Is laser hair removal induced upper lip melasma usually permanent?

Fortunately for you, what you are describing is less like a melasma and more like "Post Inflammatory Hyper-pigmentation" (PIH) .
Certain ethnic skin types, such as African, Asian Hispanic and some Semitic, are prone to developing extra melanin (the pigment in our skin) due to being irritated.  For example, for skin like this, picking a pimple will cause a brown spot that may persist long after the pimple has gone away. ... classic PIH.  Thus, irritation of almost any kind can cause PIH, including hair removal by waxing or threading... and yes, for this kind of skin, Laser Hair Removal might also cause PIH.  The good news about PIH is: with time it typically goes away on its own.  This process can be accelerated with special creams such as Hydroquinone, and special laser treatments can collaborate with your physiology and remove PIH and even melasma. 
The challenge with cosmelan when used for PIH, is that in some skin types any kind of chemical peel can also cause irritation and reinforce the PIH.  In some cases it may even make the Hyper-pigmentation worse!  For skin like this Retinal can be even worse.  The active ingredient in Retinal is Retin-A.... which is a powerful exfoliate by virtue of its ability to irritate the skin!!  The idea is that Retin-A will cause the exfoliation of the top dead layer (stratus cornium) where a lot of melanin is stored.  Theoretically this will lighten the skin.  The problem is that in skin sensitive to PIH, the Retin-A will also penetrate down to the Melanocyte cells that make melanin, and stimulate then into making MORE melanin. 
Short of specialized and customized laser procedures, your best bet is Hydroquinone, which suppresses melanocytes from making melanin. .  10% is good... just make sure that it is PURE... no exfoliants!!
Expect to see the beginning results around 3 weeks...  as new epithelial cells with less melanin in them start reaching the surface.
Last but not least... be sure to be using BROAD SPECTRUM SUN BLOCK... at least spf 50.
Let us know how it goes.  Everyone will learn from your experience..... And... if the Hydroquinone does not work sufficiently, we have never met a case of PIH that our customized protocols could no solve!! 

Melasma is a very common cause of skin pigmentation. It 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. This forms the foundation of all treatments.


I prefer to use a combination of creams and laser for melasma. Hydroquinone can be used (5-8%), along with vitamin A creams or Meladerm. I start my patients on laser (low dose Q switch or Picosure) as this has shown to decrease pigment production by decreasing the activity of the cells that produce pigment. Laser itself is not aimed at ‘blasting’ pigment, but to slow down the rate of melanin production. Another laser I use is the Clear and Brilliant in the 1927 Permea setting combined with creams. IPL should never be used to treat mixed melasma as it often worsens the condition (this is termed ‘Rebound Melasma’) 



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 according the type of melasma. Majority of patients will have mixed dermal and epidermal melasma. Approach melasma as a medical condition and not a cosmetic concern, and the success rate will be much higher. 

Consult a Board Certified Laser dermatologist with a special interest in disorders in pigmentation as well as one who has experience in treating all skin types, including darker Ethnic skin. 



All the best, Dr Davin Lim. Laser, surgical and aesthetic dermatologist. Brisbane, Australia. Real Self Advisory Board