Post-fraxel melasma treatment results with hypopigmentation white spots. Any suggestions? (photos)

Question

7 weeks post Fraxel re:store treatment for trrating melasma. Now i have white spots hypopigmentation all over my face wich i can not cover because it stills appear under makeup. Im very depressed. I asked for a post fraxel rendezvous with dermatologist to see whats the matter he tells i may need another one. Her nurse passed by after he got out of the room and told me if she was me she would totally go for obagi treatment 550$ box cream package before going on fraxel #2. What should i do? :-(

Raffy Karamanoukian, MD, FACS · Answer

I would start with twice daily use of the Melarase creams in the Kareskin Brightening Kit followed by Clear and Brilliant laser. Best, Dr. KaramanoukianLos Angeles

Jason Emer, MD · Answer

DO NOT DO LASER TREATMENTS AT THIS TIME. Please see an laser dermatologist, get on lightening creams, avoid sun, and once calmed down you can start aerolase and clear + brilliant. This will be a long road to recovery.  Best, Dr. Emer.

Hratch Karamanoukian, MD, FACS · Answer

There are some special considerations for melasma that you follow:Melasma needs long term commitment with skin care and avoidance of skin factors such as sun exposure (Spectrase Sun Block) which has wide UV spectrum and SPF 30+ protection. 
Daily good habits with topicals may well help you chieve your goals with a good skin system like the Brightening Kit from KareSkin (see link). You may want to start with Melarase and Pigmentation Correction Complex. Scler-X from another vendor is for PIH relief (see link). 
Melarase AM is non hydroquinone based. 
Clear + Brilliant laser can be added once you start your pretreatment with topicals. 
Best
H Karamanoukian MD FACS

Alex Eshaghian, MD, PhD · Answer

Thank you for your question stephra7. Melasma is a condition characterized by the appearance of dark patches on the skin. It is caused by an imbalance of hormones in the body that makes the skin more susceptible to things like sunlight. Treatment on the skin will improve the skin, but it will not address the hormone imbalance. For this reason melasma is a challenging condition that we control, not sure. I always start my melasma patients on a good skin care regimen for one to two months prior to any treatment. Products containing retinoids and hydroquinone such as the Obagi system work well. They can also work well to control hyperpigmentation after a treatment. For my patients I prefer an ablative laser such as a fractional Erbium:YAG, on top of which I apply liquid hydroquinone immediately after the laser resurfacing. Please follow up with your doctor for specific recommendations. Good luck!

Davin Lim, MBBS, FACD - Account Suspended · Answer

Yes, there are studies showing Fraxel can help with melasma both in the 1927 and 1550 wavelengths, however , as with all treatments melasma will recur. Melasma can not be completely cured, however effective treatment are possible. This is because your skin is extremely sensitive to UV and even the smallest amount can stimulate your pigment cells to produce colour. The mainstay of treatment is strict UV protection- hats, sunglasses and SPF every 4 hours.

I prefer to use a combination of creams and laser for melasma. Hydroquinone can be used (5-8%), along with vitamin A creams. I usually start my patients on laser (low dose Q switch or Picosure) a few weeks after they commence on creams.

In some cases I combine glycolic AHA peels, and in other cases I use a tablet called Tranexamic acid to help. Each dermatologist will have their own method for treating melasma, I prefer a conservative approach with HQ creams and low dose laser. Having said that, there are dermatologists who use Fraxel, be guided by their opinions and reviews.

All the best,

Dr Davin Lim

Laser, surgical and aesthetic dermatologist

Brisbane, Australia

Post-fraxel melasma treatment results with hypopigmentation white spots. Any suggestions? (photos)

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