I am considering Fraxel Dual,I need advice! I'm a male with Melasma on both my cheeks. 6 Re:fine sessions 2 yrs ago was no help.

Melasma is very difficult to treat. In
my office I like to start with Cosmelan. Cosmelan (non hydroquinone) and
Cosmelan MD (hydroquinone and Retin-A) are very effective on Asian, Hispanic,
Caucasian, Indian and African American skin.

Treatment
consists of a mask that is worn on the skin for 6-12 hours this mask includes
15 lightening agents like Kojic Acid, Azelaic Acid, Phytic Acid and Salicylic Acid. After the
initial mask there is a maintenance cream that is applied to the face starting
3-5 days after the mask. The maintenance cream is used 1-2 times a day for 1
month and then every night and can eventually be dropped down to 2-3 times a
week.

You
can reduce the chance of hyperpigmentation; reduced sun exposure and
application of sunscreen will help. The cause of Melasma is unknown but the
more pigmentation your skin has the more melanocytes you have, production of
melanocytes is increased when the skin is irritated or exposed to rising
hormones and the sun. In fact, even a small amount of sun exposure is the main
reason Melasma returns after fading.

In
terms of the Fraxel strength, though the wavelength of either 1550 or 1927 will
stay the same the amount of energy delivered to the skin can be adjusted.
However, I would recommend you start with a Cosmelan treatment.

It
is best to consult with a Board Certified Dermatologist to see which treatment
is best for your skin type.

Fraxel and Clear and Brilliant can all be used for Melasma. I wish you had posted a photo. With your skin type you would probably be best treated with Cosmelan for your Melasma. Melasma is very difficult to treat so please find a board certified dermatologist wi a great deal of experience with cosmetic procedures.