Hori’s Naevus Treatment Singapore, Why Cheek Pigmentation Can Be Stubborn
Edited by Dr Bernard Ong. Clinically reviewed by Dr Gerard Ee, Medical Director, The Clifford Clinic.
Hori’s naevus is a dermal pigmentation that produces grey-brown or grey-blue speckles on both cheekbones, and it is common in Asian women in Singapore. Because the pigment sits deep in the dermis, creams cannot reach it and it is often mistaken for melasma. It responds to pigment lasers that penetrate deeply, such as 1064 nm Pico laser or Q-switched laser, over a course of sessions. Accurate diagnosis is essential, because Hori’s naevus and melasma require different treatment.
What is Hori’s naevus?
Hori’s naevus, also called acquired bilateral naevus of Ota-like macules, is a condition in which melanocytes sit within the dermis, the deeper layer of skin. It appears as speckled or blended grey-brown, slate-grey or brown-grey macules, most often across both cheekbones, and sometimes on the temples, forehead, nose and eyelids. It usually develops in adulthood and is far more common in women of East and Southeast Asian descent.
How it appears on Asian skin
On Fitzpatrick III to V skin, Hori’s naevus often looks like a dull, ashy or muddy discolouration over the cheeks that deepens slowly over several years. Many patients first assume it is melasma or merely tired-looking skin and attempt whitening products without effect, because topical agents cannot reach dermal pigment.
Hori’s naevus vs melasma
Hori’s Naevus and Melasma Compared
| Feature | Hori’s Naevus | Melasma |
|---|---|---|
| Pigment Depth | Dermal | Epidermal, dermal or mixed |
| Colour | Grey-blue or grey-brown, speckled | Tan to brown, patchy |
| Border | Speckled clusters | Soft, blended patches |
| Response to Creams | None | Partial |
| Response to Laser | Good, clears over a course, low recurrence once cleared | Cautious, relapse-prone |
| Onset | Adulthood | Adulthood, hormone linked |
The two can also coexist, layered over one another, which is a common reason treatment stalls when only one is addressed. Our guide to pigmentation types explains how doctors separate them.
Why cheek pigmentation can be stubborn
Topical treatments and superficial laser settings cannot reach pigment that sits deep in the dermis. Progress also stalls when Hori’s naevus and melasma are present together and treated as a single problem. An accurate, layered diagnosis is therefore decisive.
Why pigment depth matters
The depth of the pigment determines the treatment. Superficial epidermal pigment can be reached by gentle treatments, whereas dermal pigment requires a wavelength that penetrates deeper, typically 1064 nm, delivered over several sessions. Matching the wavelength to the depth matters more than the choice of laser brand.
Laser treatment options
- Pico Laser at 1064 nm.Picosecond pulses fragment dermal pigment by a photomechanical effect with less heat, which lowers the risk of post-inflammatory hyperpigmentation in Asian skin.
- Q-switched neodymium YAG laser at 1064 nm.A long-established option for dermal pigmentation with a strong track record, usually over a longer course.
Why multiple sessions may be needed
Dermal pigment is cleared gradually as the body removes fragmented particles between sessions. Treatment is usually staged several weeks apart to allow this clearance and to keep settings conservative. Rushing sessions raises the risk of pigment reactions without accelerating the result.
Side effects and PIH risk
The main temporary side effect is post-inflammatory hyperpigmentation, more likely in deeper skin tones. Conservative energies, adequate spacing between sessions and strict sun protection reduce this risk. Some transient darkening between sessions is expected as pigment clears.
Maintenance and expectations
Unlike melasma, Hori’s naevus that has been fully cleared usually does not return, because the abnormal dermal melanocytes have been removed rather than suppressed. Where melasma coexists, that component still needs ongoing sun protection and topical maintenance.
Suitable and not suitable
- Suitable:diagnosed Hori’s naevus, realistic expectations of a staged course, willingness to protect skin from the sun.
- Not suitable:untreated active melasma overlying the naevus without a plan for both, recently tanned skin, or an undiagnosed changing lesion needing review.
Doctor’s perspective. Many patients arrive after months of whitening creams for what they were told was melasma, when the real problem is dermal Hori’s naevus that no cream can reach. A correct diagnosis is a genuine relief, because Hori’s naevus, once properly treated, tends not to recur. Treatment is a matter of choosing the right depth and maintaining patience across the course.
The biology of Hori’s naevus
Hori’s naevus is a form of dermal melanocytosis, meaning the pigment-producing cells sit within the dermis rather than in the epidermis. This is fundamentally different from a freckle or a sun spot, where the pigment lies near the surface. Because the melanocytes and their pigment are held deep in the skin, no topical agent can reach them, and superficial treatments pass over the pigment without effect. The grey-brown or slate colour comes from the way light interacts with pigment held at this depth.
What determines the response to treatment
Dermal pigment is cleared gradually rather than in one step. A pigment laser fragments the deep pigment, and the body then removes the fragments through its immune and lymphatic systems over the weeks between sessions, a staged course is required rather than a single aggressive treatment. Picosecond lasers, with their photomechanical effect and reduced heat, clear dermal pigment with a lower risk of post-inflammatory pigmentation than older lasers, an important consideration in the skin tones most affected. A picosecond ruby wavelength is a further option for resistant dermal pigment. Temporary darkening between sessions is expected as the pigment rises and clears, and the main risk to manage is transient post-inflammatory hyperpigmentation, which conservative energies, adequate spacing and sun protection keep to a minimum. Once the abnormal dermal cells are cleared, the pigment generally does not return.
Why dermal pigment needs a deeper wavelength
Hori’s naevus is dermal, so it cannot be reached by the superficial wavelengths that clear a freckle. It requires the deeper 1064 nm wavelength, and a 785 nm near-infrared beam is useful for stubborn dermal pigment, delivered over a staged course. A 694 nm picosecond ruby wavelength is another option for resistant dermal pigment. Because the pigment is deep, patience across several sessions matters more than intensity in any one.
Frequently asked questions
What does Hori’s naevus look like?
It appears as speckled grey-brown or grey-blue pigmentation over both cheekbones, sometimes extending to the temples, forehead or nose, developing in adulthood.
Is Hori’s naevus the same as melasma?
No. Hori’s naevus is dermal and speckled, melasma is often more superficial and patchy. They can occur together, which is why diagnosis matters.
Can Pico laser treat Hori’s naevus?
Yes. A 1064 nm picosecond laser reaches dermal pigment and clears it over a course of sessions, with less heat than older lasers.
How many sessions are needed for Hori’s naevus?
It varies with pigment density and depth, and usually requires several sessions spaced weeks apart. The number is estimated after clinical examination.
Can Hori’s naevus come back?
Once fully cleared it usually does not recur, because the abnormal dermal cells are removed. Any coexisting melasma still needs maintenance.
Why is cheek pigmentation hard to treat?
Because it is often dermal, or a mix of dermal Hori’s naevus and melasma. Creams and superficial settings cannot reach dermal pigment, so the right depth and an accurate diagnosis are essential.
Get a clear diagnosis for stubborn cheek pigmentation
Where whitening creams have not helped, the diagnosis may be the missing piece. Learn about pigmentation treatment in Singapore, or book at The Clifford Clinic, 50 Raffles Place, #01-01 Singapore Land Tower. Call (65) 6532 2400 or WhatsApp (65) 8318 6332.
Selected References
- A systematic review of picosecond laser in dermatology: evidence and recommendations. Lasers in Surgery and Medicine, 2021. https://onlinelibrary.wiley.com/doi/10.1002/lsm.23244.
- Wavelength-dependent threshold fluences for melanosome disruption with picosecond lasers. Lasers in Surgery and Medicine, 2024. https://pubmed.ncbi.nlm.nih.gov/38436524.
- Lasers and energy-based devices for treatment of pigmented lesions with histologic and ultrastructural correlation: a systematic review. Dermatologic Surgery, 2026. https://pubmed.ncbi.nlm.nih.gov/40767860.
- Disorders of hyperpigmentation, part I: pathogenesis and clinical features of common pigmentary disorders. Journal of the American Academy of Dermatology, 2023. https://pubmed.ncbi.nlm.nih.gov/35151757.
- Comparing the efficacy and safety of a 730 nm picosecond laser with a 532 nm Q-switched Nd:YAG laser for facial pigmented disorders. European Journal of Medical Research, 2026. https://pubmed.ncbi.nlm.nih.gov/41782066.
- DermNet: lasers in dermatology. https://dermnetnz.org/topics/lasers-in-dermatology.