Rosalind Hudson, MD

An option you may not have tried, is taking an antioxidant supplement that is derived from a South American Fern, Polypodium Leucotomas.This Fern is a source of extracts and antioxidants that help skin cellular function: chlorogenic acid, coumaric acid, vanillic acid, caffeic acid and ferulic acid. 


Since melasma is very susceptible to oxidative stress from UV light, taking this antioxidant has been shown in clinical studies to help pigmentary disorders, including melasma and even vitiligo (to a small extent). Some studies have used the oral supplement "Heliocare" (available on Amazon), some have used an extract form.  (Google Polypodium Leucotomas and Melasma for scientific studies).

Another antioxidant, phloretin, actually inhibited the first stage of redness from UV light (in Skinceuticals original Phloretin CF studies). Thus, phloretin prevents the first stage of oxidation. Phloretin CF would be a good Vitamin C for you to use. (notice the "F" in Phloretin CF is Ferulic Acid, which is also one of the antioxidants in Polypodium Leucotomas).

Lastly, you need to repair the DNA of your skin with a Retinoid (if you are pregnant or nursing, retinoids are contraindicated). Retinoids are the class of absorbable (into skin) Vitamin A compounds, and include RetinA, Retinol and Retinaldehyde. But these can cause photosensitivity and make you get red easier, which could actually offset the benefit of DNA repair. Differin is a retinoid that is not photosensitizing, and also repairs skin's DNA.... AND it is over the counter. Do not use it with other retinoids or hydroxyacids (does your Zo Obagi product contain these?).

Please let me know if these 3 additions significantly help your melasma. It will take many months.

  

In the clinical trials of SculpSure, the successful patients did 2-3 treatments in the same area.

This is not a single treatment approach when one's diet and exercise level are kept the same (as they were in the clinical trial). So my recommendations would be to complete the treatment regime of 2-3 treatments. Of the patients who did 2-3 treatments in the trials, 90% were satisfied with the level of improvement.

We have had patients a few patients who had results from a single treatment, but all of them made the decision at the time of the treatment to go on an anti-inflammatory diet while they were healing, and lose 2+ lbs during the 6 week healing period. It appeared that the SculpSure targeted the weight loss to the abdomen.

However, many patients who do SculpSure are already their target weight, and they have a diet resistant (frequently hormonal) fat pad. For them, the recommendation is 2-3 treatments to achieve a result. (Make sure you are not inadvertently gaining a few lbs. This can hide any result.)

When one is hyperthyroid, the bodies metabolic rate is really high, and patients can eat "whatever they want".  Treatment of Graves involves slowing down the over-active thyroid to normal. 

This is very difficult for a person used to eating whatever they wanted before. Many of my patients developed "hyper-insulinism" from eating too many refined carbs and desserts while untreated. They were not able to control their weight after beginning treatment for Graves without stopping sugar and white carb products completely, in order to get down their insulin level. Hyper-insulin MAKES YOU EAT, it has nothing to do with will power or SculpSure. 

If you make this dietary change, then your SculpSure benefit should last. The trick will be not to go back to high white carb and sugar intake, only eat 100% whole grain bread, pasta, etc with a balance of protein and vegetables and fruits (fresh only).

Remember, SculpSure results in the clinical trials were achieved with 2-3 treatments. Don't give up after one, especially if you have changed your diet. We have patients who use SculpSure with dieting to encourage themselves, and they tend to get targeted weight loss.  

Facial redness is caused by dilatation of capillaries. This can occur in fair individuals as a reaction to cumulative sun exposure, or as a reaction to foods or beverages (especially alcohol or caffeine), medications, or inflammation of the skin from oil gland dermatitis (seborrheic inflammation), and rosacea. I doubt rosacea since it is usually more prominent in the central face, , and your skin is redder in situations that dilate the capillaries (warm weather, exercise and sun).

That being said, the most obvious way to begin, is to eliminate alcohol and caffeine and any foods or beverages that you have noted to worsen your redness. Be very suspicious. You may need to do an elimination diet.

Medically, two treatments that are successful in constricting capillary beds are IPL (Intense Pulse Light) if it has a wavelength for treating redness, and Cutera's Lasergenesis treatment (a "laser facial" with a YAG laser, that is attracted to capillary beds). It will take multiple treatments, and may require maintenance treatments. However, if there is a systemic reaction to alcohol, caffeine, or hypersensitivities other compounds (e.g, taurine (in energy drinks) or acesulfame potassium (the sweetener), etc, then the condition will not go away until the offending food or beverage is stopped.

SculpSure is not a weight loss procedure. 

It sounds like you have a good habit going with regular exercise, but probably have developed some "insulin resistance" that this level of weight gain creates, and getting this under control before you develop diabetes will be essential.

I have been an Internist (board certified internal medicine physician) for 30 years. I have noted that the best results for the least amount of money (free !) is with Food Addicts Anonymous (FAA). 

We live in a society with unbelievably addicting processed foods. The food industry has focus groups to determine what product hits our "bliss point", so that can't stop and eat the entire package. The surgeon general under President Clinton described these two bliss trios: Refined carb, fat + sugar (cookies, ice cream, granola, etc) and refined carb, fat + salt (chips, crackers, pizza). The addiction comes when the bliss point in our brain demands the trios. Food Addicts Anonymous creates a support group to accomplish the dietary changes needed get out of this cycle and lose this weight in a healthful way.

You can do it. Good luck.