Facial treatment that will not worsen melasma? (Photo)

Thank you for your question, 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

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. KaramanoukianRealself100 Surgeon

Thank you for your question.  I would start applying hydroquinone morning and night and retinol in the evening.  Start those two ointments two weeks prior to a laser treatment.  I would recommend treating melasma with a fractional laser. The fractional laser will help to make the discoloration dissipate, shrink your pores and improve texture of your skin.   Stay out of the sun after the treatment and always wear spf 50.  

Absolutely agree, pico laser with medical management can improve both melasma and rejuvenate your skin. 2-4 sessions for optimal outcome. You must be on a tyrosinase inhibitor before laser. 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. Another laser I use is the Clear and Brilliant in the Permea setting combined with creams. 
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. 
All the best, Dr Davin Lim. Laser, surgical and aesthetic dermatologist. Brisbane, Australia 

The picosure laser fires 1,000 times faster than any other laser and it is the gold standard for melasma treatment. It is very popular in Asia since it is the safest laser for ethnic skin. If someone has ethnic skin and uses other lasers such IPL or CO2 laser etc, they can make their melasma worse. I would suggest you also use Lytera and/or HQ with your Picosure treatments. you will need a good sunblock which you said you are already using. You should plan at least 3 Picosure laser treatments, each spaced a month apart. The Picosure laser stimulates collagen and elastic fibers, so it will help with your fine lines and pore size. It will not help with any redness that you have in your skin. (No effective treatment can treat all problems)david berman MD