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Today, I’d like to talk about the side effects of laser toning.
As always, the demand for pico laser toning has been steadily increasing, and as a result, most dermatology clinics now offer (pico) laser toning treatments.
◆ Differences and Effects Between General Toning and Pico Toning ◆
With so many people receiving these treatments, the number of patients visiting me due to side effects from laser toning has also been gradually increasing.
Side effects from laser toning can range from mild to, in more severe cases, irreversible conditions.
That’s why it’s essential to clearly understand what to watch out for. So, let’s take a look at the potential side effects.
■ Folliculitis
The most commonly seen side effect is folliculitis.
You often hear people say things like,
“My skin broke out after the (pico) laser,” or “I feel like I have more acne now.”
However, in reality, this is not acne — it’s folliculitis.
● What causes folliculitis?
Folliculitis occurs through a mechanism similar to that of laser hair removal.
When the fine facial hairs are damaged by the laser, the hairs can become trapped under the skin, leading to inflammation.
Additionally, if laser treatment is performed without properly cleansing the skin beforehand,
residual sunscreen or makeup can react with the laser and cause irritation or inflammation.
This is why it’s essential to thoroughly wash your face before the procedure.
● How do you tell the difference between folliculitis and acne?
It can be very difficult to distinguish between the two, as they look quite similar.
A simple way to tell them apart is by checking for the presence of open comedones (blackheads) or closed comedones (whiteheads).
Also, if the breakouts suddenly appear after receiving pico laser treatment, even though they weren’t there before, there’s a high possibility that it’s folliculitis.
● How is folliculitis treated?
Fortunately, folliculitis is relatively easy to treat.
If the inflammation is mild, it can be improved by applying a steroid cream such as Lidomex.
In more severe cases, treatment with antibiotic ointment may be necessary.
※ Do not try to squeeze or pop them with your fingers, as it may lead to scarring.
Post-Inflammatory Hyperpigmentation (PIH)
The area treated with the laser may actually become darker instead of lighter.
This is not limited to pico toning — it can occur with any treatment that causes damage to the skin.
● What are the risk factors for hyperpigmentation?
Evaluating the Risk Factors of Post Inflammatory Hyperpigmentation Complications with Nd-YAG Laser Toning Using LASSO-Based Algorithm , Chao-Hong Liu(2020)
The following are findings from a study analyzing the risk factors for PIH (Post-Inflammatory Hyperpigmentation) with Nd:YAG laser toning:
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When the laser energy is too strong
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When the treatment is performed after using chemical peels like AHA
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Darker skin tones (Fitzpatrick skin types)
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Acne-prone skin
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Skin that is prone to melasma or pigmentation
● Can hyperpigmentation be treated?
Hyperpigmentation will gradually fade over time.
However, it can take longer than expected — at least 4 months, and in some cases, it may last for several years.
Therefore, if hyperpigmentation occurs, reducing the laser energy and increasing the interval between treatments can help speed up recovery.
Post-Inflammatory Erythema (PIE)
This is a side effect where the skin becomes red due to the same mechanism as hyperpigmentation.
When the skin is damaged by the laser, inflammatory cytokines are produced in the dermis, leading to pigmentation and redness.
※ Redness that appears after acne is caused by the same phenomenon.
● How is post-inflammatory erythema (PIE) treated?
While PIE may gradually fade on its own over time,
it can persist for a long period just like PIH.
Receiving proper treatment can help speed up the healing process.
Since the redness is not caused by pigment, but by dilated blood vessels,
it cannot be treated with pico toning like PIH.
Instead, vascular lasers must be used to target and treat the blood vessels.
Leukoderma (Hypopigmentation / White Spots)
Lastly, let’s talk about leukoderma (hypopigmentation) that can occur after toning.
Leukoderma refers to a condition where the pigment appears to have faded, resulting in uneven, patchy skin tone, which can be cosmetically unappealing.
This is considered the most serious side effect of laser toning.
Unlike folliculitis, hyperpigmentation, or post-inflammatory erythema, leukoderma is very difficult to treat.
● What causes leukoderma?
Leukoderma occurs when melanocytes, the cells responsible for producing melanin, enter a dormant state, or in more severe cases, are destroyed, resulting in areas of skin that appear lighter than the surrounding tissue.
While leukoderma is typically caused by autoimmune conditions, genetic factors, chemical exposure, or physical trauma,
it can also develop when high-energy laser treatment is applied to skin with reduced regenerative ability — such as skin affected by melasma, aging, or previous damage.
● How is leukoderma treated?
When leukoderma occurs as a side effect of (pico) laser toning, treatment can be quite difficult.
One possible treatment is the use of an excimer laser that emits UVB light at a wavelength of 308nm.
This method works similarly to how sun exposure causes tanning — by artificially exposing the skin to ultraviolet light, it helps stimulate repigmentation in the depigmented areas.
However, it is difficult to precisely target only the desired area and control the intensity to match the surrounding skin tone.
Therefore, the best approach to leukoderma is prevention.
To avoid side effects, it’s important to ensure that a qualified dermatologist properly evaluates your skin condition and performs a thorough pigmentation analysis before treatment.
Even with the same pico toning laser, every patient reacts differently, so if a clinic has a system where the consultant sets the treatment plan and the doctor only performs the procedure briefly, it becomes very difficult to prevent side effects.
Since toning is a relatively simple and reasonably priced procedure, it’s best to choose a clinic that offers fair pricing and provides full care from the doctor from start to finish.
◆ 3 Key Takeaways ◆
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Toning is an effective method for treating pigmentation using low energy, but that doesn’t mean it’s free from side effects.
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Folliculitis is relatively easy to treat, but hyperpigmentation and redness may take a long time to heal.
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Leukoderma, which causes uneven skin tone, is extremely difficult to treat. To prevent such side effects, it’s best to choose a clinic where the doctor is involved from consultation to treatment.
That concludes the information on the side effects of pico laser toning.
I hope this content has been helpful to many of you.
If you have any questions about the procedure, feel free to like or leave a comment — I’ll be happy to respond kindly.
Thank you!
📍 Primi Clinic
3F, 52 Seongsuil-ro, Seongdong-gu, Seoul (Primi Clinic)
