What are your opinion on fillers/Botox with melasma patients?

The appearance of your melasma should not be worsened with Botox or fillers, whether done in the glabella or your nasolabial folds.

Thank you for your question. Botox or dermal fillers should not worsen your melasma. Ensure you discuss your concerns during an in person consultation with a board certified plastic surgeon. Best, 

In general, injectables would not be expected to make melasma worse.  Melasma treatment typically involves medical therapy and, less commonly, laser.  In the event your skin is red or irritated from either of these treatments (or some other reason), I would wait until it returns to its baseline color before undergoing injections. 

Botox or filler injections should not impact or affect melasma, so you should have no problems if you'd like to have your frown lines treated. Melasma is typically influenced by a variety of other factors including sun exposure, hormonal changes (i.e. through pregnancy or oral contraceptive use), and genetics or family history.

Neither botox or fillers will have any effect on worsening melasma. Rarely , fillers could cause an inflammatory response called post inflammatory hyper pigmentation at the site of injection  .This is a reversible phenomenon that can be treated with bleaching agents such as hydroquinone  and does not cause the melasma to worsen.