Which peel would be the best treatment for my melasma?

Melasma is unfortunately a chronic and often recurring hyperpigmentation problem. Moreover, it can be an especially difficult-to-treat and resistant problem in people of color. Avoidance of unprotected sun exposure and strict use of sunscreens is essential for preventing further dyspigmentation and to maintaining improvement once treatments have worked. In my experience, topical therapies, especially OTC products, alone are often of limited value. IPLs and lasers, particularly in skin of color, pose the risk of causing further hyperpigmentation or worse, permanent loss of pigmentation, and should be avoided or reserved as measures of last resort.
I have had considerable success through the years with a series of in-office application of various chemical peeling agents, combined with regular use of certain at-home, prescription strength topicals. TCA in 10%-35% concentrations, Jessner's Solution, and full strength glycolic acid are among the peels that have a proven track record in this condition when used in a series of about six peels spaced at monthly intervals. Topical hydroquinone, arbutin, kojic acid, glyccyrrhizic acid,  alpha hydroxyacids and retinoids have all been used successfully for at-home supplemental skin lightening along with diligent use of sunscreens to retard or prevent repigmentation. I have also successfully employed fractional microneedle resurfacing coupled with the application of certain topical prescription skin lightening medications immediately following treatment. Both types of approaches are quick, relatively inexpensive, and engender little to no downtime and you can learn more about them by checking out the archives of RealSelf.com. You would do well to seek consultation and treatment by a board certified aesthetic dermatologist. Make sure to ask to see his/her before and after photos. Best of luck

Greetings,See below for treatments. 
-Pico lasers- The best type of laser for improving the condition.  Please not 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

I would suggest the Melarase cream program followed by our Hidef melasma protocol that includes light chemical peels, fractional laser, and PRP. Best, Dr. KaramanoukianLos Angeles

I recommend getting a formal evaluation with a cosmetic dermatologist. 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. Melasma will need life-long maintenance. Best, Dr. Emer

Before you get the peels, start a topical regimen and oral supplement called Scler-X for PIH relief. It is a hyperpigmented area and I agree with the regimen of Melarase creams (AM and PM) which I use extensively in my practice as well as broad spectrum UVA and UVB protection with high sun block (SPF 50+) to prevent ongoing inflammatory injury from sun rays. I recommend Spectrase for this (see link).

Lasers can make melasma worse. I would use a comprehensive cream program and then consider TCA based chemical peels. We see A LOT of patients with melasma in our clinics and have tremendous success treating melasma. One thing to remember, melasma will return. After such procedures it is important to continue the treatment program to keep it at bay. 

Thank you for writing. This is a VERY common problem for some women. You get it because you are born in your family. In your next life, ask for different parents!!Seriously, we  know that hormones play a role also. If you need birth control, by all means use birth control!!!! You can treat the melasma but you must also avoid sunlight on your face religiously. SPF45+ only 365days a yr.Forget Hydroquinone as it often rebounds/stops working/ thins your skin due to the steroids involved in compounding it.All the peels you mentioned have a place  in the management but only if the first two steps are followed. I do use my laser NdYag ( Aerolase) to speed the treatment. You must understand that this is a chronic problem. You take care of it throughout your life. I hope this helps you,Dr. Beverly Johnson

the Picosure laser is the best laser for melasma. however if your skin is too dark, you may not be a good candidate. see a board certified PS or dermatologist. they may want to do a test patch on you.david berman md

Peels can work for melasma, but lasers and creams are better. See below 
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