Most people who ask about a photofacial describe the same thing: a scattering of brown marks across the cheeks, the nose, the chest or the backs of the hands that were not there ten years ago. They call them age spots or sun spots, and they want them gone. Intense pulsed light, or IPL, is one of the most common ways to do that, and for the right kind of spot it works well. The trouble is the phrase "the right kind of spot." Brown on skin is not one condition. Some brown marks respond beautifully to light. Some get worse. And a small number are not benign pigment at all, which is why a conversation about treatment should always begin with a look at what is actually there.
This guide is a field guide to the spot first and the light second. It describes how common brown marks differ, how IPL interacts with each, what a treatment day and the two weeks after it really look like, and how to avoid the mistakes that turn a simple procedure into a long pigment problem.
What IPL is, and what it is not
Intense pulsed light is not a laser. A laser emits a single wavelength of light; an IPL device emits a broad spectrum, which is then filtered to the range needed for the target. In the skin, pigment (melanin) and hemoglobin (the red component of blood vessels) absorb different parts of that spectrum. When the right wavelengths hit the right target, the absorbed energy turns to heat that breaks up the pigment or closes the tiny vessel.
That is why one treatment can address two seemingly different complaints. Brown spots and diffuse redness both respond because each has a target that absorbs the light. It is also why IPL does not work on everything. Light needs a contrast between the target and the surrounding skin. A dark spot on fair skin gives a clear target; the same dark spot on skin that is already tanned, or on naturally deeper skin tones, gives the light a harder time telling target from background, and more of the energy lands in healthy tissue.
IPL works on the surface and upper layers of skin. It does not tighten the deeper dermis the way radiofrequency does, it does not remove wrinkles the way resurfacing lasers do, and it does not touch deep pigment sitting far below the surface. It is a color treatment, not a texture treatment, even though skin often looks fresher afterward because the color is more even.
The field guide: what kind of brown is it?
Dermatologists tell pigmented marks apart by their borders, their color, their location and their history. A patient can learn the rough categories, with the caveat that only an examination settles the question.
Solar lentigines, usually called sun spots or age spots. These are flat, tan to dark brown marks with fairly even color and sharp edges. They appear where the sun hits hardest over years: the cheeks, the temples, the forehead, the backs of the hands, the forearms and the upper chest. They do not itch or change quickly. They are the classic target for IPL, and in suitable skin they often fade noticeably within days to weeks of treatment.
Freckles, or ephelides. These are smaller, lighter and tend to darken in summer and fade in winter. They usually start in childhood and are genetic. IPL can lighten them, but they often return with sun exposure, so treating them is a decision about how much you mind them and how well you will protect the skin afterward.
Melasma. This looks different: larger, patchy, often symmetrical areas of tan to gray brown on the cheeks, forehead, upper lip and sometimes the jaw. It is driven by hormones, sun and heat, and it is notorious for returning. The cells that make pigment in melasma are unusually reactive, and strong heat or light can make the patches darker. Melasma is the most important condition on this list to identify before any light treatment, because IPL can worsen it in many people. Gentler approaches and medical therapy are usually the first line.
Post-inflammatory hyperpigmentation. Dark marks left behind after acne, a rash, a burn or an injury. These tend to follow the shape of whatever caused them. Some fade without treatment over months. Light treatment can help in some cases, but it is also a recognized trigger, especially in deeper skin tones, so caution and sometimes test patches are used.
Seborrheic keratoses. Waxy, raised, stuck-on looking brown lesions. They are benign and are usually removed by freezing or other methods rather than IPL, although IPL may lighten flat ones.
Moles and other lesions. Raised or flat brown or black marks with uneven edges, multiple colors, recent change in size or shape, bleeding or itching deserve a medical exam. These are not for IPL. Treating a lesion that should have been examined can delay a diagnosis, and light-based destruction removes the tissue that a pathologist would need to look at.
The rule that follows is simple. Any spot that is changing, asymmetrical, irregular in border or color, larger than a pencil eraser, bleeding or different from its neighbors should be examined by a physician before anyone treats the skin around it.
Why the exam comes before the machine
A responsible practice looks at the skin before suggesting a photofacial. That look includes the type of skin, the distribution of the spots, a review of sun and tanning history, and a conversation about medications. Certain prescription drugs, supplements and topical products make skin more sensitive to light, and skin that has recently tanned, in a booth or on a beach, is at greater risk of burns and pigment shifts.
The exam also sorts the spots into groups. Some are straightforward candidates. Some need a test spot. Some are better treated another way. And some need to be referred. A photofacial plan that skips this step, treats the entire face with the same settings and does not photograph the baseline is a warning sign.
Skin tone and IPL: the honest version
The relationship between skin tone and IPL is the single most misunderstood part of the treatment. Lighter skin generally gives the device a clear contrast and a wider margin for safe settings. Deeper skin tones carry more natural melanin in the surface, which competes with the target, and treating them with the wrong device or settings can cause burns, lightening or darkening.
This does not mean IPL is off limits to anyone; it means the choice of device, filter and energy matters a great deal, and the practitioner's experience with a range of skin types matters more than the brand name on the machine. Some patients are better served by different technology or by gradual treatments that carry less risk. A practice that treats patients of diverse backgrounds should be able to explain what it does differently for them, and a patient who is told that IPL is safe for every skin type without qualification should ask more questions.
Redness is the other half of the photofacial
Not all patients come for brown spots. Many want help with diffuse facial redness, visible tiny vessels on the cheeks and nose, or the flush of mild rosacea. The same pulses that target pigment can also target hemoglobin in superficial vessels, which constrict or close and fade over the following weeks.
Redness is more variable in its response than sun spots. Fine, thread-like vessels often respond well. Deeper, larger vessels may need other devices. Rosacea can improve in appearance, but it is a chronic condition with triggers, and IPL changes how it looks, not whether it exists. Maintenance sessions and trigger management are usually part of the long-term plan. Heat-sensitive skin and active flares call for caution. The wider laser therapy menu includes other devices for vessels that IPL does not close.
The hands, chest and neck: where spots go to hide
The face gets most of the attention, but sun damage shows first and most clearly on the backs of the hands, the neck and the upper chest. These areas have thinner skin, fewer oil glands and less ability to heal, so they are treated more conservatively than the cheeks. The hands in particular age quickly because they are constantly exposed, and many people who have treated their faces forget them.
IPL on the chest and hands is usually done with lower energy and with more sessions spaced further apart. Healing can be slower, and crusting of treated spots is common. A treatment plan for hands often includes attention to volume loss and visible veins, which are separate issues and are handled with hand rejuvenation techniques that restore fullness. The neck and chest are more sensitive to pigment shifts than the face, which makes a test area especially valuable.
Other ways to treat the same spots
IPL is one option among several, and for some spots another option is better. Cryotherapy, a quick application of extreme cold, is a standard method for isolated sun spots and benign raised lesions, and it is inexpensive in time and effort. Its drawback is that it works one lesion at a time and can leave a lighter mark if applied too aggressively.
Medium depth chemical peels treat the whole area at once and can even out tone and fade pigment in the upper layers. They suit patients who want to treat broad, diffuse mottling and who can accept several days of peeling. Fractional lasers reach somewhat deeper and also improve texture, which is why they are chosen when fine lines accompany the spots, though healing takes longer than with IPL. Topical prescriptions can lighten pigment slowly over months, and they pair well with in office treatment.
A fair way to choose is to ask what else the skin needs. If the only complaint is color, IPL is efficient. If texture and color both bother you, a staged plan with resurfacing and light may do more. If the diagnosis is melasma, the answer begins with medical management, not light.
Hormones, pregnancy and the melasma window
Melasma often appears or worsens during pregnancy, with hormonal contraception or with hormone therapy, and it may fade when those exposures end. For that reason, brown patches that appear in these windows are usually watched and managed gently before anyone considers energy based treatment. Light treatments are generally postponed during pregnancy altogether. Patients who are pregnant, planning to be, or newly changed on a hormonal medication should say so at the consultation, since it changes both the diagnosis and the safe options.
Tanning, sunbeds and the waiting period
A tan is pigment, and IPL cannot separate tan from target. Treating tanned skin raises the chance of burns and uneven results, so most practices ask that the area be free of tanning for several weeks before a session. That includes sunbeds and sunless tanners, which stain the surface and confuse the settings.
If you have tanned recently, tell the clinician honestly. A delayed appointment is better than a patchy result. The same applies after treatment: a vacation within a few weeks on either side of a photofacial is worth rescheduling around.
Taking your own baseline photographs
A few photographs at home make consultations and reviews more useful. Use natural window light, a plain background, no makeup and the same distance each time. Take the face straight on and at both three quarter angles, and photograph the hands and chest if they will be treated. Date the images. Spots can look very different in a mirror than on camera, and a record taken before treatment makes progress easier to judge because memory is unreliable about how dark things looked.
A year of skin, planned in seasons
One way to plan is to think in seasons. Autumn and winter are natural times for the active phase: an examination, a test spot, and two or three sessions spaced several weeks apart. Spring is for review and, if needed, a final touch up before sun exposure rises. Summer is for maintenance: sunscreen every day, reapplied outdoors, hats, and shade at midday. A single check in the following autumn catches new spots early, when they are lightest and respond best.
This rhythm turns a one-time fix into a habit, and it matches how skin behaves, which is the more durable approach.
What a treatment day looks like
A session begins with cleansing and removal of makeup. Photographs are taken. A cooling gel is applied, and eye protection is placed because the light is intense. A test pulse on a small area confirms settings. The operator then moves across the skin in overlapping pulses, with each pulse feeling like a quick snap of a rubber band and a flash of warmth. Most people find it tolerable without numbing, though stronger settings or sensitive areas may call for topical anesthetic.
The whole face usually takes under half an hour of pulsing, with prep and photos adding time. Skin is cooled afterward, and sunscreen is applied. You leave with pink, slightly warm skin and written instructions. Because there is no open wound in most settings, most people return to normal activity immediately, although they will look flushed for a few hours.
The fourteen days after: a diary
Patients are often surprised by what happens next, because the spots do not fade at once. They get darker first. Here is what the typical arc looks like, with the caveat that settings, skin type and the individual all change the timing.
Day 0, the same evening. The skin is pink and warm, like a mild sunburn without the pain. Spots may look slightly darker and sharper than before. A light moisturizer and sunscreen are enough, and the instructions generally say to avoid heat, hot showers and exercise that leaves you flushed.
Day 1 to 2. Redness fades. The treated spots look darker, almost like coffee grounds scattered across the cheek. This can be alarming if you are not expecting it. It means the pigment has absorbed energy and is on its way out.
Day 3 to 5. Dark spots begin to feel slightly rough. Some form fine crusts or flakes. The temptation to scrub or pick them off is strong and should be resisted, since picking can lead to marks and sometimes scars. Gentle cleansing and moisturizing help.
Day 7 to 10. The dark spots start to flake and lift away. Underneath, the skin is pinker and then returns to normal color. Some spots disappear completely. Others are lighter but still visible.
Day 10 to 14. Most of the flaking is over. Skin looks clearer and more even. Redness treated at the same time may continue to fade for several more weeks. The clinician typically reviews photographs at about four weeks, when the result is easier to judge.
The sequence is nearly always the same: darker, flaky, lighter. Knowing it ahead of time is half of managing it.
Sun rules that decide the outcome
The most important instruction after IPL is also the least exciting: stay out of the sun. Treated skin is more sensitive to ultraviolet light, and sun exposure during healing can bring spots back or cause new pigmentation. Daily broad spectrum sunscreen, a hat and shade are the minimum, and many practices ask patients to avoid tanning, including self-tanner on treated areas, for a period before and after.
Planning matters. A person who books a photofacial the week before a beach vacation is setting up a problem. Many people choose fall and winter for this reason, though a disciplined patient can be treated in any season. Heat matters too: saunas, hot yoga and hot baths in the early days can aggravate redness and increase the chance of unwanted pigment.
How many sessions, and why
A single session can lighten some spots dramatically, particularly dark, well-defined ones on fair skin. More often, a series of treatments is used, spaced several weeks apart, because each pass removes some of the pigment and lets the clinician reassess. The exact number depends on the density of the spots, their depth, the skin type and the goals. Deeper texture problems are the territory of fractional laser work, not light. A practice should be able to describe the expected course without promising specifics, and the plan should be adjusted based on how the skin responds to the first session.
Maintenance is separate. Sun spots return if the skin continues to be exposed, which is why many patients schedule a single touch-up each year and use sunscreen daily. The result is not permanent in the sense that skin stays frozen; it is durable in the sense that a good sun protection routine keeps it.
When IPL is the wrong tool
IPL is not the best option when the pigment is deep, when the lesions are raised or irregular, when the diagnosis is melasma, or when the skin is tanned or inflamed. It is also not the right choice for texture problems such as wrinkles and acne scars; those call for different technology, such as fractional CO2 resurfacing or radiofrequency microneedling.
For patients with significant sun damage that includes both color and texture changes, a combined plan is common. Light treatment addresses color, resurfacing addresses texture, and a chemical peel or medical grade topical program supports the whole. Some people begin with a gentle approach and progress as their skin tolerates it. The sequence matters, because overlapping heat-based treatments too closely can overload the skin.
Topical programs: what helps between sessions
A good skincare routine supports every in-office treatment. Daily sunscreen is the foundation. Antioxidants such as vitamin C can support the skin's defenses against ultraviolet damage. Retinoids speed cell turnover and help keep pigment from building up, although they are paused around treatment dates. Ingredients that interfere with pigment production, such as azelaic acid or tranexamic acid, play a role especially for melasma-prone skin and are best selected with medical guidance.
The common mistake is aggressive home exfoliation. Scrubs, acid cocktails and at-home devices can inflame the skin and trigger the same pigment that a treatment is trying to remove. Less is usually better, and a physician should approve additions to the routine during a treatment series.
Mistakes that cost people months
A few repeat offenders explain most bad experiences with photofacials. Treating tanned skin, because the device cannot distinguish tan from target. Treating melasma as if it were sun damage. Skipping the test spot on a deeper skin tone. Going into the sun right afterward. Picking at flaking spots. Combining the treatment with a new strong topical the same week. Using a device with settings chosen for a different skin type. And assuming that cheap or rushed treatment is equivalent to one that includes an exam and a plan.
Each of these is avoidable, which is why the early part of the process, meaning the examination and the questions, is a better predictor of success than the machine.
Small areas, big caution: the nose, lip line and around the eyes
Some of the spots people mind most sit in the most delicate places. The skin around the eyes is thin, and the eye itself must be protected from the light, so treatments there use shields and lower settings and often skip the lid margin entirely. The upper lip is where melasma likes to settle and where heat can trigger cold sore outbreaks. The nose tends to be oily, sun exposed and prone to redness, and it can carry both spots and vessels in a small area.
For these areas, a conservative first pass is common. The clinician treats a small zone, waits for the full result, and adjusts. Patients sometimes feel this is overly cautious, but one extra session is easier to fix than a mark on the nose.
Layering products around treatment dates
Home routines should be quieter near treatment. Retinoids and strong exfoliating acids are usually paused several days before and after a session, depending on the clinic's rules, because they thin the surface and make skin react more. After treatment, the routine is simple: gentle cleanser, plain moisturizer, mineral or broad spectrum sunscreen. New products are introduced one at a time so that any reaction can be traced.
Brightening ingredients are typically reintroduced after the skin has fully healed, and only if the clinician agrees. A patient who adds three new products the day after a photofacial makes it impossible to tell which one caused redness or darkening, and may lose the benefit of the treatment altogether.
When results are slower than expected
Not every spot clears at once. Some are deeper, some are mixed with other kinds of pigment, and some respond better to a second pass. If a spot is unchanged after a full cycle, the useful questions are whether it was the right diagnosis, whether the settings were adequate for that spot and whether another approach would be better.
Patience helps because redness and pigment can keep changing for weeks, but it should not become indefinite waiting. A review at four to six weeks, with comparison photographs, is the right time to decide on a next step: repeat, switch methods or leave it alone.
Side effects and risks, plainly
Mild redness, swelling and warmth are expected. Temporary darkening of treated spots is part of the process. Less common effects include blistering, crusting beyond what is expected, burns, longer-lasting pigment change (either darkening or lightening), and scarring. Rarely, a lesion treated without proper evaluation turns out to need medical attention.
Risk rises with tanning, with the wrong settings, with deeper skin tones when treated without care, and with certain medications. A patient with a history of cold sores around the mouth may be advised to take preventive medication because heat can trigger an outbreak. Anyone who experiences unusual pain, blistering or signs of infection should contact the practice promptly.
The questions worth bringing to a consultation
A short list of subjects makes the first appointment more useful. Ask what kind of pigment the clinician thinks you have and how they know. Ask whether a test area is part of the plan. Ask which device is used and why it suits your skin type. Ask how many sessions the clinician expects and what will cause the plan to change. Ask what the aftercare involves and what happens if the spots return. Ask whether suspicious lesions are examined in house or referred. The quality of the answers, and the willingness to give them, is informative.
Choosing where to go
For a treatment that looks simple, a photofacial rewards careful judgment. The best practices examine first, photograph, match the device to the skin, describe the healing honestly and plan for sun protection. Dr. Doshi is a double board certified facial plastic surgeon whose practice offers IPL alongside resurfacing and surgical options, so recommendations can be made across the range and not just for one device. Patients who live at a distance can start with a virtual consultation and photographs taken in natural light.