How to get rid of untreatable PIH/melasma (eyes, forehead, jawline)? (Photos)

Question

I had the Erbium Yag Laser two years (2/2020) ago and PIH developed under / around my eyes, on my forehead and on my jawline one week after I was lasered. Exactly where it is today. I have used Triluma, hydroquinone, steroids and retionds. I have had two Halos, two micropeel lasers, four PicoSure treatments and two Perfect Peels. Nothing fully gets rid of it or it comes back. I most recently tried two Enlighten peels starting in December 2021 with strict 4% hydroquinone, steroid and retinol use for three months. The pictures are from today while I'm still following this regimen. I still have pigment. I finally saw my dermatologist after the plastic surgeon couldn't fix it and he thinks it's melasma that just happened to start at the exact same time as when I had the Erbium Yag two years ago and started me on oral Tranexamic Acid six weeks ago. I just want it to go away. What will make this fully go away? Is this permanent? What else can I do?

Raffy Karamanoukian, MD, FACS · Answer

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser.  Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.  
Best,
Dr. Karamanoukian 
Realself100 Surgeon

Ramandeep Sidhu, MD · Answer

Melasma can never be permanently removed, with treatments and the correct skincare though you can suppress the melasma. The most important factor to keep melasma at bay is to avoid direct sun exposure, so make sure to wear SPF 40+ everyday and reapply every 2 hours. Others factors such as variations in hormone levels and stress can also worsen melasma. Avoid treatment such as IPL because the heat from this treatment can also worsen melasma. A good skincare regimen using the PicoSure, PCA skincare (HQ free pigment gel), and PCA chemical peels will help suppress the melasma.

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How to get rid of untreatable PIH/melasma (eyes, forehead, jawline)? (Photos)

Answers (2)

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