Is the new pigmentation melasma or PIH?

I had melasma since 2011. I had patches on upper cheeks. Last year after second session of cynosure laser i developed darkening above my upper lip, and chin. It's like this whole section of the face is 3-4 shades darker than the rest. Is this melasma or PIH? Nothing has worked on it from dermamelan, HQ10% + kojic acid 4% , and few other creams. I want to know if this is melasma or not. My dermatologist said melasma but i never had it before the laser!!

Doctor Answers 5

Melasma versus PIH

I treat so many patients with melasma and even more who consult me after having had laser which caused PIH.  It sounds like you have both and the laser made it worse with significant PIH.  This is more difficult to reduce but I have found the combination of Cosmelan, chemical peels, and my pigment protocol that I have designed for my patients removes the pigmentation over time.  Please consult an expert.  Best, Dr. Green

New York Dermatologist
5.0 out of 5 stars 76 reviews

Clear and Brilliant laser and Melarase creams for melasma

It sounds like you have developed very resistant pigmentation post laser. Start with the Kareskin Brightening Kit with Melarase followed by Clear and Brilliant laser. 


Dr. Karamanoukian

Los Angeles

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 94 reviews

Picture will help, possibly Wood lamp....

Laser or IPL if intense can worsen or bring out melasma. This is because the melanocytes are 'activated' by heat, damage, and or UVR. Video explains distribution of melasma and treatment options. Dr Davin Lim. Brisbane. Australia. 

Davin Lim, MBBS, FACD
Brisbane Dermatologist
4.7 out of 5 stars 74 reviews

Post Inflammatory Hyper-pigmentation

Melasma is caused by internal changes in the chemical balance of the body. That is why it frequently occurs around pregnancy, etc. PIH occurs after any injury to the skin. What you have is, therefore, the latter. Some of what you have used such as the hydroquinone should work but needs to be used properly. I prefer use of hydroquinone in the Obagi Nu-Derm System since it works several times better than the hydroquinone alone. The only machine or other invasive device that can improve you without causing more PIH is an IPL (Intense Pulsed Light) that has a very specific wavelength range (between 500-950 nm like the Elipse machine) that will not cause heating of the surrounding tissue or cells. Therefore, do not get talked into any laser, peel, microneedling or other invasive procedure.

Robert T. Buchanan, MD
Highlands Plastic Surgeon
5.0 out of 5 stars 6 reviews

Treating Recurring Melasma with Peels, Clear + Brilliant Laser, Microneedling/PRP

This is hard to answer without a picture, but melasma is a recurring condition. I recommend a formal evaluation.  You need combination of peels, skin care, clear + brilliant laser, microneedling/prp, and proper sun protection.  You can get amazing results if you go to a laser and skin care expert who specializes in melasma. Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 190 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.