Should I use tretinoin and hydroquinone?

Hello,
In our experience, topical products do not work well for sun spots and freckles. We rely on a laser that has the power and precision to target conditions with cells of dark color. Alternatively, we do not believe that lasers should be used to treat melasma due to the high failure rate, cost of treatments, and the likely possibility of the condition rebounding worse than baseline. For melasma - we rely on 8% hydroquinone as lower percentages do not work well in our practice for this stubborn and chronic condition.
Retinoids have been known to help with pore size through the exfoliation process, but it's usually an uphill battle. We prefer retinoids for anti-aging purposes such as prevention of lines, wrinkles etc.
Hydroquinone does not have any benefit for pore size or wrinkles - only brown discoloration.

You may want to schedule a consultation with a practice that specializes in "cosmetic dermatology" to have a treatment plan that offers the correct technology or product for the condition(s) you have.

In summary:

Melasma - 8% hydroquinone without retinoids
Sun spots, freckles - Q switched YAG lasers
Pore size - laser resurfacing or Quantel Aramis laser w/ or w/out retinoids

Thank you for your question, Melasma needs a combination approach to get the best improvement and will need a series of treatments. In our practice, we combine Clear + brilliant, peels, microneedling(/RF)/PRP, aerolase, and sometimes erbium laser (coollaser) to get the best results. See an expert for a formal evaluation. Best, Dr. Emer

Thanks for your question.  The first thing you need to do is see your board certified dermatologist for a skin check, to make sure all the brown spots are normal age spots and don't look suspicious.  You wouldn't want to ignore a pre-cancer or an actual melanoma.  If your dermatologist is satisfied that your skin is just sun damaged and you have melasma, they will help you find the right regimen, probably including both tretinion (retin-a) at night, and hydroquinone 4% either also at night, or in the morning under your good quality sunscreen. The most important part of your beauty routine, regardless of whatever else you do, is wearing sunscreen, since the brown spots will certainly get darker with time and sun exposure.  See a dermatologist in person, who is trained in the health and beauty of the skin, be aware of their credentials and shy away from anyone just trying to sell you products without knowing if you have any suspicious lesions on a very sun damaged face.  Best of luck!

Tretnoin is the gold standard for anti-aging. You should start using the product only at night time and increase your frequency when you feel more comfortable with the product. Hydroquinone will help with melasma but you should take a break after 3 months of using the product. 

Thank you for your message! Tretinoin and hydroquinone are great at home options for helping with skin pigmentation. You do not want to use HQ for long term however. Tretinoin is a great option however you must be cautious with sun exposure as it will make your skin more sensitive to sunlight. Other options would be laser resurfacing and/or microneedling however you will need to be out of the sun for both treatments.

Thank you for your question.  Melasma is very difficult to treat and heat often makes it worse.  We would not recommend fractional Co2 or IPL PhotoFacial.  Start by looking for prescription strength 4% Hydroquinone (HQ).  Do not buy it over the counter or off the internet.  Laws vary by state.  In Texas, physicians can prescribe and dispense in office.  We have been very successful using the PicoSure laser with the FOCUS and / or Flat Lenses eliminating hyperpigmentation with a series of treatments.  Our Melasma protocol is a series of very low pulse count combined with using our chiller unit blowing cold air.  FOCUS lens treatments have the extra benefit of reducing fine lines, wrinkles and scars.  This is one of our go to treatments for patients older than 40 and worried about the signs of aging.  The PicoSure laser is SAFE for ALL SKIN TYPES.  Start with sunscreen every day!  Once you have treated your hyperpigmentation to your satisfaction, you will probably need a follow treatment every 6 to 12 months depending your level of re-pigmentation.  Best of luck.

Thank you for your question, when using hydroquinone you must be careful as to avoid possible irritation. Hydroquinone is a great lightening agent, but should be used under direction of a physician. This can be used at times to treat Melasma and some brown spots if recommended by your specialist. Sunscreen use daily should be used to prevent further pigmentation changes and avoid premature sun-aging. Retin-A is a good product that helps with the cell turnover so, it can help with fine lines and to renew the skin. You could benefit from using growth factors with micro needling to help stimulate collagen production to help with fine lines and wrinkles. 
I hope this helps.
Regards,
Sheetal Sapra, MD, FRCPC