Melasma is Ruining my Life? (photo)

I advise my patients to begin a six month course of Melarase AM and Melarase PM, coupled with RR Complex to treat the melasma.  Raffy Karamanoukian, Los Angeles

Hello, see below for treatments. Melasma is a condition which requires multiple steps and treatments to effectively improve the condition consistently over time.  In our office, here are steps which are effective:
-Pico lasers- The best type of laser for improving the condition.  Please note it takes multiple steps to improve melasma safely
-Nd:YAG Nano lasers with toning- Here a laser is used for deeply resistant melasma to break up particles without generating excessive heat
-Melanage peels- A variety of peels can work and melanage is one of the best for melasma
-Skin topicals- A variety of products including use of lighteners (we prefer natural lighteners such as arubtase found in our product Luminoso) as well as sunscreens can help improve the condition
-Lifestyle choices-Avoiding the sun, hormonal changes (we have a hormone expert in Dr. Chughtai in our office) can all impact melasma.
While melasma is common, patients must understand a multi pronged approach is often the best strategy and controlling this condition.
Best, 
Anil Shah MD

Hi Owen.  If Melasma is ruining your life, we can help.  We have the ability to use (q-switched) lasers or topical treatments and we choose topical treatments instead of lasers for several reasons.

1.  Neither lasers nor hydroquinone can cure your Melasma.  It will almost always come back and will never disappear completely.

2.  Lasers are very expensive in comparison.  Thousands vs. hundreds of dollars.

3.  Lasers can make your Melasma worse, topicals will never do this.  50% of patients in our laser trials reported worsening of their Melasma.

4.  Lasers take more time and more treatments.  Your time is valuable and our products are used at home and shipped to your home.

5.  Our hydroquinone program works better than our q-switched lasers did.  Only 50% of our laser patients got better whereas 80% of our patients that purchase the topical program use it again.

In trials we did about 5 years ago with high fluence q-switched Nd:Yg lasers (the same ones they use in Asia where HQ is not available), we often had to do 6, 8 or 10 treatments to lighten the Melasma at $400 per treatment.  The lasers did not lighten the Melasma more than the HQ, some patients got worse, and it was 10 times the expense of the topical program.  The only reason we can think of that a medical practice would be using lasers for this purpose would be to take your money. 

Our hydroquinone program is 8% compounded in the office (mixed same day) and in liquid format.  So, if you have not tried this formulation (without Retin A) then you have not tried everything.  The liquid helps it penetrate more easily and the lack of etin A avoids the irritation many patients have.  Ultimately, the proof is in the results.  If you like the before and after pictures at the link below, give us a call as we are in Los Angeles.

A new effective, published treatment is available for Melasma with a full-face iontophoresis mask using vitamin C and M2  (Mandelic/Malic acid) skin care.  This may be used alone or in combination with a new low-energy Q-switched ND;YAG laser treatment. This treatment is safe and effective for all skin types.  The article on this treatment was published in the Journal of Drugs in Dermatology in January 2013.  The web reference link is included below.