What the research shows
Temporary darkening is the most common problem after resurfacing in darker skin. After full laser resurfacing in olive and light brown skin, about two in three patients developed dark patches that began a month after treatment and faded over about four months; none lost pigment permanently (Sriprachya-anunt 2002). A single, lighter pass of the CO2 laser improved all skin types, and darker skin improved the most despite near-universal temporary darkening (Alster 2003).
Fractional lasers, which treat a grid of tiny columns and leave the skin between them intact, carry less risk. A single fractional CO2 treatment in medium-brown and brown skin caused no dark patches (Tan 2008). In Chinese patients, fractional laser darkening was uncommon, and patches around the mouth appeared when the skin was not cooled during treatment (Chan 2007). Needling caused dark patches less often than the fractional CO2 laser in acne scar treatment (Batool 2026).
Superficial peels are safe in darker skin. About 1 in 25 superficial peels in skin types III to VI caused a problem such as crusting or darkening, and every one resolved; the darkest skin type had the highest risk (Vemula 2018). Reviews advise caution with medium-depth peels and avoiding deep peels in dark skin (Lee 2026, Garelick 2026).
Melasma, a patchy brown pigment of the face that mostly affects women, is treated with creams first. Hydroquinone and triple combination cream work best, while peels and lasers are equal or worse with more side effects (McKesey 2020). An international consensus names sunscreen as essential and supervised triple cream as the standard (Sarkar 2026). A non-ablative laser made melasma worse in a side-by-side trial against cream (Wind 2010).
Where surgeons disagree
- Lasers for pigment. Fractional CO2 combined with cream held melasma improvement longer than either alone (Trelles 2010). A review of dark spots after inflammation found laser the only treatment that fully cleared spots in some patients, but it worsened spots in others (Mar 2024).
- Which peel. Pooled trials in darker skin favored glycolic acid over trichloroacetic acid (Dorgham 2020), and a broader review also found glycolic acid the safest and most effective (Sarkar 2024).
What is new
- Aftercare lowers the risk. A fusidic acid cream after fractional CO2 reduced inflammation and dark patches compared with the usual ointment (Wei 2021).
- A peel before and after fractional CO2 lowered dark patches in skin types III to V without slowing healing (Hang 2025).
- Oral tranexamic acid has joined the melasma options, alongside azelaic acid and kojic acid (Sarkar 2026).
What is still unknown
- Long-term results: melasma trials are small and short, and the condition often returns (McKesey 2020).
- Results in the darkest skin types: peel studies rarely include them (Garelick 2026).
Key papers
- Sriprachya-anunt 2002: darkening after laser resurfacing in skin type IV is common and fades.
- Alster 2003: a single CO2 pass works across all skin types.
- Chan 2007: risk factors for darkening after fractional laser in Asian skin.
- Tan 2008: fractional CO2 without darkening in brown skin.
- Vemula 2018: superficial peels are safe in darker skin.
- McKesey 2020: creams beat peels and lasers for melasma.
- Mar 2024: treating dark spots in skin of color.
- Sarkar 2026: international melasma consensus.