Picosure Melasma treatment; can anyone help on this issue?
Doctor Answers 2
Picosure and Melasma
First melasma is indeed very difficult to treat. Prior to doing Picosure, I tell patients that it is a good idea to prime the skin with tretinoin 0.05 to 0.1% along with Hydroquinone 4% in the evenings and Vitamin C serum in the am and pm (apply this first on clean skin). This allows the melanocyte to calm down on production of melanin and may lighten the pigmentation by 10-15%. (always take hydroquinone holidays where you use for 2 months and then 2 weeks off). Then after 4-6 weeks, you can begin Picosure treatments. I tell patients that 1/3 will improve, 1/3 will stay the same and 1/3 will get worse- this is my general consultation for any laser for melasma. With than being said (we have fractional nonablative, fractional ablative, QS and IPL), I do believe that the best laser to try is indeed Picosure Focus lens. When treating melasma, what we have found is that for about 5 days to 1 week, the pigment will get darker as it absorbs the wavelength and then will lighten up. I have found that treating every 6-8 weeks gives time for the skin to recover and then begin. Patients are still instructed to continue with their Vitamin C serum/sunscreen/and tretinoin and hydroquinone as these help augment the results.The biggest issue with melasma is having energy high enough to treat, while low enough to not induce PIH (post inflammatory hyperpigmentation). May also be a good idea to hold off on treatment during the summer and resume in October as it is hard to treat if tan and just the inherent nature of more sun exposure (even though you are most likely very diligent about sunscreen), in the summer.
Hope that helps.
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