Under eye circles, melasma, postinflammatory hyperpigmentation from acne, mottled hypopigmentation from photodamage, and lentigines from sun exposure are all typical concerns from patients in dermatology offices. Patients want the magic of creams and lasers to erase any sign of dyspigmentation with no wait time. Dermatologists want to perfect effectiveness of prescriptions, find lasers that work for all forms of dyschromia, and insist on patient compliance with sunscreen. Cosmetic companies also have tuned into the war on dark spots that consumers are waging, with a plethora of lightening products that promise an even skin tone. By the time most patients reach the dermatology office, they have tried many of the available over-the-counter remedies and are looking for extreme treatment modalities.