Spot/Pigmentation Treatment in Fukuoka, Tenjin | How to Distinguish Melasma, Freckles, and ADM, and Treatment Options

How to read this article

The Treatments listed are performed at our Fukuoka clinic (Tenjin). All are self-pay (not covered by insurance). Clicking on a Treatment name will take you to a page with detailed explanation and the latest price list. Since treatment varies depending on the type of spot, please start by reading how to distinguish them.

The most common misunderstanding when consulting about spots is"Spots = something to remove with a laser"This understanding is mistaken.

In reality, some spots respond well to laser treatment in a single session, butapplying the same laser to other spots can darken them.Even if they look similar, the processes happening in the skin are different.

1. Age spots — accumulation of sun damage. Lasers work well.
2. Freckles — innate skin type. Lasers can fade them.
3. Melasma —Strong irradiation makes it darker.Oral medication and sun protection are the foundation.
4. Post-inflammatory hyperpigmentation — after acne or injury. It fades over time.
5. ADM — the pigment is located deep in the skin. Weak irradiation cannot reach it.

Among these,melasma alone is handled in the opposite way from the other four.While the others are treated by "targeting and destroying," melasma is treated by "avoiding irritation." If you get this wrong, it becomes darker with each treatment.

Conclusion of this articleWhen treating age spots, identifying what is presentis more important than deciding which treatment to apply.Melasma and ADM look similar but require opposite treatments. Be cautious about treatments like 'unlimited spot removal' that do not distinguish between types.

Look in a mirror under bright, natural light.Shape, borders, and left-right symmetryYou can narrow it down fairly well with these 3 points.

Solar lentigo (age spot)

A brown patch with a clear boundary, round or oval in shape. Size ranges from a few millimeters to about 1 centimeter. Appears in scattered locations on either side. Increases after the 40s.

It is a condition where cells that produce melanin have increased due to years of sun exposure. The color is located in the shallow layers of the skin,Among the 5 types, this responds best to laser treatment.

• How to tellIf the edge is so distinct that you can trace the outline with your finger, it is solar lentigo.

Freckles (ephelides)

Small spots smaller than a few millimeters scattered across the nose and cheekssymmetrically distributed on both sides. Present since childhood. Darken in summer and fade in winter.

It is due to constitution and darkens with sun exposure. While it can be lightened with laser treatment, the constitution itself does not change, so it will reappear over time.

• How to tellIf you have noticed it since childhood and the darkness changes with the seasons, it is freckles.

Melasma

around the cheekbones,spreads symmetrically on both sides in a hazy manner. The boundary is not clear. Most common in women in their 30s to 50s. May appear triggered by pregnancy or oral contraceptives. Feels like it darkens when rubbed.

Female hormones, friction, and ultraviolet rays are involved.a property of becoming darker in response to irritation, which is the decisive difference from other types of age spots.

• How to tellIf spots appear at the same position on both sides in a similar shape, the possibility of melasma is high. Blurred edges are also characteristic.

Post-inflammatory hyperpigmentation

Brown discoloration that remains after acne, insect bites, injuries, or dermatitis.The shape follows the shape of the original inflammation.Fades over time.

Regarding the color of acne scars, the acne scar article describes this in detail.

ADM (Acquired Dermal Melanocytosis)

Small patches of grayish-brown that appear from the 20s onward,gather symmetrically on the cheekbones and templesThey can also appear on the sides of the nose.

With this alone,the pigmented area is deep— melanin is in the dermis, not the epidermis. That is why shallow treatments cannot reach it. It resembles melasma in appearance and often occurs at the same time,making it a category that is difficult to distinguish even for dermatologists.

• How to tellIf it appears more blue-gray than brown and the spots are clustered, ADM is suspected. Self-diagnosis is difficult, so please confirm at your consultation.

mixed together is normal It is not uncommon for melasma, ADM, and senile lentigines to coexist on one face. Therefore, rather than asking "what is this spot,""which types are mixed together, and in what order should we treat them"becomes the role of the consultation.

This is what I most want to convey in this article.

Other spots are treated in the direction of "breaking down and expelling melanin." However, with melasma,the irritation itself of trying to break it down causes it to darken.When a strong laser is applied, it may appear lighter at first, but after several weeks it can become darker instead.

Therefore the foundation is oral medication, sun protection, and "not rubbing"

• Oral medicationTranexamic acid oral medication is considered the foundation of melasma treatment. It is something to continue for several months.
• Sun protectionUltraviolet rays will definitely darken melasma. Sunscreen is part of the treatment.
• Not rubbingDuring facial cleansing, with towels, when removing makeup, and massage — all friction darkens melasma. Surprisingly, this is the primary cause for some people.

When using laser

For melasma as well,applying at low power over a broad areais an approach (toning). However, this is supplementary on top of the foundation and is not intended to cure by itself. If the power or number of sessions are miscalculated, it can worsen, so settings must be decided with the understanding that melasma is present.

From Dr. Hane I sometimes receive consultations saying, "After getting a spot-removal laser, it actually became darker." When I hear the details, it is almost always a case where melasma was present but it was treated strongly as senile lentigines. This is something that could have been prevented by just distinguishing it initially, so I find it unfortunate.

Regardless of type, what you need to do is common. Andcontinuing this influences results more than any procedure.

Sunscreen is part of the treatment

Ultraviolet rays darken all 5 types. Skin after laser treatment is especially vulnerable, and if sun exposure occurs at this point, the color returns.If you receive treatment, think of sunscreen as part of the package.

Even on cloudy days and near windows indoors, ultraviolet rays reach. Often not enough is applied, so it is ideal to spread it thoroughly over the entire face and reapply at midday.

Not rubbing

Especially with melasma, friction is the greatest aggravating factor. Cleanse with foam, pat the towel dry only, and do not rub when cleansing.Stopping rubbing works better than adding something.

Choose by active ingredient

• Vitamin C derivativeWorks in the process of melanin production and also suppresses oxidation. Can be used on any type.
• Tranexamic acidTargets melasma and post-inflammatory hyperpigmentation. Available as topical or oral.
• HydroquinoneStrongly suppresses the function of melanin production. Because the effect is high, irritation is also more likely, and concentration and duration require management.
• RetinoidPromotes turnover and brings existing color to the surface faster. Redness and peeling occur.

At our Fukuoka location, we carry medical-institution-exclusive skincare. Which is suitable depends on your skin condition and the type of spots, so please check with us at the clinic.

Spots are categorized by type, depending on what the treatment targets. Pricing and detailed explanations are available via the links under each treatment name.

For spots and freckles with clear boundaries

Pico spot

We deliver strong energy as a point to the targeted spot, shattering melanin. This is the most efficient approach for age spots and produces visible results in fewer sessions.

• Guideline1–2 sessions. Darker spots may require additional treatment.
• DowntimeScabbing forms within a few days and typically sheds within about a week. The area is protected with tape during this time.
• Good forThose with a few spots that have clearly defined boundaries.
• Not suitable forThose with melasma mixed in. Those unable to avoid sun exposure after treatment.

For melasma and broad color unevenness

Pico toning

We apply low-power energy across the entire face to gradually disperse melanin. This method is gentle on melasma and can also treat dullness and color unevenness. Results build with repeated sessions.

• GuidelineEvery 2–4 weeks, around 5 sessions
• DowntimeMinimal. Mild redness immediately afterward.
• Good forMelasma, broad color unevenness, dullness
• Not suitable forThose seeking to quickly remove only deeply pigmented spots with clear boundaries

For overall skin dullness and turnover

Massage peel (PRX-T33)

The agent penetrates deep layers without abrading the skin surface, promoting collagen production and cell turnover. Downtime is minimal, so it can be scheduled between other treatments.

• GuidelineEvery 1–2 weeks, 4–5 sessions
• DowntimeMinimal. Mild redness immediately afterward, slight dryness for a few days.
• Good forThose with dullness and reduced firmness at the same time.
• Not suitable forThose with active acne or open wounds.

Milano Repeel (BioRePeel)

A peel combining multiple acids and amino acids. It works on both the surface layer and deeper layers, evening out color and refining texture.

• GuidelineEvery 4 weeks, 3–5 sessions
• DowntimePeeling and dryness for a few days.
• Good forThose with dullness and roughness at the same time.
• Not suitable forThose with strong dryness or those unable to tolerate peeling during their schedule.

How to combine treatmentsIf you have only spots with clear boundaries, Pico spot settles it quickly. If you have melasma, start oral medication and sun protection first, then proceed with toning. If you have both, calm the melasma before applying spot treatment.Reversing the order means melasma will darken before you can address it.

We write honestly.

• Preventing new spots from formingNot possible. As long as you are exposed to ultraviolet rays, new pigmentation will continue to form. Sun protection can delay it.
• Completely resolving melasmaMelasma is influenced by constitution and lifestyle, so it tends to recur. The treatment is about "maintaining a calm state" rather than "curing" it.
• Ensuring freckles never returnSince it is constitutional, even if faded, it will reappear over time.
• Erasing all spots in one treatmentDifferent spot types require different treatments, so those with mixed types need to proceed in stages.

Spot treatment is similar in nature to professional teeth cleaning.Rather than a one-time procedure, think of it as something to maintain regularly.This reduces the gap between expectation and reality.

As someone involved in nose surgery, I will address the topic of surgery and pigmentation. While it is rarely mentioned in articles about spots, we do receive these inquiries frequently.

Scars remain brown with sun exposure.

After surgery, scars remain in a state where melanin is produced more easily for some time. Sun exposure during this period causescolor to persist along the scar line.Once discoloration appears, it takes time to fade, so prevention is far more effective.

It is not just surgical cutting. Discoloration can occur in the same way if tape fixation after nose surgery causes irritation, or if swollen skin is rubbed strongly.

There are only two things to do.

• Sun protectionEven after the tape is removed, continue using sunscreen for several months. This is the most effective approach.
• Not rubbingDo not scratch even if itchy, and do not massage to reduce swelling. Friction invites discoloration.

When reviewing postoperative progress, we check not only the state of the scar but also how the color develops. If you have any concerns, please mention them at your consultation.

Is it okay to receive a menu like unlimited spot removal?

It is fine if the types are distinguished first. The problem is when melasma or ADM are mixed in but treated uniformly with strong laser. Before treatment, confirm which spots will be treated with what method.

After laser treatment, it became darker once. Is this a failure?

Temporary darkening after treatment is postinflammatory hyperpigmentation, which in most cases fades within several months. However, this is different from worsening when strong laser is applied to melasma, and the distinction is determined at consultation.

How many sessions until I see a change?

Sharply demarcated senile lentigines show visible change in 1–2 sessions. Melasma and broad color unevenness are gradually resolved over approximately 5 sessions.

Can I tell if I have melasma myself?

If it is bilaterally symmetric, has blurred edges, and appeared after age 30, the likelihood is high. However, distinguishing it from ADM is difficult by appearance alone, and getting this wrong reverses the treatment approach. Please have it confirmed at consultation.

Can treatment be done during pregnancy or breastfeeding?

Oral medications and some topical drugs cannot be used. Melasma tends to darken during this period, so it is common to maintain it through sun protection and avoiding friction, then begin treatment after it settles.

Can men receive treatment?

Yes. Those with outdoor work or exercise habits have significant cumulative sun exposure, and consultations for senile lentigines are not uncommon.

The treatments introduced on this page are:all self-funded (not covered by insurance).

What can occur:

• Redness and stingingMay occur immediately through several days after treatment.
• Scab formationWith Pico Spot, scabbing occurs within several days and typically falls off within a week. Forcibly removing it can leave discoloration.
• Post-inflammatory hyperpigmentationMay temporarily darken after treatment. Most fade within several months.
• DepigmentationRarely, areas may become white compared to surrounding skin.
• Melasma worseningStrong laser applied to melasma will darken it. This is why distinguishing types beforehand is critical.
• Individual variation in resultsExpected changes may not be achieved. Variation especially occurs with ADM or deep discoloration.

Pricing, required sessions, and treatment-specific risks for each procedure are listed on the linked page for that treatment.

Medical supervisor of this page:

Kazuhide HaneDirector, Zetith Beauty Clinic Fukuoka

Graduated from Kobe University School of Medicine in 2021. Previously served as director of the Osaka clinic, and has been director of Zetith Beauty Clinic Fukuoka since 2025. In addition to cosmetic surgical procedures centered on nose reshaping, also handles injectable and device treatments in cosmetic dermatology.

When unsure what type of spot you have

Melasma and ADM, senile lentigines and postinflammatory hyperpigmentation are difficult combinations to distinguish in a mirror. Moreover, they are often mixed together. At consultation, we examine shape, borders, and bilateral symmetry to identify which types are present and propose the order of treatment. We offer free consultations at our Fukuoka clinic (Tenjin), so please contact us first.

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Related pages

• Fukuoka cosmetic dermatology guide Pores, acne scars, spots, and sagging organized by concern
• Acne scar guide Redness, discoloration, and depressions—different treatment approaches
• Nose pore guide Three types: comedones, enlarged pores, and blackheads
• About Fukuoka clinic Access, hours, and physicians on staff

※ This page provides general medical information and does not guarantee results. All treatments listed are self-funded (not covered by insurance). Treatment indication, cost, and risk are determined individually at consultation. Results vary by individual. ※ All photos shown are illustrative images. They are not before-after cases from our clinic.