What's the best topical regime for melasma to use in conjunction with Revlite Laser?

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

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

the Picosure is a much newer and better laser for Melasma than any other laser on the market. it is fine to do this treatment with Fitzpatrick 3. you should pretreat with 4-8% HQ for 10 days before each laser session. Plan at least 3 sessions, spaced a month apart. Use a good sunblock whenever you are out in the sun.david berman md

Options listed below. All dermatologists will tell melasma patients that the FIRST step is medical management, followed by laser therapy. Melasma can not be completely cured, however effective treatment are possible. Melasma patients have skin that is very sensitive to UV light. 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. My most frequently prescribed topicals include hydroquinone, along with vitamin A creams and botanical extracts. The exact percentages will depend on your skin sensitivity, clinical presentation and your current skin care routine. 
I usually start my patients on a series of lasers (low dose Q switch or Picosure), along with medical therapy. Another laser I use is the Clear and Brilliant in the Permea setting. In some cases I combine glycolic AHAs, TCA low strength single coat peels, and in other cases I use a tablet called Tranexamic acid to help modulate the blood vessels that are associated with melanocytes (pigment cells). Melasma treatments should be tailored to each patient. 
All the best, Dr Davin Lim. Laser, surgical and aesthetic dermatologist. Brisbane, Australia. Cutis International