What it is
IPL is not technically a laser. It is a flashlamp that emits a broad band of visible and near-infrared light (roughly 500–1200 nm), with filters that exclude wavelengths you do not want. The remaining energy is absorbed by the two pigments IPL targets best: melanin (in sun spots and freckles) and oxyhemoglobin (in superficial vessels and diffuse redness).
Absorbed light becomes heat. Pigment-laden cells take in the energy, darken, and slough off as the skin turns over the next one to two weeks. Small vessels coagulate and reabsorb. The surrounding skin is largely unaffected, which is why IPL has so little downtime relative to ablative lasers.
What IPL does well: brown spots from sun damage, diffuse facial redness, broken capillaries on the cheeks and nose, mottled photodamage, freckling on the chest and hands. What it does not do: deep wrinkles, scarring, skin laxity, melasma in most patients.
How Dr. Brown approaches it
The variables are filter selection, fluence, pulse duration, and number of pulses per spot. Skin type drives the conservative end of every setting. Recent sun exposure is the largest single contributor to bad outcomes — pigment that should not have been a target absorbs energy and burns or hyperpigments.
Esvie protocol:
- Consult and skin-type assessment. Fitzpatrick type, recent sun exposure, history of melasma, current medications, and pregnancy status.
- Filter selection by target. Shorter cutoff filters for pigment-dominant cases; longer cutoffs and longer pulses for redness or for slightly more pigmented skin types.
- Test pulse if uncertain. A test spot in a discreet area before treating the visible cosmetic zone, especially for skin types III–IV.
- Series planning. Three to five sessions, three to four weeks apart, then a maintenance visit one to two times per year if sun behavior is reasonable.
For patients with confirmed melasma, IPL is rarely the right first move. Topical therapy, sun avoidance, and gentler interventions like Laser Genesis or chemical peels typically come first. Aggressive light energy on melasma can darken it for months.
What to expect
Day of treatment. Skin is cleansed, ultrasound gel applied, eye shields placed. Pulses feel like a warm rubber-band snap. Treatment runs 15–30 minutes depending on area. Mild redness and warmth follow for a few hours.
Days 1–5. Pigmented spots darken visibly — they look like small flecks of coffee grounds on the skin. This is the treatment working, not a complication. Mineral makeup may be applied the next day if desired. No scrubbing, no exfoliants, no retinoids for several days.
Days 5–14. The dark flecks slough off as the skin turns over. The treated areas look meaningfully clearer. Diffuse redness improves more gradually over two to four weeks.
Between sessions. Pigment continues to lift over each subsequent session. Most patients see substantial improvement by session three; the full series finishes the work.
Maintenance. Sun is the reason the pigment came back the first time. Sun is the reason it will come back again. Maintenance one to two times per year, plus a real sun-protection routine, holds the result.
Candidacy
Good candidates have sun-damage pigment or diffuse facial redness; have skin types I–III with stable pigment; have not had recent sun exposure or a tan; are not pregnant or nursing; and are willing to do a series rather than expect a one-and-done.
Not a candidate today if you have an active tan or recent unprotected sun exposure on the area, are pregnant or nursing, are on a photosensitizing medication, or have an active skin infection at the site.
If you have melasma, the conversation is different — IPL frequently worsens melasma and is not the right starting point. Better tools for melasma include topical therapy, conservative chemical peels, and certain non-ablative laser protocols.
If you have skin type IV–VI, IPL is approached with significant caution and is often not the right device. Long-pulse 1064 nm Nd:YAG protocols and other longer-wavelength options are typically safer for darker skin.