When I encounter pigmentation in the dermatology clinic, before putting a name to the lesion, I first look at which side of the face the color sits on and in what shape. The patient I am introducing this time is a man in his late 40s who came in because of pigmentation that stood out on his right cheek only. At first glance the color could have looked like melasma, but the moment I saw its distribution, the direction changed.
The moment I suspect lentigo in pigment sitting on one side only
Even when they are the same brown, melasma and lentigo settle in differently. Melasma tends to spread symmetrically over both cheekbones and cheeks, whereas lentigo often appears asymmetrically on one side with a clear border. When the color is concentrated on the right cheek only, as in this patient, I think of lentigo before melasma.
Of course, I do not draw conclusions from distribution alone. Only after looking at the depth of the color, the sharpness of the border and even the surface texture do I decide on the direction of treatment. The criteria I use to divide the same pigmentation into three are explained further in How I sort pigment that patients bring in as "age spots" into three types in the clinic.
What makes melasma and lentigo different enough to change the treatment?
The two pigmentations have similar-sounding names in Korean and overlapping colors, but their causes and approaches differ. The axes I use to distinguish them in the clinic are summarized below.
| Category | Melasma | Lentigo |
|---|---|---|
| Distribution | Tends to be symmetrical on both sides | Tends to be asymmetrical on one side |
| Border | Blurry and diffuse | Relatively clear |
| Underlying factors | Epidermal and dermal pigment intertwined | Epidermal melanin locally dense |
| Approach | Lower stimulation and manage gradually | Remove with a laser matched in wavelength |
This distinction matters because if melasma treatment is applied as is to lentigo, the response goes off course. There is a histological point to examine regarding why lentigo does not clear well with simple toning alone, and I covered that background in detail in the post that looks at histology to explain why lentigo does not clear with toning.
Even if it is the same brown, if it comes from a different place, the way to clear it is different too. The diagnosis that names it comes first; choosing the device comes after.
Rather than deciding for yourself that it is lentigo just because the color is concentrated on one side, it is safer to separate the diagnosis first. Start a chat consultation now
How I approached this lentigo with the Reepot laser
The lentigo on this patient's right cheek was a form sitting clearly in the epidermis. So I approached it by matching the wavelength with the Reepot laser, which reacts selectively to pigment. Why I consider the wavelength before the device when treating lentigo is summarized in Why I look at wavelength first when choosing a laser for lentigo.
Right after the laser, it is common to see the pigmented area temporarily darken or form something like a scab. This is a reaction that occurs as the pigment is pushed up to the surface, and it follows a course of falling off naturally over several days. The speed of recovery and the degree of reaction vary from person to person.
If you are curious about how the Reepot laser is actually used, you may also refer to the Reepot laser treatment guide.
What happens after clearing matters even more
With lentigo, the result is decided more during the healing process than at the moment of removal. If the area is exposed to UV before the wound has fully healed, or if the scab is forcibly removed, post-inflammatory hyperpigmentation can remain in that spot. That is why I ask patients to follow this care after the procedure.
- Do not pick off the scab; wait until it falls off naturally
- During recovery, be more thorough than usual about sun protection
- Put off irritating peels or friction for a while
- If redness lingers or the color darkens again, come back for a follow-up check
How I view the recovery period after clearing is written up in The recovery care I recommend two weeks after lentigo removal.
If the color stands out on one side only
If you see clear pigmentation on only one cheek, I recommend first finding out whether it is melasma or lentigo. The two pigmentations follow different treatment paths, and approaching them the wrong way can actually throw the response off course. Because the cost depends on the condition of the lesion, it is explained during the consultation after the examination.
If pigment concentrated on one side, like on the right cheek, is bothering you, let us start by looking at the diagnosis together. Consult via chat
Author: Dr. Cho Mingyeol, Medical Director (board-certified dermatologist; Master Certification in Pigmentation, Acne, Rosacea and Hair from the Korean Dermatologists Association). You can find the full profile on the Medical Team page. First published 2024-10-23 / Last reviewed 2026-07-09
This article is intended for general information only; the appropriate treatment and outcomes may vary depending on each individual's condition.