Pico laser for melasma in Malaysia: what it can do, the risks, and the 2026 rules

What is melasma?

Melasma is a common condition that causes flat, brown or grey-brown patches, usually on both cheeks, the forehead, upper lip, nose or chin. It is not itchy, infectious or cancerous. It is most common in women aged 20 to 40 and in people with light-brown to brown skin, including many Malaysians.

Triggers include sunlight (both UV and visible light), hormones such as pregnancy, the contraceptive pill and hormone therapy, and a family tendency. Up to half of pregnant women may develop some melasma.

It is easily confused with other pigmentation, which is treated differently:

• Sunspots (solar lentigines): separate, well-defined brown spots on sun-damaged skin.
• Post-inflammatory hyperpigmentation: dark marks left after acne, eczema or injury.
• Hori’s naevus: deeper, blue-grey patches, often on the cheeks.

Because the right treatment depends on the type, a doctor should diagnose your pigmentation before any laser.

Why melasma keeps coming back

There is no cure for melasma. Even after a good result, sun exposure or hormonal changes can bring it back, and it often returns after treatment stops. Pregnancy-related melasma may fade after delivery but can return in a later pregnancy.

That is why dermatologists treat melasma as a long-term condition that needs ongoing sun protection and, often, maintenance treatment. Be cautious of any clinic that promises permanent removal.

Treatments to try first

• Sun protection every day: a broad-spectrum sunscreen of SPF 30 or higher. A tinted sunscreen containing iron oxides also blocks visible light. In one trial it gave better results than a UV-only sunscreen. Reapply outdoors and wear a hat.
• Prescription creams: creams that combine a lightening agent with a retinoid and a mild steroid are considered the most effective first treatment, improving 60–80% of cases. They must be prescribed and supervised by a doctor, used for limited periods, and avoided in pregnancy.
• Other options your doctor may suggest include azelaic acid, and tablets or creams containing tranexamic acid. Tranexamic acid tablets are a medicine that needs a doctor’s assessment, as they are not suitable for everyone.

What pico laser is, and what it can do

Picosecond (“pico”) lasers fire extremely short pulses of light, measured in trillionths of a second. The pulses shatter pigment mainly through a pressure effect rather than heat, using less energy than older nanosecond (Q-switched) lasers.

The evidence differs by use:

For melasma, a 2023 analysis of trials found the 1064 nm pico laser effective without significant side effects, while the 755 nm laser was no better than creams and more likely to cause darkening. A 2026 review concluded that no single device is a definitive answer, and that maintenance is crucial.

Risks for Asian and darker skin

Brown skin is more prone to pigment changes after any laser. Possible effects include:

• Darkening (post-inflammatory hyperpigmentation), usually temporary but sometimes lasting months.
• Rebound melasma, where melasma comes back darker.
• Patchy white spots (mottled hypopigmentation), reported in about 10% of East Asian patients after repeated low-energy “laser toning”, and linked to too much total energy.
• Redness, swelling, blistering and, rarely, scarring or burns, which are more common when an untrained person operates the laser.

Avoid sun exposure before and after treatment, and tell the doctor if you are pregnant, take medicines that make the skin sensitive to light, or get cold sores.

Malaysia’s 2026 rules on aesthetic lasers

Since 1 June 2026, the Medical Device (Designated Medical Device) Order 2026 lists many aesthetic lasers as designated medical devices. These include Nd:YAG (532 and 1064 nm), alexandrite, ruby, diode, fractional CO2 and other lasers when used to reduce pigmentation such as melasma and freckles, or for other aesthetic purposes. HIFU devices are also covered.

Under the Medical Device Act 2012, no one may operate a designated medical device without a permit. The penalty is a fine of up to RM100,000, up to a year in prison, or both. The Medical Device Authority says operators must have qualifications and skills recognised by the government.

The Ministry of Health’s guidelines also class lasers for pigmentation as an aesthetic medical procedure, to be done by a registered doctor with the right training and credentials, in a registered clinic. A medical-grade laser in a salon or spa is a red flag.

How to check a clinic before booking

1. Doctor: look them up on the Malaysian Medical Council’s MeRITS register and ask whether they hold a Letter of Credentialing and Privileging (LCP) for aesthetic procedures.
2. Clinic: it should be registered with the Ministry of Health, not a salon or home business.
3. Device: ask which laser will be used and check it on the MDA medical device register.
4. Plan: ask for a diagnosis, the expected number of sessions, the risks for your skin type, what happens if pigmentation gets worse, and a written quote.

A warning about whitening creams

Many people with melasma try lightening creams bought online. Some contain hidden ingredients. In 2025 and 2026, the National Pharmaceutical Regulatory Agency (NPRA) cancelled the notification of 20 cosmetic products for containing mercury, hydroquinone or tretinoin. Half of them contained mercury.

• Mercury is banned in cosmetics. It can damage the kidneys and nerves, and harm the developing brain of an unborn baby or young child.
• Hydroquinone and tretinoin are medicines in Malaysia, not cosmetic ingredients. They should only be used with a health professional’s advice.

Check a product on NPRA’s list of cancelled cosmetics before using it, and stop using any cream that is not properly labelled.

Finding a doctor for pigmentation

A GP can diagnose your pigmentation and start first-line treatment, and refer you to a dermatologist if needed. For laser treatment, choose a doctor-led aesthetic clinic and check the doctor, clinic and device first. Our directory lists GP and aesthetic clinics with opening hours and directions.

Browse the clinic directory

Frequently asked questions