Roberta Del Campo, MD

Melasma is a lifelong condition however many women notice improvement with age (as female hormone levels decline).  There are many options for treatment including topical creams, chemical peels, fractional lasers and broad band light.  Commonly a combination therapy is used.  It is not uncommon for topical medications to only make subtle improvement, meaning other treatment modalities may need to be considered.  I recommend consulting a dermatologist in the area who can discuss other options with you.  Further, most importantly, good sun protection is a must, as even with treatment the pigment will recur and darken with sun exposure.

Exilis and Thermage are both monopolar radiofrequency devices which use heat to tighten the second layer of skin giving the treated areas a more smooth and lifted appearance.  Common treatment areas include the lower face (lower cheeks and jawline) as well as the neck and periocular area.  Further, this is completely noninvasive and requires no downtime after the procedure.  

My practice currently uses Excilis (previously we treated with Thermage) as it is more effective and also much more comfortable during the procedure.  I generally recommend two to three treatments spaced a month apart.

Broad Band Light/Intense Pulsed Light is a highly effective treatment for sun spots.  Effectiveness may be increased when used in combination with either hydroquinone or hydroquinone free topical treatments.  Most importantly a daily broad spectrum sunblock should be used to maximize the treatment and to prevent new lesions in the future.  

Botox, as well as, other neurotoxins such as Dysport or Xeomin can be used to not only treat but prevent wrinkles caused by dynamic muscle movement.  In fact, once dynamic wrinkles become static in nature (wrinkles are noticed not only with movement but also at rest) they are more difficult to treat and may require other treatment modalities such as fillers to completely resolve or soften the lines.  Further, neurotoxins can be used to give a slight "eyebrow lift" if placed in the proper location.