Facial pigment issue worsening. Dark and white spots. Never pregnant, on birth control or spent much time in sun. Fraxel?(Photo)

Melasma, or facial hyperpigmentation, comes in different forms and some patients do have white discoloration as well (idiopathic guttate hypomelanosis). It is not reasonable to expect a 100% correction and NO doctor can guarantee success in reducing melasma.  There may be considerable improvement, but it's very important to realize that once someone has melasma, the treatment is not considered a cure, but maintenance. If you do obtain a good result, you'll probably have to go back to the doctor for further treatment in the future when the pigment returns.  Just a few minutes of unprotected sun exposure can bring it back overnight!Any treatment, chemical peel or laser, has a risk of postinflammatory hyperpigmentation in any patient but some skin types are more prone for this to happen.  Often the laser treatment is done in conjunction with the use of topical lightening creams to minimize the rebound darkening that can occur and the laser also helps the creams work best.Permea, which is a mild fractional laser of the Clear and Brilliant type, has helped gently reduce melamsa in many of our NYC patients at the Laser & Skin Surgery Center of New York. But, with all types of lasers, I have seen failures too. It's important to see an experienced doctor when having this treatment done for this condition.

Hi mipup-- this looks like melasma, which can be a very difficult condition to treat. Over the last 14 years, the laser that I have seen work the best is the Fraxel Dual laser using the 1927nm wavelength. Melasma can recur or even worsen so you make want to try more conservative measures first. Best, Dr. Groff

Fraxel? Yes. But combination therapy is the best
treatment of your facial pigmentation problem.As has been mentioned, this can be a challenging condition to treat,
requiring a multifaceted approach with various creams, lasers, and peels all
adding possible benefit.You likely
won’t be happy with just one treatment of Fraxel alone.See your dermatologist to discuss the many
good options out there for you and to establish a relationship that can help
you get the long lasting improvement you want.

When hyper pigmentation is the result of sun damage the Fraxel is a fabulous option. If the sun damage is Melasma then there are some different treatment options available. Clear and Brilliant which is a mini Fraxel can be effective as well as the Fraxel on the 1550 setting. I have also had a great deal of success with Cosmelan. For the best results please consult a board certified dermatologist with experience with Fraxel and cosmetic skin issues.

Melasma
is best treated with creams containing hydroquinone. It would be best
to use a hydroquinone cream in the morning and a hydroquinone +
tretinoin cream combination
in the evening. You can also use a vitamin c serum in the morning to
help brighten your skin tone such as Skinceuticals CE Ferulic Acid.
Fraxel 1927 is not recommended for melasma. Fraxel 1550 can be a
consideration but I strongly recommend the hydroquinone
creams for at least 3 months and then I would recommend chemical peels
before any laser treatments. I also recommend a good physical block
sunscreen such as Elta SPF 45 (contains zinc oxide).

You have melasma. This doesn't necessarily have anything to do with hormones. See a dermatologist in your area for treatment options. "This answer has been solicited without seeing this patient and
cannot be held as true medical advice, but only opinion. Seek in-person
treatment with a trained medical professional for appropriate care."