Melasma is a special breed of its own for treatment. What is important prior to any treatment for melasma is to make sure Vitamin C serum, retinoic acid (tretinoin for example) and a skin lightening agent are on board prior to treatment. And of course, all patients must commit to wearing sunscreen. I typically recommend this 1 month prior to treatment. Of all the lasers I have used, I do feel that Picosure is the one I go to for possible laser treatment (some patients with melasma, I don't recommend laser at all). Picosure will certainly darken up solar lentigenes (sun spots) for about 5 days to 1 week, similar to IPL and they will then dissipate and exfoliate off. IPL does not have as great of an effect on the deeper dermal pigmentation of melasma and that is where Picosure Focus Lens can be tried. Typically the area will darken for 1-2 weeks and then lighten over 3- 5 weeks. I usually separate them by about 6 weeks to see if any PIH (post inflammatory hyperpigmentation may develop), if not I proceed on with treatment typically between 4-6 treatments. It is important to note that while picosure can decrease pigmentation, melasma will forever be an issue so sun protection is very important. Hope that helps.
