Ask a doctor

Would you recommend Clear and Brilliant for Dermal Melasma?

I have had dermal melasma since my first child was born. I've tried hydroquinone combined with Retin-A and glycolic peels with no success. Two clinicians have told me I am not a candidate for laser treatments (because of PIH risk), but today I met with a doctor who suggested I try the Clear and Brilliant Laser treatment. I have olive complexion and of Mediterranean decent. Is this superficial laser really a good choice? After doing some reading, I'm not so sure. What have other people found?

Doctor Answers 3

January 20th, 2015

Try a test spot for Clear & Brilliant before treating your entire face.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Hello there,

In general, I caution the use of lasers for the treatment of melasma, but you can certainly ask your doctor to try a test spot before treating your whole face. Clear & Brilliant would be my choice for those with melasma - and I would treat conservatively.

Melasma has many different causes, and must be approached this way. One common cause is hormonal imbalance or use of hormone medications such as oral contraceptives or supplements. Please be sure to check in with your internist to make sure everything is ok. If you are using any unnecessary supplements, stop those.

Sun exposure is another important trigger of melasma. Be sure to wear a mineral sunblock every day, and re-apply throughout the day if possible. The ingredients you should look for include: zinc oxide, titanium dioxide, and ferrous oxide. Powder sunblocks are a great addition to your daily routine. You can even take supplements such as Heliocare, which provides internal sunblock, or niacinamide, which can decrease the uneven pigmentation and any inflammation. Wear a hat and/or use umbrellas when you walk outside.

Next, at-home prescription and physician-dispensed treatments can help. Medications like Triluma contains a lightener (hydroquinone), retinoid (tretinoin) and anti-inflammatory (fluocinolone). Usually my patients use a medication like this for 4-6 months until they achieve their aesthetic goals, and then we transition to a tretinoin-only product.

Procedures such as chemical peels can also help. Please caution use of lasers, as this can cause worsening of melasma if done incorrectly.

Of course, good skincare is very important. Use gentle cleansers and moisturizers, and avoid using acids at home, which can irritate the skin.

Good luck!


San Francisco Dermatologic Surgeon

February 17th, 2017

An interesting discussion

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Those of us who treat a lot of melasma know there is no one device that is a home run in every patient, but Clear and Brilliant, with conservative settings, can give great results. It is a good idea to have your dermatologist carefully evaluate your skin for an underlying vascular component to the melasma. When present, C and B is riskier and low level Excel V would be preferable.

Good luck.

Mary P. Lupo, MD
August 16th, 2016

Clear + Brilliant and Melasma

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Hello and thank you for your inquiry. Unfortunately, there is no definite answer to your question. As you know Melasma is systemic and I see you have been battling with it for quite sometime. Usually when we have patients with this condition, we will start you on our ZO Skin Health Multi-hydroquinone Therapy Program for at least 4 weeks before the treatment. After seeing how your skin is progressing, we will determine whether it is safe to perform the treatment. If you have responded well, we can start a series of Clear & Brilliant treatments at a low setting and progressively work our way up if necessary. The Clear and Brilliant is a safe controllable fractional laser, so your risk of Melasma worsening is decreased vs. other lasers. Its worth a try to see if it helps improve the hyperpigmentation. But keep in mind this is something long term and its very important to wear and SPF 365 days a year and avoid sun exposure as best as possible. I hope this helped answer your question.  

Learn more: https://www.deepbluemedspa.com/laser/clear-and-brilliant/

Michael Dobryansky, MD, FACS

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.