How Long Should I Wait After Peel Before Getting Laser Treatment?

Question

I had a medium TCA peel 3 weeks ago and would like to do a Q-switched YAG laser treatment for melasma next. How long should I wait after the peel? Thanks.

Harold J. Kaplan, MD · Answer

Hi Claremont.  We would not recommend a laser or TCA peel for Melasma.  Simple 8% hydroquinone in liquid format (pads) like we have has worked better than traditional hydroquionone (4% w/ Retin A), q-switched lasers (often Melasma gets worse with lasers) and deeper peels.  While TCA peels and even q-switched lasers can sometimes improve Melasma, they cannot cure it.   And in some cases, the lasers will aggravate it and make it worse.  

	For these reasons, we stick with the easiest, cheapest and most effective treatment, 8% Hydroquinone pads with no Retin A.  Check the photo pages below for our results.

Michael Contreras, MD · Answer

Melasma is very easily provoked by medium chemical peels, IPL, Q-switched laser, or non-ablative laser, all of which have been used to treat it.  I would wait at least 2 weeks to let the inflammation from the peel settle down completely and then assess what effect the peel had on your pigmentation before proceeding with laser treatment. 

	 

	Topical bleaching agents such as Triluma (recently re-released) containing hydroquinone are proven to be most effective to treat Melasma and are, therefore, first-line treatment.  If not adequately improved after 3-4 months, I then will usually start a patient on a series of salicylic acid peels alternating with either low-level BBL (intense pulsed light device) or non-ablative 1540 treatments.  Non-aggressive settings are key given the sensitivity of melasma to these treatments.  No matter the approach used to treat melasma, recurrence is very common; a solid sun protective regimen including daily zinc containing sunscreen is important as is removal of possible aggraviting factors like oral contraceptive of hormones if possible.

R. Stephen Mulholland, MD (retired) · Answer

It depends on how aggressive the peel was for you. It's a common misconception that the peels strength will react the same on everyone. Assuming your skin has stopped peeling, it is a good time to reevaluate the skin and see if a YAG remains your best option. I've had patients that required topical HQ after peels to further their treatment while others required lasers. You need to seek a consultation before booking the YAG treatment.

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