My melasma has got a lot worse especially on My forehead and under eyes What would you recommend ?

melasma will always be there, but you can improve it with a combination approach and you will need life long aggressive skin care, peels, and sun protection to keep it maintained.

Hyperpigmentation from any type needs a combination approach of peels like cosmelan,  lasers like clear and brilliant and aerolase or laser genesis, radiofrequency like venus viva, and constant skin care and sun protection.  Bimontly facials with silk peel dermalinfusion is 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.  I suggest a formal consultation with an expert in lasers and peels. Best, Dr. Emer.

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

Thank you for your question! Melasma is one of the most difficult skin conditions to treat as it is triggered by hormones and exacerbated by heat. What this means is that while most pigmentation issues respond well to lasers such as IPL, Melasma has a tendency to get worse after heat is exposed to the area. Here are my recommendations for treating Melasma, good luck.
------Chemical Peels- Peels such as the Melanage Peel or the Reve Peel offer safe results for patients with Melasma. A combination of acids and non-acids penetrate the skin to lift micropigmentation. You will also be sent home with an at-home care regimen to maintain your results.
-------Lasers- The safest way to treat melasma via laser is with a laser that fires in Picoseconds. This is to insure a careful heating of the skin not to further exacerbate the melasma. Here in my office we use the Piqo4 Laser by Lumenis. It is the only laser proven to treat melasma safely and effectively.
It is important to know that melasma is a moving target and requires patience and diligence to treat.Luminoso is one of our most popular skin brightening cream, it has arbutin which will safely lighten pigmentation and stubborn brown spots.
Best,
Anil Shah

Melasma is a chronic condition that can be very prominent at times and barely noticeable at others. This condition is somewhat complicated to treat, but can be effectively managed through a combination of laser procedures. In my office, we offer more than 45 laser devices so we can customize treatments to address even challenging cases of melasma. I encourage you to seek the services of a board-certified dermatologist that offers a broad range of treatment options. Through a thorough examination, this professional should be able to tailor a treatment plan just for you to produce an optimal outcome. Good luck!

Melasma is a chronic condition that tends to flare up and then subside again over time. While there is no cure for melasma at this time, there are some excellent treatment options to manage the symptoms. At my office, we feature chemical peels and microneedling, which can be used separately or together to achieve a very satisfying outcome. I encourage you to find a board-certified plastic surgeon with extensive experience treatment pigmentation irregularities like melasma to ensure the best possible results.

First off, I need to emphasize that at least for the present, melasma remains a chronic condition for which ups and downs (clearing and relapses) are to be expected even following the best of treatments. I have been treating melasma with gratifying results for well over three decades employing a combination of at-home prescription topicals, which include not only hydroquinone in higher concentrations, but retinoids, anti-inflammatory agents, and topical bleaching medications, including arbutin, kojic acid and licorice derivatives. I have also found oral niacinamide and Heliocare helpful as well. Of course, assiduous sunscreen use is an absolute must, and since even visual light may play a contributory role, the use of cosmetics containing iron oxide can also be valuable. In-office superficial peels complete the treatment protocol. These include full strength glycolic and salicylic peels, Jessner's solution or low strength concentrations of TCA. Improvement from the above may take as much as six months to fully realize. So, patience is required. Make sure that you consult with a board board certified aesthetic dermatologist. Best of luck. (BTW one of my sons is currently study medicine at the University of Nicosia Medical School.)

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 

you need to pre-treat with 4-8% Hydroquinone for 10-14 days before staring the Picosure laser. You need to use an excellent sunblock since you cannot be treated if you are tanned. you should plan at least 3 sessions, each spaced a month apart. The Picosure laser fires 1,000 times faster than any other laser, so it is very unlikely to cause hyper-pigmentation (unlike other lasers or deep peels). The Picosure laser is expensive to buy so you will only find them in plastic surgeons and dermatology offices that treat a lot of melasma. I have treated my own wife's significant facial hyperpigmentation with the Picosure laser with great results.david berman md