Severe Melasma on cheeks: When and how to use triluma, retin A, Vitamin C serum and sunscreen?

Question

I have severe discoloration on my cheeks for a decade at least !! it is very depressing :( I am starting a new routine for severe Melasma (and anti aging) I have been using Retina A for years, but now I am adding Tri Luma and Vitamine C , Plus the sunscreen. I am not sure which one to start with at night and in the morning. Thank you for your help.

Raffy Karamanoukian, MD, FACS · Answer

Melasma is associated with hyperpigmentation caused by a combination of hormones, sun exposure, inflammation, and deposition of melanin pigment. In our office, we specialize in melasma treatments and start with Melapads, Melarase AM, Melarase PM, and Replenish; followed by pulsed dye laser to eliminate inflammatory erythema and light fractional laser. 
  
Best, 
  
Dr. Karamanoukian
  
Realself100 Surgeon

Jeff Angobaldo, MD · Answer

Thank you for your question.  I would suggest doing a fractional treatment for melasma.  Apply hydroquinone morning and evening two weeks prior to your treatment.  The fractional treatment would help to suppress the discoloration and improve texture of your skin along with shrinking your pores.

Harold J. Kaplan, MD · Answer

Hi Manue.  Melasma can be a troubling and resistant condition to treat.  But you are on the right track.  Some of our patients have seen relief with Triluma.  It's important to note that Triluma already has Retin A in it, so you may need to cut back on your existing Retin A or risk too much irritation.  Sunscreen is a must.For those patients that do not respond to Triluma or are looking for a cheaper alternative, we offer an 8% hydroquinone serum that works better because it is twice the strength of Triluma and also penetrates the skin more easily because it's not a cream, it's a gel.  As an aside, there is little to no benefits for lasers and microneedling.  They can actually make the condition worse.  Stick with a hydroquinone based solution with the understanding that the condition is chronic and needs to be manged rather than cured.  Hopefully your new regimen works out nicely.  If not, check the before and after photos of our Melasma program at the link below to evaluate another option.  Best of luck.

Jason Emer, MD · Answer

I recommend getting a formal evaluation with a cosmetic dermatologist. 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, Cosmelan, and sometimes erbium laser (coollaser) to get the best results. Melasma will need life-long maintenance. Best, Dr. Emer

David E. Berman, MD (retired) · Answer

you should strongly consider getting 3 Picosure laser treatments, spaced one month apart. there is no downtime from this breakthrough laser. it fires 1,000 times faster than other lasers so that there is little to no redness. It is safe for skin types 1-4. This is much easier and more effective than the routine you are following. you will want to use a good sun block after your treatments. david berman md

Davin Lim, MBBS, FACD - Account Suspended · Answer

TriLuma at night, Vitamin C in am. Ideally melasma should be approached with multiple modalities. 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

Severe Melasma on cheeks: When and how to use triluma, retin A, Vitamin C serum and sunscreen?

Answers (6)

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