Facelift and/or fillers with melasma. Will it cause the melasma to flare? (Photo)

Similar to the sun, medical procedures that result in heating, redness or inflammation of the skin can exacerbate or worsen melasma (e.g. certain lasers, BBL, etc). On the other hand, surgical procedures and injectables are quite unlikely to have a significant effect.  Occasionally, surgical bruising can result in a more transient type of pigmentation know as inflammatory pigment or PIH. Unlike melasma, inflammatory pigment is not a chronic condition and is relatively easy to treat.As an aside, we now treat melasma with the Q-switched Nd:YAG laser on low energy settings.  We have seen remarkable results across the board, including those patients that were previously hard to treat . Best wishes.

I think it is very unlikely fillers would aggravate melasma. If there was a significant inflammatory response to the filler which is extremely unlikely it might. In my practice that is not been a complaint.

Either procedure could be safely performed. While any inflammatory process could induce hyper pigmentation, I feel the risk is low. Both the advanced facelift and fillers can both be performed safely if desired.  Additionally, good medical skin care can help long term with your melasma. 

Significant bruising of the skin can stimulate the pigments cells and cause deterioration of melasma but it will not be likely. The reality is that your melasma can be treated with laser at the same time of facelift or another time. You should consult a surgeon who specializes in both of these areas. Your laser treatment, if you decide to proceed with it, is going to require adequate experience because of the type of skin that you have.Good Luck

In your photos, the melasma does not appear to be very severe at all.  Did it come with pregnancy as we usually see?  If it is hormonal melasma, there should be not connection between injections, surgery, and the pigmentation.  If it is post-inflammatory hyperpigmentation as opposed to melasma, your surgeon will need to be a bit more careful, but there are certainly very effective ways to control the pigment.  Best Wishes.