Melasma after Fraxel, made worse by IPL. Besides sun protection & tazorac, what should I do? Is IPL a bad idea?

Question

43yo, male with bl eyes, light br hair, dark complexion. Sought Fraxel re:pair for mild ice pick scars on cheeks. After 5 Fraxel sessions in 07, developed mild bronzing on the cheek and temple sides of eyes that faded over 3 years. 2nd round of Fraxel in 13. After IPL a few months later for roseacea, noticed bronzing above eyebrows. Patches worsen with sun. Been on tazorac since 07, which greatly improved acne & scarring. Besides sun protection & tazorac, what should I do? Is IPL a bad idea?

Raffy Karamanoukian, MD, FACS · Answer

Photoaging and melasma are intricately related. Biologic processes of aging contribute to dyschromia and the development of pigmentation. Melasma is further influenced by hormones and endocrine problems. In my clinic, I begin with a carefully curated protocol of Melarase products followed by laser therapy, fractional ablation, and Limelight IPL with LED and chemical peels to brighten the skin and reduce pigmentation.
Melaclenz twice daily
  Melapads twice daily
  Melarase AM
  Melarase PM
  Replenish Retinoid Cream
  Best, 
  
Dr. Karamanoukian
  
Realself100 Surgeon

Joshua L. Fox, MD · Answer

IPL is not a bad idea. Though, I would suggest alternatively to consider a series of chemical peels with continuation of tazorac at bedtime as well. Additionally I would include a topical regimen of hydroquinone to hasten the process.

Melasma after Fraxel, made worse by IPL. Besides sun protection & tazorac, what should I do? Is IPL a bad idea?

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