I often hear people say they sit in front of the mirror looking at brown that has spread across the centre of the cheek together with redness beside the nose, and they have no idea what to tackle first. Pico toning and Genesis toning are both called "toning," but they aim at different targets, and when brown and red overlap on one face, deciding the order comes first. This article walks through why pigment and vascular redness are looked at separately, what decides the result, and what to check before and after treatment.

The short answer first

Pico toning and Genesis toning may share the number 1064nm, but the purpose stated in the guide is different. In the ATTITUDE Clinic treatment guide, Pico toning is listed as a 1064nm picosecond laser that helps with pigment and brightening, Genesis toning is listed as a 1064nm laser that helps with anti-aging, and redness and vascular lesions are handled separately by the 532nm Vbeam. So before asking "which of the two is better," you need to establish where the brown and the red on your face each come from. Once the nature and depth of the brown and the cause of the red are sorted out, which device, at what intensity, and at what interval is decided next.

Why look at pigment and redness separately?

Discolouration visible on the skin comes from two broad sources. One is brown, caused by melanin pigment building up, and the other is red, showing through because blood vessels have multiplied or dilated. It is not just a difference in colour — what is happening inside the skin is different, so the target to aim at is different too. Lasers use the property that light of a given wavelength is absorbed well by a given colour. Use a wavelength melanin absorbs well, and you get selective photothermolysis (a principle of concentrating energy on the target pigment while relatively sparing the surroundings); use a wavelength haemoglobin absorbs well, and blood vessels become the target. The ATTITUDE Clinic column also notes that pigment concerns use a wavelength absorbed by melanin, while redness and red vessels use a wavelength absorbed by haemoglobin, and points out that picosecond lasers have almost no effect on vascular concerns.

Cross-section of skin showing different light targeting brown pigment and red vessels

So why do ambiguous cases arise? It is when red is mixed into an area you thought was brown, or pigment lies beneath a red mark. Choosing a device based only on the colour you can see easily misses the target. Melasma is a particular case in point. According to the American Academy of Dermatology's melasma guidance, melasma can look similar to other pigment disorders, so it is distinguished by examination, and if needed a Wood's lamp, dermoscopy, or rarely a skin biopsy is used to check how deep the pigment reaches. You need to know the depth to set the wavelength and intensity.

One more point to note. There is no single best treatment for melasma that works for everyone; sun protection, topical medication, and sometimes procedures are combined, and the same guidance adds that it can take 3–12 months for results to appear. This period is not a session count for a particular device but the time span of the whole plan for dealing with the problem of melasma.

Why is the same 1064nm used differently?

Even with the same number, different pulse duration and delivery change what the light does to the skin. In a picosecond laser, "picosecond" means the light turns on and off in around one trillionth of a second. Delivering energy in such a short instant leaves little time for heat to spread, so the strength goes into fragmenting pigment particles finely, and the body gradually clears the broken pigment. Genesis toning, by contrast, is listed in the treatment guide as anti-aging rather than pigment or brightening, and in the ATTITUDE Clinic column it is introduced alongside the vascular laser family that handles redness. It is closer to delivering warmth to the skin to address tone and texture and faint redness, while the job of directly breaking up pigment clusters falls to the pico family.

There is a common misunderstanding here. "Pico is stronger, so pico is always better." Stronger energy is not always an advantage. In a state like melasma, where the pigment cells themselves are overactive, strong intensity can stimulate the pigment cells so that the area temporarily lightens and then deepens as rebound hyperpigmentation. This is why the basic approach to melasma is to lower the intensity and repeat at intervals. Intensity, interval, and device combination depend on the type and depth of the pigment, skin reactivity, and sun exposure habits.

What decides the result?

The depth and type of the pigment, skin type and reactivity, treatment interval, and sun exposure before and after the procedure all influence the result. Even the same spot responds quickly if it is gathered near the epidermis, while pigment spread into the dermis is safer to clear slowly over several sessions. If the skin is thin, sensitive, or prone to flushing, intensity and area are set lower even with the same device. Interval is also a variable. If you fire repeatedly without giving the body time to clear the broken pigment, only irritation accumulates. As the ATTITUDE Clinic column emphasises, sun protection is a key means of reducing recurrence, and lifestyle measures to reduce heat stimulation go alongside it.

Sessions and intervals are commonly set like this. Spots are commonly treated with the picosecond family in 1–3 sessions at 4–8 week intervals, while melasma or widely spread pigment is continued with low-power toning in 8–12 or more sessions at minimum intervals of 1 week or more. Pores and skin texture are commonly treated with fractional laser in 3–5 sessions at 4–6 week intervals, acne scars in 4–6 sessions, and redness and vessels with vascular laser in 3–5 sessions at 4–6 week intervals. All of these are examples only, and they vary with pigment depth, skin type, and sun exposure.

Table 1 What decides the result?
Category Mainly targets Good for What to check in consultation
Pico toning (PicoPlus 1064nm) Pigment, brightening Widely spread pigment, overall tone Whether low-power repetition is needed, interval and total duration
Pico spot (532nm pico) Individual pigment spots Clearly defined spots, freckles When the crust falls off, sun protection plan
Genesis toning (1064nm) Anti-aging (tone, texture) Skin texture, faint redness Whether it is an item that targets pigment directly
Vbeam (532nm) Redness, vascular lesions Redness, visible capillaries Whether the cause is superficial vessel dilation
Erbium fractional Pores, scars, skin texture Concerns where the structure itself has changed Downtime and sun exposure schedule

Swipe sideways to see the whole table.

In short Brown is handled by the pico family that targets pigment, while redness is shared by Vbeam and the Genesis family that target vessels. When the two overlap, which to address first and how to lower the intensity are decided in consultation, and that order changes the sessions and intervals.

If this applies to you

Two women seated in a consultation room with a bag and flowers on the next chair

When a ceremony or shoot is a few weeks away

Treating spots with high-power picosecond leaves crusts that usually take 7–10 days to fall off, and high-power fractional can involve swelling and oozing for 7–14 days. If you have a fixed date, adjust the order toward low-power toning with short downtime or treatments with a maintenance goal. If you mention the date first, the intensity and device are chosen by working back from that date.

Clinician pointing at a woman's cheek while talking, with white containers on a side table

If you have managed melasma for a long time

Melasma is a state of overactive pigment cells, so it is not cleared by one strong treatment. Continuing at low power with intervals while combining sun protection and cause management reduces irritation. Telling the clinic exactly which devices and intensities you have had, how you responded, and whether the colour ever deepened in between helps build the plan.

Gloved hand pressing a cold gel pack to the flushed cheek of a woman's face

Sensitive skin that flushes easily

Not all redness is the same. When superficial vessels such as capillaries are dilated, a vascular laser can be used to reduce them, but redness coming from reactivity — sensitive skin or rosacea (a condition in which skin reactivity increases) — may respond only limitedly to laser. In that case, set the intensity conservatively along with care that lowers irritation rather than forcing the redness down.

Woman seated in a waiting area as a clinician approaches to greet her

Overseas visitors on a short stay

For treatments that need multiple sessions, the key question is how many can fit within your stay. If consecutive sessions are difficult, rather than raising the intensity of a single session, it is better to leave with a record of the device, intensity, and response so you can continue after returning home. It also helps to consider whether you can maintain sun protection yourself after the procedure.

Before your consultation, please tell us Your sun exposure within the last 2 weeks (travel, outdoor activity, tanning), medications you are taking and topical medications and functional cosmetics you are using, previous laser treatments and how you responded (whether the colour deepened, whether blisters formed), fixed dates such as ceremonies or shoots, and whether you are pregnant or breastfeeding. This information is the starting point for setting intensity, device choice, and treatment interval.

How ATTITUDE Clinic proceeds

  1. Clinician using a skin analysis camera on a woman's cheek
    AI skin analysis record: a step that records and organises skin condition to support the consultation. The analysis tool only gathers and presents information and does not make a medical diagnosis; the doctor judges the pigment type by examination.
  2. Clinician examining a woman's cheek with a magnifier in a consultation room
    Doctor consultation to interpret type and cause: adding sun exposure, hormonal changes, lifestyle habits, and your concerns to the analysis record, the doctor judges by examination whether it is pigment or vascular and at what depth it sits, and designs the treatment combination.
  3. Woman lying on a treatment bed receiving laser treatment near the eye, gloved hand nearby
    Treatment performed by the doctor: among the devices held, including PicoPlus, Pico spot, Genesis toning, Vbeam, and erbium fractional, the one matching the goal is chosen and the doctor personally adjusts intensity and combination. What is needed now, what is not, and the order are also decided at this stage.
  4. Clinician offering a white pump bottle to a seated woman
    Recovery and care guidance: soothing care, sun protection, and the interval to the next session are explained, and progress is checked. If redness lasts a long time or crusts fall off later than expected, the next plan is adjusted again.

Aftercare and side effects

  1. Gloved hands placing a gel sheet on the face of a woman lying on a treatment bed
    Soothing: skin temperature is elevated right after the procedure. Cool it down, and avoid activities that add heat, such as saunas, jjimjilbang, and intense exercise, for 1–2 weeks.
  2. Gloved hand applying white moisturiser to the face of a lying woman
    Moisturising: after breaking up pigment or after fractional treatment, the skin tends to dry out. Keeping it more hydrated than usual reduces irritation while the barrier recovers.
  3. Woman in a wide-brimmed hat holding a white bottle in forest shade
    Sun protection: right after the procedure the skin's defensive barrier is weakened, so protection becomes the thing that preserves the result. Outdoors, reapply about every 2 hours, and use a wide-brimmed hat and shade together. If you have melasma, as the American Academy of Dermatology guidance notes, applying a broad-spectrum sunscreen of SPF 30 or higher throughout the day, with a formulation containing zinc oxide, titanium dioxide, or iron oxide, helps.
  4. Clinician gently holding a seated woman's chin and examining her face
    Checking progress: leave crusts until they fall off on their own, and if redness or stinging lasts more than 3 days or suddenly worsens, contact the clinic without waiting for the next session.

Common reactions are redness, swelling, crusts, and temporary darkening of the treated area. Rarely, hypopigmented spots where the skin colour lightens, blisters, or scars can occur, and pigment may rise again over time. Small crusts after a spot laser usually fall off in 7–10 days.

Frequently asked questions

How do pico toning and Genesis toning differ?

Their stated purpose in the treatment guide is different. Pico toning is a 1064nm picosecond laser that helps with pigment and brightening, while Genesis toning is a 1064nm laser that helps with anti-aging. Redness and vascular lesions are handled separately by the 532nm Vbeam. So rather than expecting Genesis to be the mainstay of pigment treatment, understanding it as addressing tone and texture and faint redness is closer to what happens in an actual consultation.

How do I know which toning suits my skin?

It is hard to judge by colour alone. Melasma has indistinct borders and spreads widely, while spots tend to be small with clear borders, but the two often overlap or take an intermediate form. The right order is to confirm the type and depth of the pigment by examination and then set the wavelength and intensity, and if redness is mixed in, the vascular target is looked at as well.

How many sessions, and at what interval?

Spots are commonly 1–3 sessions at 4–8 week intervals, and melasma or widespread pigment commonly involves 8–12 or more low-power toning sessions. Pores and skin texture are commonly given as 3–5 sessions at 4–6 weeks, and redness and vessels as 3–5 sessions at 4–6 weeks. These are examples, however, and because they vary with pigment depth, skin type, and sun exposure, they are set after seeing your skin at the first consultation. For a melasma treatment plan as a whole, results can take 3–12 months.

How much pain and downtime is there?

Low-power picosecond toning involves redness and stinging for a few hours to the same day, and treating spots at high power involves crusts for about 7–10 days. Fractional takes 3–5 days at low power and 7–14 days at high power including swelling and oozing. Vascular laser involves redness and swelling for a few days, and bruising takes 1–2 weeks to fade. Pain varies with energy intensity and the thickness of the skin at the treated area.

What should I look for when choosing a clinic?

The American Academy of Dermatology's consultation guidance states that results depend heavily on the practitioner's skill and experience, and advises asking how much they have performed the same procedure and how many patients of your skin tone and age group they have treated. In the consultation, check the realistically expected result, risks and alternatives, procedure time and number of sessions needed, recovery period, before and aftercare, and cost. Costs are often itemised and prices are frequently shown excluding VAT, so it is more accurate to ask together whether the consultation fee, anaesthesia fee, and aftercare costs are included.

At a glance

Table 2 At a glance
Item Key point
First step Separate brown and red, and confirm pigment type and depth and the cause of redness by examination
Pico family Targets melanin to fragment pigment particles finely; pigment and brightening purpose
Genesis family 1064nm laser for tone and texture with an anti-aging purpose; also introduced for redness management
What decides the result Pigment depth, skin reactivity, intensity and interval, sun exposure before and after
Sense of session counts Spots 1–3, melasma 8–12 or more, pores and redness 3–5 are common examples
Aftercare essentials Leave crusts alone, moisturise, SPF 30 or higher sunscreen and avoid heat stimulation