Microneedling or IPL for spots and melasma?

Question

Not sure if I should get microneedling or IPL for some spots and melasma? Not sure if what I have (circled in picture) is melasma?

Raffy Karamanoukian, MD, FACS · Answer

Melasma and age spots can be due to hormones, aging, sun exposure, thyroid dysfunction, and genetics. Treatments range from IPL to laser therapy; but pigmentation may recur if not complemented with topical creams to stabilize the pigment cells.

I would suggest starting with Melarase Brightening Kit with Melaclenz, Melapads, Melarase AM, and Melarase PM to help stabilize pigmentation and reduce recurrence. Once started, an active protocol that includes Covalent peels, IPL, fractional laser, and microneedling can further remove pigmentation.
Best, 
Dr. Karamanoukian
Realself100 Surgeon

Anil R. Shah, MD · Answer

Melasma is one of the most difficult skin conditions to treat as it is triggered by hormones and exacerbated by heat. What this means is that while most pigmentation issues respond well to lasers such as IPL, Melasma has a tendency to get worse after heat is exposed to the area. Here are my recommendations for treating Melasma, good luck.
------Chemical Peels- Peels such as the Melanage Peel or the Reve Peel offer safe results for patients with Melasma. A combination of acids and non-acids penetrate the skin to lift micropigmentiaton. You will also be sent home with an at-home care regimen to maintain your resutls.
-------Lasers- The safest way to treat melasma via laser is with a laser that fires in Picoseconds. This is to insure a careful heating of the skin not to further exacerbate the melasma. Here in my office we use the Piqo4 Laser by Lumenis. It is the only laser proven to treat melasma safely and effectively.
It is important to know that melasma is a moving target and requires patience and diligence to treat. Best,Anil Shah

Jeff Angobaldo, MD · Answer

Thank you for your question.  Always keep your skin protected from UV rays because even the slightest bit of exposure will make the pigment darker. Fractional treatments, chemical peels, microneedling are all beneficial treatments for treating melasma.

Nelson Lee Novick, MD · Answer

There is no substitute for an in-person, i.e. an up front and personal examination to pin down the diagnosis. However, from the photos, it is not clear that you actually have any significant melasma. It looks more like freckles (ephelides). If this is indeed so, then sun protection to prevent their darkening and prominence would be the first order of business, followed by the at-home use of a prescription strength bleaching cream, containing one or a combination of the following ingredients hydroquinone, kojic acid, arbutin or licorice extract, and a series of superficial in-office peels employing glycolic acid, Jessner's solution, or low concentrations of TCA. I am not a fan of bells and whistles devices like IPL, especially in skin of color, since such skin is particularly prone to dyspigmentation problems when exposed to light therapies, like IPLs and fraxels. Microneedling is "color blind," however, and may play a role, especially if combined with the topical application of tranexamic acid--should the other first line treatments mentioned not give rise to sufficient progress. Bottom line, you would be wise to seek consultation and treatment by a board certified aesthetic dermatologist who will both be able to accurately diagnose your problem and initiate appropriate treatment. Good luck to you.

Jason Emer, MD · Answer

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/PRP, aerolase, and sometimes erbium laser (coollaser) to get the best results. See an expert for a formal evaluation. Best, Dr. Emer

Anteneh Roba, MD · Answer

it’s hard to say for sure if you are dealing with Melasma. Melasma does not respond well to microneedling or IPL. You might want to see a dermatologist or a cosmetic dr for a proper diagnoses and treatment.

Davin Lim, MBBS, FACD - Account Suspended · Answer

Melasma is a very common cause of skin pigmentation. It 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. This forms the foundation of all treatments.

I prefer to use a combination of creams and laser for melasma. Hydroquinone can be used (5-8%), along with vitamin A creams or Meladerm. I start my patients on laser (low dose Q switch or Picosure) as this has shown to decrease pigment production by decreasing the activity of the cells that produce pigment. Laser itself is not aimed at ‘blasting’ pigment, but to slow down the rate of melanin production. Another laser I use is the Clear and Brilliant in the 1927 Permea setting combined with creams. IPL should never be used to treat mixed melasma as it often worsens the condition (this is termed ‘Rebound Melasma’)

In some cases I combine glycolic AHA peels, and in other cases I use a tablet called Tranexamic acid to help. Melasma treatments should be tailored to each patient according the type of melasma. Majority of patients will have mixed dermal and epidermal melasma. Approach melasma as a medical condition and not a cosmetic concern, and the success rate will be much higher.

Consult a Board Certified Laser dermatologist with a special interest in disorders in pigmentation as well as one who has experience in treating all skin types, including darker Ethnic skin.

All the best, Dr Davin Lim. Laser, surgical and aesthetic dermatologist. Brisbane, Australia.

David E. Berman, MD (retired) · Answer

There is no question that the picosure laser is the very best treatment for melasma. You should also use 4-8% HQ. you must plan to do at least 3 treatments, each a month apart. An excellent sunblock is imperative. The Picosure laser has little to no downtime. for the very individual dark spots, you may want to use a laser like the Cynosure Elite laser but for your overall skin, I would use the Picosure laser.david berman md

Deborah E. Mendelson, MD (retired) · Answer

If you have melasma IPL is not the way to go. Melasma is heat sensitive and the IPL can worsen the discoloration. Microneedling, chemical peels, or other types of laser treatments would be best. Also, applying a skin lightener and daily SPF 30 will be beneficial.

Microneedling or IPL for spots and melasma?

Answers (9)

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