat every winter. Many people love them and leave them alone. Where you would rather reduce them, laser targets the clusters precisely without touching the skin between.
Patchiness rather than distinct marks
Sometimes there is no single mark to point at, just a general muddiness, a loss of clarity, a complexion that photographs flatter than it used to. Cumulative sun damage and slowing cell turnover are usually behind it. Resurfacing and brightening lift the whole canvas rather than chasing individual spots.
Sometimes called the mask of pregnancy
Chloasma is melasma that arrives with pregnancy, and it often softens by itself in the months after birth. We treat it gently and patiently, and we wait until you have finished breastfeeding before introducing prescription actives. Daily sun protection does more in this window than anything else.
Real results from our Marylebone clinic, photographed under consistent lighting. Pigmentation responds at different speeds depending on its type and depth, so treat these as an honest illustration of what is achievable rather than a promise of your own outcome.
PicoSure laser
PicoSure laser
MaxG IPL photorejuvenation
Ultraclear Laser
6 weeks post 1 treatment
ZO® Non-Hydroquinone Hyperpigmentation System
| Compare | PicoSure LaserPrecision pigment laser | MaxG IPLBroad sun damage and redness | UltraClear LaserResurfacing and overall tone | ZO Peels and SkincareGentle, layered, melasma safe |
|---|---|---|---|---|
 |  |  |  | |
| Best for | PicoSure Laser Sun spots, age spots, freckles | MaxG IPL Widespread sun damage across face, neck and chest | UltraClear Laser Uneven tone, dullness, texture alongside pigment | ZO Peels and Skincare Melasma, post-acne marks, prevention |
| Typical course | PicoSure Laser 1 to 3 sessions | MaxG IPL A course of 4 | UltraClear Laser 1 to 3 sessions | ZO Peels and Skincare A course, then ongoing home care |
| Downtime | PicoSure Laser Minimal, spots darken then flake within about a week | MaxG IPL Minimal, treated spots darken briefly | UltraClear Laser Several days of redness and flaking | ZO Peels and Skincare Mild flaking for a few days |
| Skin tones | PicoSure Laser All tones, settings matched to your skin | MaxG IPL Best suited to lighter tones | UltraClear Laser Most tones, assessed individually | ZO Peels and Skincare All tones, including deeper tones |
| Price from | PicoSure Laser £420 face, smaller areas from £250 | MaxG IPL £350 face | UltraClear Laser £850 face | ZO Peels and Skincare £350 face |
| View PicoSure | View MaxG IPL | View UltraClear | View ZO 3-Step Peel |
Short clips from the treatment room at our Marylebone clinic, from PicoSure and MaxG IPL to UltraClear and ZO.
No single device suits every type of pigmentation, so the clinic keeps four routes to clearer skin and matches them to what your skin actually shows. Around them sit the supporting players: Enerpeel chemical peels, SkinPen microneedling where texture sits under the pigment, and HydraFacial for brightening between treatments. Where overall skin quality needs attention, Dr Joney also performs injectable skin boosters, which improve hydration and radiance without acting on pigment directly.
Picosecond laser
Our workhorse for discrete pigment. Picosecond pulses shatter a sun spot into fragments fine enough for the body to carry away, with very little heat reaching the skin around it.
Most people need one to three sessions.
IPL photorejuvenation
Works across a whole area rather than spot by spot, which suits the scattered sun damage that collects on the face, neck and chest. It addresses pigment and redness in the same pass.
A course of four is standard.
Laser resurfacing
Renews the surface layer so clearer skin comes through. Where pigmentation arrives alongside dullness, fine lines or roughened texture, resurfacing lifts everything at once instead of chasing individual marks.
It asks for several days of redness and flaking in return.
Peels and skincare
The gentle, layered route, and what we reach for first with melasma and post-acne marks. Brightening actives, controlled exfoliation and daily sun protection work more slowly than a laser.
For pigment that flares under heat, that patience is the point.
Every plan at Dr Joney De Souza Clinic opens with a proper consultation, because naming the type of pigmentation you have is most of the work. Two marks that look similar in a bathroom mirror can need opposite treatments, and getting that wrong is the one thing that genuinely sets people back.
Your practitioner looks first at pattern and edge. Crisp borders and a scattered distribution suggest sun damage. Soft borders arranged symmetrically across the cheeks point towards melasma. We then consider depth, since pigment sitting in the upper layers behaves quite differently from pigment that has settled deeper, and depth is often what decides whether laser is the right tool at all. We assess your skin tone on the Fitzpatrick scale, which guides both device choice and settings, and we take a history that covers sun exposure, pregnancy, medication and any previous treatment.
Where laser or IPL is on the table, a patch test comes first. It confirms how your skin responds before anything is done at full strength, and for medium and deeper tones it is not negotiable.
“My ‘less is more’ approach has become the mainstay of my practice and clients appreciate that they will have natural looking results.”
Dr Joney De Souza, speaking to The Sybarite
That restraint matters more with pigmentation than with almost anything else we treat. The temptation is always to go harder and faster. With melasma in particular, going gently is what actually works.
Here is what happens before, during and after treatment at our Marylebone clinic.
You start with a consultation, where we identify the type of pigmentation you have, assess your skin tone and depth of pigment, and agree a plan. If laser or IPL is part of it, we carry out a patch test and leave it to settle before booking your first full session. You will be asked to avoid sun exposure and self tan in the two weeks beforehand, since treating recently tanned skin raises the risk of an uneven result. Where you are already using prescription actives, we may adjust them in the run up.
Most pigmentation sessions run between twenty and forty five minutes depending on the area. Laser and IPL feel like a quick warm snap against the skin, repeated across the treatment zone, and most people describe it as very manageable without anaesthetic. Peels bring a few minutes of tingling or warmth. Your practitioner protects your eyes throughout and talks you through each pass, so nothing arrives as a surprise.
Treated sun spots usually darken over the following days, which is the sign it has worked, then flake away within a week or two. Expect mild redness for a few hours and possibly a little swelling. You can wear makeup the next day in most cases. Daily broad spectrum SPF becomes non negotiable from this point, because unprotected skin will simply lay down fresh pigment over the work you have just done. Your practitioner gives you written aftercare and books your review.
A good deal, and it is worth doing well. Early and superficial pigmentation often lifts with steady use of vitamin C, niacinamide, a retinoid and the prescription strength brightening agents that sit well above anything on a high street shelf. Layer a broad spectrum SPF over the top each morning and you stop fresh pigment forming while the older marks fade. That is exactly the sort of routine our team builds around your skin with ZO Skin Health prescription skincare, and for melasma it is the foundation rather than an add on.
Where home care runs out of road is with anything established or deep. Set sun spots, true melasma and stubborn post-acne marks rarely shift with over the counter products, and melasma in particular can flare if it is attacked with harsh scrubs or strong acids. The fastest and safest route pairs a considered in clinic treatment with a home routine that protects it.
What treatment will not do. We would rather say this plainly. Pigmentation treatment does not stop new pigment forming, so without daily sun protection the marks will return. Melasma is managed rather than resolved, and it can come back with a strong summer or a change in medication. Results vary between people and between pigmentation types, and deeper pigment improves more slowly than surface pigment. If any mark is changing shape, growing, itching or bleeding, that is not a job for skincare or laser at all, and you should see your GP or a dermatologist first. For everything else, this is one of the most rewarding concerns we treat.
You may also want to read about related concerns we see alongside pigmentation, including age spots and sun damage, dull skin and sallow skin.
These are the questions our Marylebone team hears most often, from what pigmentation is to what treatment involves and costs. If yours is not here, message us on WhatsApp and a practitioner will answer properly.
Related reading: treating post-inflammatory hyperpigmentation.
In everyday use they mean the same thing. Pigmentation simply describes colour in the skin, while hyperpigmentation is the medical term for too much of it in one place. When someone says they have pigmentation, they almost always mean hyperpigmentation, whether that is a sun spot, melasma or a mark left by acne.
Look at the edges and the symmetry. Age spots and sun spots are small, well defined and scattered, and they sit where the sun lands most. Melasma forms larger patches with soft, blurred borders, usually arranged symmetrically across both cheeks, the forehead or the upper lip. Telling them apart genuinely matters, because laser clears one and can aggravate the other.
Yes, and reliably, for the right type. PicoSure breaks excess pigment into fragments the body clears, which suits sun spots, age spots and freckles very well. Melasma is the deliberate exception. Because heat can provoke it, we generally keep melasma away from laser and treat it with skincare and gentle peels instead.
Restraint, essentially. Melasma flares when it is treated aggressively, so we layer ZO Skin Health prescription skincare, careful peels and strict daily sun protection rather than reaching for a laser. Steady control produces a better long term result than a risky attempt at quick clearance.
Yes, with the right device and the right settings. PicoSure can be configured appropriately for medium and deeper tones, and carefully chosen peels are well tolerated. A patch test always comes first. The British Association of Dermatologists publishes useful background on caring for skin across all tones.
It depends on the type and how established it is. A few discrete sun spots may clear in one to three laser sessions. MaxG IPL is usually a course of four. Melasma and widespread pigmentation are worked over a longer course and then maintained. You will be given a realistic number at your consultation rather than a guess over the phone.
After laser, surface sun spots darken for a few days and then flake away within a week or two, with tone continuing to even out over the following month. IPL follows a similar pattern across a course. Peels brighten progressively. Melasma and deeper pigment improve more slowly and are measured over months rather than weeks. Your practitioner sets a realistic timeline for your type at consultation.
Minimal for laser and IPL. Expect redness for a few hours, then treated spots darken and flake over roughly a week, and most people return to normal activity immediately and wear makeup the next day. Peels bring mild flaking for a few days. UltraClear resurfacing asks for several days of redness and peeling.
It can, particularly melasma and particularly where skin goes unprotected. Sun spots and freckles often stay clear once the pigment has been broken down and carried away, provided you protect the area. Daily broad spectrum SPF, brightening skincare and an occasional maintenance session are what keep results in place. Think of it as upkeep rather than a one off fix.
You can, though it needs more discipline. Recently tanned skin should not be treated, and strong sun straight after treatment risks an uneven result and fresh pigment. Many people prefer autumn and winter for a laser or IPL course for that reason. If you are treating through summer, rigorous sun protection and avoiding direct exposure around your sessions are essential.
It depends on the treatment and the area. PicoSure starts from £250 for a small area such as the eye or mouth region, with the full face at £420 and course rates bringing the per session cost down. MaxG IPL starts from £350 for the face, and the ZO 3-Step Peel from £350. Prescription skincare plans are quoted once we have seen your skin. Our full price list has the detail.
Dr Joney De Souza Clinic is at 49 Blandford Street in Marylebone, a short walk from Baker Street and Bond Street and moments from Harley Street. We look after patients from across central and north London for pigmentation, hyperpigmentation and melasma. Get in touch to arrange a consultation.
Verified Google reviews from patients treated for pigmentation and sun damage at Dr Joney De Souza Clinic in Marylebone.
Roma has tailored my treatments to fit in with my skin and pays a lot of attention to make sure you get the best possible results. So talented, knowledgeable and kind. I have had such amazing results with her for my facial pigmentation and my skin looks so much brighter and more even.
I had the BEST experience with my PicoSure treatments with Roma! I couldn’t be happier with the results. Roma was very thorough and attentive. I felt like I could fully trust her. I had three PicoSure sessions and my skin has been transformed.
I have been getting the Picosure laser facial and it has completely changed my skin! My acne scars have faded, texture is gone and my skin is glowing! Roma performs the treatment and she is so knowledgeable and kind, I highly recommend this clinic!
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