Is darkening of melasma normal after a Pico Genesis treatment?

The PICO Genesis laser procedure uses a non-thermal laser that won't cause damage to surrounding tissue and works by destroying the pigment, leaving your skin clearer and giving you a more even complexion.
Darkening of melasma is not normal nor common after PICO Genesis. I would recommend using a topical skin lightener of at least 5% hydroquinone on the area and would also seek medical advice to make sure there are no contributing factors to your condition.  Sun block protection of both UVA and UVB rays is always essential and must be used properly with multiple reapplications throughout the day.
Best of luck to you,
James Mirabile, M.D., FACOG

No this is rebound melasma and can occur with IPL, pico lasers, medium depth peels and ablative lasers. I do use Pico lasers to treat melasma however lasers are always adjunctive treatment to this MEDICAL condition. You do need to see a dermatologist to have this managed correctly, and having more pico lasers can make things worse in the long run. Many people have another treatment, and yes, pigment will fade over 2-3 weeks only to rebound. This is called REBOUND melasma - good news, with the correct management the cycle can be halted. Melasma is a very common cause of skin pigmentation. It 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. This forms the foundation of all treatments.

I prefer to use a combination of creams and laser for melasma. Hydroquinone can be used (5-8%), along with vitamin A creams or Meladerm. I start my patients on laser (low dose Q switch or Picosure) as this has shown to decrease pigment production. Another laser I use is the Clear and Brilliant in the 1927 Permea setting combined with creams. IPL should never be used to treat mixed melasma as it often worsens the condition (this is termed ‘Rebound Melasma’)

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.