Dr David Main

Michael, my experience with melasma is that Fraxel erbium does help - we reserve it for people not responding to bleaching formulae. Settings are typically lowish: energies 15 - 30 mJ, level 11 - 12. Improvement is unpredictable, but typically 30 - 75%. Q-switched YAG 1064 laser is also beneficial. Some Drs report good results with IPL, but this is not our experience. In respect of area treated, I recommend treating cosmetic units/areas, eg, cheek, chin, upper lip, etc, as rarely, a slight textural difference can be noted in treated versus untreated areas.

I certainly agree with Dr Molton's points. Our clinic has performed over 1200 Fraxel Restore treatments. We have had one small scar only in one patient, and none for the last 2 years. Results are really only begin to be seen after 3 treatments, and continue thereafter. We do see some temporary post-treatment hyperpigmentation in darker skin types, but no long-lasting PIH.