Gingival depigmentation impacts patient self-confidence and quality of life. This study compares the Er,Cr:YSGG laser to the traditional scalpel technique for reducing gingival hyperpigmentation, assessing their effectiveness and other relevant factors. For this double-blind randomized trial with a splitmouth design, 40 participants were selected from a university dental clinic and randomly assigned to receive treatment via an Er,Cr:YSGG laser (2,780 nm) or surgical scalpel. Treatment duration was evaluated, and pain intensity and smile satisfaction were assessed postsurgery. The Dummett Oral Pigmentation Index (DOPI) was used to determine the initial severity of pigmentation and track both reduction and potential repigmentation over time. The Gingival Melanosis Record (GMR) was used to evaluate the presence and extent of pigmentation and monitor recurrence after 1 and 12 months. Both the Er,Cr:YSGG laser and surgical scalpel similarly reduced GMR and DOPI scores over time, without significant differences at 12 months (P > .05). Significant examiner variability was noted in GMR scoring (β = –1.2 for Examiner 2; P < .001). Power analysis indicated a higher confidence for detecting treatment effects in DOPI (75%) compared to GMR (55%). The Er,Cr:YSGG laser required longer surgery times (P < .001), treatment type did not influence postoperative pain levels, and patient smile satisfaction significantly improved (P < .001). Under the present conditions, the Er,Cr:YSGG laser and surgical scalpel were equally effective in reducing gingival hyperpigmentation. Although lasers offer better bleeding control and require less anesthesia than the scalpel technique, clinicians should also consider surgery duration, cost, and expertise when selecting a treatment method. Future research should focus on long-term outcomes and economic evaluations, utilizing standardized clinical measures.