I recently had Fraxel 1927 used on my face for melasma with excellent results. It's been two weeks, and I'm getting the sense that some of the pigment is starting to come back just slightly. I'm wondering whether the slight darkening is from the dermal pigment rising to the epidermis, and that this will then be taken care of in my next session. What causes the dermal melasma to rise into the upper layers, and is this why I'm seeing some slight darkening? p.s. I'm using triluma daily.
Does Fraxel 1927 Make Dermal Pigment Rise to the Suface?
Doctor Answers 5
Melasma is stubborn!
I am so glad you are using Triluma, since it is FDA approved for melasma. Fraxel 1927 is the best treatment I have seen for melasma, but no treatment permanently cures this stubborn, often inherited condition. A strict protocol of sun protection with hats as well as high SPF (like Anthelios 60, or Neutrogena 75) as well as antioxidants and Triluma reduce recurrence. Most people do need 2-3 Fraxels for best results.
Effective long-term treatment of melasma requires an effective short term treatment and a long-term maintenance program of skin
The Fraxel Dual 1927/1550 Laser is an excellent short-term treatment. In my hands, the best treatment for melasma involves an aggressive short term treatment to get rid of the pigment (Fraxel Dual) and then a long-term skin maintenance program to keep the pigment away. Short-term I recommend two or more treatments with the Fraxel Restore 1550nm or Palomar 1540nm laser spaced about two weeks apart. In between Fraxel Restore Laser treatments, I recommend using the Cosmion Iontophoretic Rejuvenating Mask three times a week for one hour each treatment. This mask infuses 20% ascorbyl glucoside (Vitamin C) into the skin using a proven medical process called iontophoresis. A 0.5mm needle wheel is used before each mask treatment to enhance infusion of the Vitamin C. For daily maintenance skin care, I recommend M2 mandelic/malic acid products (SkinCareRx.com) in 12% for sensitive skin and 20% for less sensitive skin. These products contain long-chain alphahydroxy acids that inhibit the production of pigment in the skin. In addition I recommend a shoulder-to-shoulder hat and an effective UVA/UVB sun block such as Laroche Possay Anthelios 60 to completely protect the face from sun exposure. I have treated over 100 patients over the past three years with this protocol.
Melasma and Fraxel Dual 1927nm laser
As you had Fraxel Dual (1927nm) laser for melasma two weeks ago, the darkening that you are seeing now could be pigmentation resulting from the inflammation of healing. If this is the case, then pigment could actually be going deeper, but that is doubtful this early. Triluma and UVA and UV-B sunscreen protection as well as a Zinc or Titanium dioxide sunscreens are very important. Remember that wide-brimmed hats are helpful but don't prevent reflected waves of ultraviolet bouncing off the ground and hitting your face. Reapply your sunscreen frequently. Sunforgettable by Colorescience is a great convenient tinted titanium dioxide sunscreen that you can apply with an attached, all-in-one applicator and powder, brush over your makeup through the day.
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Fraxel Dual (1927) works great for hyperpigmentation
Lasers like the Fraxel Dual 1927 and light based devices like intense pulsed light (IPL, Photo Facial) that work on hyperpigmentation and melasma often appear to bring the pigmentation to the surface before removing it. Often it will look like coffee grinds, a dirty type of look, before it fades away. Fraxel Dual 1927 definitely works better on melasma then Fraxel re:store.
Laser treatment for melasma
Melasma is extremely difficult to permanently remove. Two factors which can make it worse or recur are ultraviolet light (sun exposure) and estrogen supplements. Both estrogen and sunlight will worsen Melasma and should be avoided if possible.
The dual Fraxel restore with the Thallium wavelength is excellent for improving brown pigmentation in the skin such as Melasma. It is important to make sure that the treating physician has the Dual Fraxel Restore with the additional wavelength for pigment. It can take several treatments for maximal improvement and the results will need to be carefully maintained with good skin care including a sun blocking agent.