Hyperpigmentation and melasma - what can help with the dark spots on my face? (photos)

Question

I have very fair skin, melasma, and freckles. My sun damage has gotten progressively worse since I started Triluma (have since stopped) and I have upped my sunscreen and always cover my face outside. Even my derm has admitted my hyperpigmentation looks worse after VI peel, Triluma, etc. She now says try Clear & Brillant, but I am skeptical because it seems like my skin gets worse with every treatment. Desperate for help with these dark spots on my face! Any suggestions?

Raffy Karamanoukian, MD, FACS · Answer

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.

Best,
Dr. Karamanoukian 
Realself100 Surgeon

Jason Emer, MD · Answer

​Hyperpigmentation of any kind needs a combination approach of peels like cosmelan, enlighten and aerify along with dermarolling (EmerageSkin roller with anteage AERIFY MD ampules weekly,; lasers like Clear + Brilliant, Aerolase or Laser Genesis; radiofrequency like Venus Viva; and constant skin care and sun protection. Bimonthly facials with SilkPeel DermalInfusion are essential to hydrate, exfoliate and infuse vitamins and antioxidants into the skin. If you have acne you can do additional treatments and peels to get more improvement. Hypopigmentation will need more of an evaluation and possibly additional lasers to get improvement. I suggest a formal consultation with an expert in lasers and peels. Best, Dr. Emer.​

Monika Kiripolsky, MD · Answer

Hi Thriving!
Let me first commend you for seeing a dermatologist for this!
A series of Clear and Brilliant treatments with the Permea handpiece would likely help you! Another option would be a series of picosecond laser treatments (for example the PiQo laser). The latter is a bit more effective (in my opinion), but, the former is also a great option. Regardless, I'd recommend that you start on a twice daily home regimen of medical grade (topical) skin care, as this will act synergistically with your laser treatments to give you the absolute BEST results! Don't be discouraged, everyone's skin is different and some hyperpigmentation is trickier to treat than others. But, I've cleared skin with a lot more hyperpigmentation than yours, so don't lose confidence that this can be improved!
Hope this helps!
Dr. Kiripolsky

Mavis Pak, MBBCh - Account Suspended · Answer

I would suggest that you stop triluma immediately. There are some people who reacts badly to hydroquinone. Treatment for melasma is multimodal approach, oral medication combined with topicals such as retinols and laser would be the best approach to controlling melasma.

Hyperpigmentation and melasma - what can help with the dark spots on my face? (photos)

Answers (4)

Answer: Melasma treatment

Answer: Melasma treatment

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Hyperpigmentation and melasma - what can help with the dark spots on my face? (photos)

Answers (4)

Answer: Melasma treatment

Answer: Melasma treatment

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Everything you need to know about Clear and Brilliant

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