Should I stop my laser treatments for melasma if the lighter patches haven't disappeared yet?

Question

I have been through 6 sessions one every month. The had dark patches on my cheeks and forehead.The doctor here recommended a series of treatments using the spectra laser.Before the laser a hydra facial was done to clean and exfoliate the skin.Melasma is still there but they said it takes time.It looks lighter but I’m not sure.If the darker patches got lighter shouldn’t the lighter ones have disappeared altogether? Just worried.Im not sure if I should continue or stop.

Raffy Karamanoukian, MD, FACS · Answer

Dark spots on the skin are caused by sun UV exposure, hormonal load, birth control pills, and genetics. If you’re thinking about dark spot correction or melasma correction, you would be best advised to start with creams that control the production of melanin before starting lasers or chemical peels. I recommend Melarase creams first for pigment correction, followed by a protocol of lasers, chemical peels, exfoliation, IPL, and pulsed dye laser. 
  
 
  
Recommended Creams: Melarase Brightening Kit
  
MelaClenz
  Melapads
  Melarase AM
  Melarase PM
  Replenish Retinoid Cream
   
  
Best, 
  
Dr. Karamanoukian
  
Realself100 Surgeon

Anil R. Shah, MD · Answer

Hello, there are more effective treatments. Please see below. Melasma is a condition which requires multiple steps and treatments to effectively improve the condition consistently over time.  In our office, here are steps which are effective:
-Pico lasers- The best type of laser for improving the condition.  Please note it takes multiple steps to improve melasma safely
-Nd:YAG Nano lasers with toning- Here a laser is used for deeply resistant melasma to break up particles without generating excessive heat
-Melanage peels- A variety of peels can work and melanage is one of the best for melasma
-Skin topicals- A variety of products including use of lighteners (we prefer natural lighteners such as arubtase found in our product Luminoso) as well as sunscreens can help improve the condition
-Lifestyle choices-Avoiding the sun, hormonal changes (we have a hormone expert in Dr. Chughtai in our office) can all impact melasma.
While melasma is common, patients must understand a multi pronged approach is often the best strategy and controlling this condition.
Best, 
Anil Shah MD

Jason Emer, MD · Answer

spectra does VERY LITTLE for melasma you need cosmelan peels combined with the right skin care, bio c masks, microneedling/prp and clear and brilliant. I suggest you see an expert in pigmentation.  Best, Dr. Emer.

Davin Lim, MBBS, FACD - Account Suspended · Answer

Respectfully, I wil have to disagree with this statement regarding lasers- the CORRECT laser in the correct setting by a Specialist can improve but not cure melasma. Need to step up to have a session every 14 -16 days, if you can see a laser dermatologist for advice. 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. 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. 
  
All the best, Dr Davin Lim. Laser, surgical and aesthetic dermatologist. Brisbane, Australia.

Rodainah Mhaidat, MD - Account Suspended · Answer

Thank you for your question. According to the recent recommendations of  European Society for Lasers and Energy Based Devices( ESLD ) Melasma shouldn't be treated by lasers as it will give temporary improvement for the patient ..later the Melasma would come back larger and darker. I would recommend for the Melasma to be treated with Chemical peels that contain Hydroquinone or Kojic Acid like Amelan or Cosmelan that will work to inhibit the pathway of melanin synthesis( that results in the pigmentation of the Melasma) and therefore control of the Melasma.

David E. Berman, MD (retired) · Answer

The Picosure laser is the very best laser for melasma and hyperpigmentation for skin types 1-4. It fires 1,000 times faster than other lasers so there is less risk of reactive hyperpigmentation. There is virtually no downtime. You should plan 3 treatments, each a month apart. The lasers can only improve the dark areas. they cannot darken the light areas. You should use an excellent sunblock between sessions. you don't need a peel before the Picosure treatment. You can use 4% HQ but you should stop all active agents 3 days before the Pico treatment. david berman md

Should I stop my laser treatments for melasma if the lighter patches haven't disappeared yet?

Answers (6)

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