I'm 49 and have severe melasma. I have tried three halo lasers that made it so much worse. What to try now? (photo)

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

Thank you for your question.  I would suggest doing a fractional treatment for melasma.  Apply hydroquinone morning and evening two weeks prior to your treatment.  The fractional treatment would help to suppress the discoloration and improve texture of your skin along with shrinking your pores.  

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

Thank you for your pictures. Unfortunately Melasma is a lifelong chronic inflammatory skin condition and needs constant upkeep and maintenance. Lasers treatments + good skincare are essential for good results.Please read about PicoSure Focus for Melasma, which is FDA cleared and will not make your melasma worse at all. It is a breakthrough in laser resurfacing and needs an expert to be performed safely.  I have been using it for 2 years and have helped many many patients to get their melasma under control.  Hope this helps. Best, Dr. Avaliani

Sorry to hear of your predicament. Unfortunately Melasma is a difficult condition to treat and its incurable although its effects can be minimized with combination treatments that include HQ 6-8% , Vitamin A preparations, chemical peels, sunscreens etc... You can  also try Cosmelan, it is a very good facial mask treatment especially for resistant Melasma. 

Hi JOC.  We are sorry to learn of your situation.  No lasers should ever be used for Melasma as it is an incurable condition, and as you have experienced, it often gets worse with laser treatments.We use and have always used hydroquinone.  We use an 8% hydroquinone solution without Retin A.  It works better than most options because it is high strength HQ and penetrates the skin easily because of the gel form.  If you review the photos at the link below, you will see others that have been in your same situation and achieved results with our product.  Good luck.

since you have had problems with lasers in the past, you can always do a test patch with the picosure laser. however this laser fires 1,000 faster than other lasers and there is no downtime. you should plan to do 3 treatments, each a month apart.david berman md

See my other post, HALO is NOT FOR MELASMA. Your Specialist should know the cause of this condition and not place you on dermal remodelling treatments and erbium fractional laser. HALO is great for pigmentation but will rebound melasma in 90% of cases. 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