Postinflammatory hyperpigmentation (PIH) is very likely the most common adverse effect of laser treatment in dark-skinned individuals. Treatment of PIH is difficult, thus emphasizing the need for prevention strategies. Acquired bilateral nevus of Ota–like macules (ABNOMs) are clinically characterized by blue-brown macules on periocular and nasal skin, and Q-switched lasers represent an excellent therapeutic modality. In this randomized, controlled, split-face study, Manuskiatti et al sought to evaluate the benefit of epidermal cooling on reducing the occurrence of PIH after Q-switched Nd:YAG laser treatment of ABNOMs. Unexpectedly, cold air cooling was associated with an increased risk of PIH after laser treatment, through an unknown mechanism.