Melasma is a common acquired pigmentary disorder and difficult to treat with a high rate of recurrence. Conventional methods in the treatment of melasma have drawbacks and limitations. The so-called "laser toning" treatment, which uses a collimated low-fluence 1,064 nm Q-switched neodymium-doped yttrium aluminum garnet laser, was introduced a few years ago for the treatment of melasma. Laser toning has attracted much popularity and attention, and has become a crucial method for treatment of melasma. Laser toning is now a mainstay for treatment and management of melasma, however some dermatologists have excessive concerns about the risk of hypopigmentation. This inordinate fear may have originated from a few studies which insisted that laser toning therapy has a high risk of hypopigmentation and should be considered as a second-line treatment, not a first-line treatment for melasma. In the current study, we suggest that hypopigmentation after laser toning is a preventable and controllable complication based on our clinical experiences and reviews of various literatures. Key words

Melasma is one of the most common forms of acquired hyperpigmentation in Asians. It is often intractable with a high rate of recurrence. Several years ago, the collimated low-fluence 1,064 nm Q-switched neodymiumdoped yttrium aluminum garnet laser was introduced as the "laser toning" for the treatment of melasma. Laser toning has been established as an excellent treatment option for melasma with proven efficacy, and it has gained widespread usage. Compared to the early days of laser toning, recent laser toning treatment is associated with lower fluence, fewer passes, wider intervals between treatment sessions, and a minimal and milder tissue response. This recent approach can reduce the risk of mottled hypopigmentation, postinflammatory hyperpigmentation, rebound hyperpigmentation, and recurrence of melasma. However, there are a growing number of non-responders to the recent laser toning technique, which can be problematic for some doctors. Dermatologists should be aware of the various ways to manage non-responders. Moreover, they should also have an accurate understanding of the mechanisms and principles of these modalities to apply optimal treatment methods for each patient condition and melasma state. Further research and updates are necessary to improve the safety and efficacy of laser therapy for melasma.