What treatment would you suggest for my melasma (self diagnosis) on my cheeks, upper lip and nose? Laser? Peel? (Photos)

there are many options for improvement but very little for a cure. I suggest you see an expert for treatment options including lasers, skin care and microneedling.  Sunscreen is essential. Best, Dr. Emer.

Hello, melasma unfortunately can only be treated. Please see below. Melasma is a condition which requires multiple steps and treatments to effectively improve the condition consistently over time.  In our office, here are steps which are effective:
-Pico lasers- The best type of laser for improving the condition.  Please note it takes multiple steps to improve melasma safely
-Nd:YAG Nano lasers with toning- Here a laser is used for deeply resistant melasma to break up particles without generating excessive heat
-Melanage peels- A variety of peels can work and melanage is one of the best for melasma
-Skin topicals- A variety of products including use of lighteners (we prefer natural lighteners such as arubtase found in our product Luminoso) as well as sunscreens can help improve the condition
-Lifestyle choices-Avoiding the sun, hormonal changes (we have a hormone expert in Dr. Chughtai in our office) can all impact melasma.
While melasma is common, patients must understand a multi pronged approach is often the best strategy and controlling this condition.
Best, 
Anil Shah MD 

Thank you for your question.  Skin discoloration is a very prevalent problem in women over the age of twenty.  It is also increasingly common in men with increased sun exposure.  
Risk factors include thyroid disease, sun exposure, hormones, pregnancy, family history, PIH, and birth control. Melarase AM and Melarase PM have been extremely effective in reducing pigmentation associated with skin discoloration and hyperstimulation of melanocytes. 
In my practice, patients with hyperpigmentation benefit from twice daily application of the creams. Melarase AM in the morning, followed by Melarase PM in the evening. Melarase AM contains four active sunblocks, so sunscreen is not needed unless your sun exposure is very high or you had a recent procedure/laser. SPF of 30. Melarase PM contains active skin lighteners to even out skin pigmentation. If you are concerned about the development of pigmentation, contact our office to discuss details and to obtain a regimen for Melarase. 
Recommendations:  5-step Daily Brightening Kit has everything you need to improve dark spots, skin discoloration, melasma, and hyperpigmentation caused by sun exposure, hormones, scarring, and the environment. It’s a powerful daily brightening kit that can help bring out your skin’s natural, healthy glow. Ideal for use on the face, neck, and hands. 
Includes: Melaclenz, Melapads, Melarase AM, Melarase PM, Elevase, and Spectrase
Best, 
Dr. Karamanoukian
Los Angeles

IPL can exacerbate melasma.Melasma needs long term commitment with skin care and avoidance of skin factors such as sun exposure (Spectrase Sun Block) which has wide UV spectrum and SPF 30+ protection. 
Daily good habits with topicals may well help you chieve your goals with a good skin system like the Brightening Kit from KareSkin (see link). You may want to start with Melarase and Pigmentation Correction Complex. Scler-X from another vendor is for PIH relief (see link). 
Melarase AM is non hydroquinone based. 
Clear + Brilliant laser can be added once you start your pretreatment with topicals. 
Best
H Karamanoukian MD FACS

 Melasma is an inflammatory process that is chronic. It is caused by too much sun exposure, family history, and hormonal fluctuations including possibly being on birth control pills. I recommend that you limit your soy and your dairy. You must use sun block everyday rain or shine January through December regardless of your ethnicity. I use chemical peels, Fraxel laser and Cosmeceutical to treat-- It really depends on my evaluation. I wish you the best luck. Dr. Downie.

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. What ever you do, DO NOT try IPL for this condition, especially in your skin type. There is a very high chance of melasma worsening after IPL. Gentle lasers at low power are the best treatments. 

In some cases I combine glycolic
AHA peels, or lately low strength TCA Peels, and in other cases I use a tablet called Tranexamic acid to help.I suggest you consult an expert in melasma management in Atlanta, 

All the best,

Dr Davin Lim

Laser, surgical and aesthetic
dermatologist

Brisbane, Australia