What is the best treatment for pigmentation and pores treatment? (Photos)

Question

I was diagnosed by dermatologist to have melasma and pores. I tried different laser types and peels but didn’t get the expected results. Currently my routine is neotrigina deep clean cleanser, elta md sunscreen for morning and same cleanser, innisfree aloe vera skin mist, biluma cream for night, but now i use epiduo cream for acne instead of biluma. I also do chemical peel once a month. Please advise with my photos attached

Jason Emer, MD · Answer

Thank you for your question, 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 (Cool Laser) to get the best results. See an expert for a formal evaluation. Best, Dr. Emer

Jeff Angobaldo, MD · Answer

Thank you for your question.  I would start applying hydroquinone morning and night and retinol in the evening.  Start those two ointments two weeks prior to a laser treatment.  I would recommend treating melasma with a fractional laser. The fractional laser will help to make the discoloration dissipate, shrink your pores and improve texture of your skin.   Stay out of the sun after the treatment and always wear spf 50.

Raffy Karamanoukian, MD, FACS · Answer

Melasma can make your skin look mottled and hyperpigmented. Melasma is usually caused by endogenous and exogenous hormones, the sun, inflammation, and possibly thyroid dysfunction. I would use a combination protocol that includes topical Melarase creams first, followed by a combination of light fractional laser, depigmenting lasers and IPL, vascular pulsed dye laser, and Covalent peels.

Recommended Creams: Melarase Brightening Kit

MelaClenz
Melarase AM
Melarase PM
Melapads
Replenish Retinoid Cream

Best,

Dr. Karamanoukian

Realself100 Surgeon

Recommended Creams: Melarase Brightening Kit
  
MelaClenz
  Melarase AM
  Melarase PM
  Melapads
  Replenish Retinoid Cream

Best, 
  
Dr. Karamanoukian
  
Realself100 Surgeon

Kevin T. Belasco, DO · Answer

Hello,
Thanks for your questions.  
 First of all, sun protection and avoiding any irritation on skin is most important for melasma.  Melasma is not easy to treat but rather you need to choose right laser treatments as well as topical therapy.  You may avoid IPL or any light treatments which will make your melasma worse.  Halo Hybrid Skin Resurfacing Laser proved as a safe and effective treatment for melasma.  Halo laser skin resurfacing with right settings will improve your melasma, enlarged pores, fine wrinkles, and skin textures. The recommended melasma treatments at our clinic are a few Halo treatments every 4-6 weeks and use RX HQ between the treatments as well as sun protection. 
I encourage you to see a dermatologist for consultation. 
Best, 
Dr. Kevin Belasco

David E. Berman, MD (retired) · Answer

the Picosure laser is the best treatment for melasma. you must use a strong sunblock as well. You should space your picosure laser treatments, one month apart. plan at least 3 but you could benefit from additional sessions.david berman md

Davin Lim, MBBS, FACD - Account Suspended · Answer

Pico laser in the 755 -off label 6 mm 0.71 setting along with HQ and T acid can improve things dramatically. This is hard to perform as the settings and passes need to be exact or rebound can occur. See a Dermatologist or Plastics for this procedure. 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

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