Have you had melasma laser treatment?

I am sorry to say that the Fraxel left me totally hyperpigmented and it has been a year now and it is still there. I don't think fraxel should be done on olive skin that suffers from Melasma. I don't think sufficient studies were done on melasma sufferers with type IV or V skin given all the horrible scenarios that I have heard of through other sites.

I also had post inflammatory hyperpigmentation after Fraxel. It has been almost 2 years and my skin is still dark brown (and white around the eyes, where fraxel was not applied). It looks terrible. I do not recommend Fraxel at all!!!!!

I wish I read this before my series of treatments. Fraxel Laser Dual has left me more hyper pigmented than before the treatments. I am very worried about the progression of pigmentation. I am olive skin as well. I agree with a prior post, stating that this is not for ethnic or olive skin.

I also had the fraxel treatment for my melasma. And I am not happy with the results at all. I now have a raccoon look going underneath my eyes. I have been using Retin-A Micro with little results. The next cream I am going to try is E-Lure.

Thanks for the info! I have had melasma for about two years and I feel that nothing is really working so far. Today I started to notice another spot cropping up on my upper lip! I hate it and feel that it is so obvious. I do not know of anyone else personally that has it. What is a meleanase inhibitor? After reading the reviews on the fraxel laser I am not that impressed! Thanks, jenilee

I have had melasma for years as well and like you, I feel frustrated and that it is very noticeable. I have been having IPL treatments which I suppose have made a very subtle change. It's hard to keep returning for treatments because they are $500, not covered by insurance and changes are so minimal. I was considering the fraxel as well but I don't know if it is worth it either because it seems that it can further aggrevate the melasma. Anyway, I am sorry you have the melasma, I completely understand how much you hate it and how frustrating it is trying to manage it. Good luck witn your treatments.

I am a skin care specialist P.A and would NEVER suggest a woman's melasma would "just disappear" after having Fraxel Laser treatments. I agree it is a difficult skin condition to treat (personally and professionally). However,the broad generalization of all P.A.'s skills is akin to saying "all pediatricians are just not smart enough to do any other type of medicine". I'm sorry you may have had the misfortune of one "bad apple", but we (Physician Assistants) have more stringent CME guidelines and board recertification guidelines than that of Physicians. Furthermore, a P.A. is still liable for their actions and so is their supervising Physician (who should be reviewing the charts!).

Just because a PA goes through more stringent processes does not mean that they are more qualified or better at their job than a physician. What a ridiculous concept. Perhaps the reason PAs have to go through more stringent Continuing medical education and board recertification guidelines is because they don't have the rigorous testing and examinations and years of training that a physician has to go through?? Physicians are still required to complete CMEs- perhaps less sessions in a year, than a PA but at a SIGNIFICANTLY higher educational level than a PA.

If a PA still needs the physician to look through the chart and review their work ( and also bear some if the responsibility for their work ) then they most certainly need more stringent CME and Recertification guidelines.

As someone who hyperpigments easily I wouldn't trust anyone but a physician with a good understanding of lasers and experience with such a skin type. It's just to risky. You definitely get what you pay for.

is jamie a nurse or pa

My specialist told me that IPL actually aggravates melasma so she won't do it on my face but has done it on my arms for sun spots and that works.

Dear Dr. Epstein, I had a series of fraxel treatments done 10/06, 11/06, 12/06 and 1/07. I had the fraxel done because I wanted to smooth out my acne scars and I had a tiny patch of pregnancy mask above by left eyebrow that I wanted to eliminate. Well, on March 17, 2007 (about 13 months ago and 5 months after the treatment), I developed post hyperpigmentation. I went back into the skin care center and inquired about my patches. They didn't understand why I developed this. They said that they had never seen that before. They were no help at all. As the summer months came and went, my hyperpigmentation didn't get any better. Finally, I saw my doctor in January 2008 for an unrelated issue and she recommended Triluma. I began using the Triluma at the end of February 2008(I was very hesitant b/c of the side effects). After about three weeks of using this cream, my hyperpigmentation faded about 70%. It was amazing. However, I developed tiny littly blood vessels (aka telangiectasia). I was told to stop using the Triluma cream. My skin also became very dark in the last two weeks (when I stopped using it). Now, I'm so confused and don't know what to do. My skin looked so much better before I had the fraxel done. Now, I'm stuck with these red lines on my face and brown patches everywhere. I'm worse now than prior to having the fraxel done. So, Dr. Epstein, can you please answer the following questions?: 1. Will the post hyperpigmentation from the laser go away completely (per your e-mail--'it will fade eventually')? Not related to the cream. 2. Will the adverse side effect of dark skin patches from using the Triluma fade too or is that permanent damage from using the cream? 3. I'm pretty sure that the exposed blood vessels at the surface of my skin will not go away unless I have them removed via laser, which will never happen. I won't do that again. Any suggestions on those? Thank you for your time Dr. Epstein!!!

Heather, The tiny blood vessels were probably caused by the steroid in the Triluma. Don’t use any more steroids on your face and see if the blood vessels resolve (hopefully they will – no guarantees). If they don’t go away, you may need laser treatments to resolve this issue. Make sure you see someone who is very experienced in cosmetic skin care and laser vein treatments. Triluma contains Hydroquinone and RetinA (in addition to the steroid). Both can irritate the skin and cause more postinflammatory hyperpigmentation. A more gentle remedy for the hyperpigmentation is Vit C derivatives (5-10%). You may want to try something like this. Use the most gentle strength and don’t use it often or leave it on very long. Work you way up very slowly. Other possible remedies would be tranexamic acid and chemical peels. These are well known treatments for hyperpigmentation and melasma in Japan. The postinflammatory hyerpigmentation usually fades. It usually fades sooner than 13 months. Maybe you have something other than postinflammatory hyperpigmention (ie. worsening of your melasma or something else???). . If you tell me what city you live near, I might be able to recommend a doctor near you who is an expert in cosmetic skin care. It is best to see someone, get a firm diagnosis of your problem and then get possible remedies. You would want to see a dermatologist who uses lasers and does cosmetic procedures. This type of dermatologist would know the most about hyperpigmentation problems following the Fraxel. I hope this helps. Good luck.

Hi Doctor Epstein, I had my first Fraxel treatment 6 days ago. I found the pain level to be pretty mild - only red for a day - no peeling at all. It seems as though my skin texture has slightly improved and the melasma has lightened just a tiny bit. I was wondering if it is bad that I never experienced any peeling? Could it be that the first treatment was not strong enough? I was told the melasma should be completely gone after 3 treatments - is that possible when i only see slight results at this point? I'm scheduled to have the second treatment in 3 weeks (spaced 4 weeks apart). Will my skin continue to improve between now and then? Is it possible that the melasma will fade even more before the next treatment? Your advice would be appreciated. Al

Hi Dr. Epstein, Thank you so much for your comments about the hyperpigmentation. I too have had 5 treatments of fraxel (about 5 weeks apart) at a level of, I think 17. I had the fraxel done on my face for acne scars and sunspots or hormonal spots. It helped the acne spots somewhat, but not really helped the little brown dots on my face (that I think is from sun or hormonal). I also had the fraxel done on spots on my back that were originally burned from Fotofacial that was done too close together when I was alittle tan. I also had a curling iron burn on my leg that I had treated with Fraxel. The fraxel has helped lighten the burns alot overall, but with this last treatment (about 3 weeks ago), I feel that I have more hyperpigmentation covering the whole burn and the surrounding area treated, so it looks bigger now! I have been using hydroquinone/kojic acid cream (10%/5%) and have worked up to this amount starting at 4%, then 6%, then 8% and now 10%. It helps alittle, but I am worried about it staying hyperpigmented like this, esp. the areas that were treated with Fraxel that weren't hyperpigmented before. Any suggestions? Also, if the Fraxel did not really help these little brown spots/dots on my face (mainly on my cheeks), is it sunspots or hormonal? Finally, I live in West Los Angeles, CA and would love to know of a very experienced dermatologist in my area to help me repair. My email is: {edited contact information} Thank you. Banafshe Editor note: You must be contacted privately to receive the information you requested. Other registered users may privately contact you by clicking on your username, provided that you have opted to receive private messages (Select “My settings” to update your preference).

Cari, in response to your IPL I would strongly advise you, based on my own experience, to not have any further IPL treatments. I went through 5 IPL treatments myself, all the while believing I just had sun spots. By the 5th treatment my face was far worse than when I started out. I went to a new dermatologist for second opinion and she said I had melasma and IPL was NOT for melasma; it only aggravates it. I've been investigating herbal remedies lately. I figure instead of treating the symptoms at the enormous expense they are, I should be focusing on the causes instead. I've gone off the birth control pill and just started a regimen of MSM, Vitamin C, Zinc & Vitamin B. ...we'll see how it goes.