Would you recommend chemical peels or Halo laser for age spots, freckles, melasma?

Question

I am 30 years old and my dark spots got significantly worse after pregnancy. And now I am noticing a large brown patch on my forehead. I'm afraid its going to become worse. which treatment would work best? Thank you.

Jason Emer, MD · Answer

Thank you for your question, Melasma needs a combination approach to get the best improvement and will need a series of treatments. In our practice, we combine Clear + Brilliant, peels, microneedling/PRP, Aerolase, and sometimes Erbium (Cool Laser) to get the best results. See an expert for a formal evaluation. Best, Dr. Emer

Raffy Karamanoukian, MD, FACS · Answer

Melasma is associated with hyperpigmentation caused by a combination of hormones, sun exposure, inflammation, and deposition of melanin pigment. In our office, we specialize in melasma treatments and start with Melapads, Melarase AM, Melarase PM, and Replenish; followed by pulsed dye laser to eliminate inflammatory erythema and light fractional laser. 
  
Best, 
  
Dr. Karamanoukian
  
Realself100 Surgeon

Paul M. Friedman, MD · Answer

Melasma is a chronic skin condition that requires a multifaceted approach to treatment. The mainstay of treatment is sun avoidance and sun protection. A cautious approach to treatment is necessary as some treatments may exacerbate the condition. Prepping the skin with a skin brightener and/or retinoid for 4-weeks prior to treatment is beneficial. I have had success with a series of low-fluence laser treatments such as the Clear & Brilliant Permea, PicoWay, or Spectra devices.  In some patients, we have identified a vascular component to their melasma that can be targeted with the Vbeam laser.   More recently, we have also been prescribing a 4-6 month course of Tranexamic acid in appropriate candidates.  There is a risk of recurrence and maintenance treatments are typically required.

David E. Berman, MD (retired) · Answer

the picosure laser fires 1000 faster than any other laser so that there is no downtime and little to no redness that resolves in a few minutes. you should plan 3 treatments, done one month apart. this laser is expensive to buy so you may have to search to find one. however it is worth searching for.david berman md

Davin Lim, MBBS, FACD - Account Suspended · Answer

HALO is definitely out. Can temporarily improve melasma for a week to three then rebound will occur. Melasma can not be completely cured, however effective treatment are possible. This is because your skin is extremely sensitive to UV and even the smallest amount can stimulate your pigment cells to produce colour. The mainstay of treatment is strict UV protection- hats, sunglasses and SPF every 4 hours.
I prefer to use a combination of creams and laser for melasma. Hydroquinone can be used (5-8%), along with vitamin A creams. I usually start my patients on laser (low dose Q switch or Picosure) a few weeks after they commence on creams. Another laser I use is the Clear and Brilliant in the Permea setting combined with creams. 
  
In some cases I combine glycolic AHA peels, and in other cases I use a tablet called Tranexamic acid to help. Melasma treatments should be tailored to each patient. 
  
All the best, Dr Davin Lim. Laser, surgical and aesthetic dermatologist. Brisbane, Australia

Would you recommend chemical peels or Halo laser for age spots, freckles, melasma?

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