Hyperpigmentation on face. Is it melasma? How can I treat it? (Photo)

Question

Recently I have notice some heavy hyperpigmentation on my lower face that really bothers me, I tried an IPL and it got worse. I'm wondering if it is melasma

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. 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

Best,
Dr. Karamanoukian 
Realself100 Surgeon

Jason Emer, MD · Answer

​Hyperpigmentation of any kind needs a combination approach of peels like cosmelan, enlighten and aerify along with dermarolling (EmerageSkin roller with anteage AERIFY MD ampules weekly,; lasers like Clear + Brilliant, Aerolase or Laser Genesis; radiofrequency like Venus Viva; and constant skin care and sun protection. Bimonthly facials with SilkPeel DermalInfusion are essential to hydrate, exfoliate and infuse vitamins and antioxidants into the skin. If you have acne you can do additional treatments and peels to get more improvement. Hypopigmentation will need more of an evaluation and possibly additional lasers to get improvement. I suggest a formal consultation with an expert in lasers and peels. Best, Dr. Emer.​

Kian Karimi, MD, FACS · Answer

This absolutely looks like melasma and it would make sense that it flared up after an IPL treatment as heat and light can trigger melasma. The only laser that I've known to be safe for melasma patients which also treats hyperpigmentation is the PicoSure General laser. This laser is amazing since it is safe to use on all skin types and can target many skin concerns such as pigment and texture without triggering post-procedure inflammatory melasma. I would also suggest getting on a compound cream with hydroquinone as this can address your hyperpigmentation and melasma simultaneously. Going forward, I would recommend you to complete multiple in office consultations with board certified experts to discuss your ideal aesthetic goals. This way, they can better assess your face and create an ideal treatment plan for you.

Best of luck,
Kian Karimi MD, FACS

Best of luck, 
Kian Karimi MD, FACS

Anshul Gambhir, MD · Answer

Thank you for your question! It doesn't quite look like melasma but it is hard to tell. It does look like it could just be some sun spots and pigmentation issues. I would suggest doing a couple VIpeels to improve the tone of your skin.  If you tend to hyperpigment then you might want to pretreat with Lytera before and after your peel to minimize any risk of hyperpigmentation. Hope this helps!

Alejandro Mora, MD · Answer

It is difficult to say if this is melasma or not, but, you will likely need a multi-modality treatment. The IPL may have worsened it if the settings used were incorrect. Or it may have also caused increased inflammation leading to more darkening. In my opinion you would likely benefit from hydroquinone based topicals and then adding a fractional picosecond laser.

Reuel Aspacio, MD, FAAD - Account Suspended · Answer

Thank you for your question and photograph. It's difficult to evaluate your skin through this type of forum, but from what I can see, it could be either freckles, early age spots, or melasma. An in-person evaluation is needed to determine what those brown spots are and to select appropriate treatment. I highly recommend you consult with a board certified dermatologist to have your skin evaluated. Take care and good luck.

Hyperpigmentation on face. Is it melasma? How can I treat it? (Photo)

Answers (6)

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