I've been suffering from Melasma for 20 yrs. Can u recommend someone on the west coast for fraxel laser?

I have dark brown skin and Melasma on several spots. Can u recommend someone on the west coast for fraxel laser? I have tried everything else!

Doctor Answers 5


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Kristinama, I would not recommend Fraxel or in fact any laser for melasma.  There is certainly a chance you could get better but there is a significant chance that there will either be no change or you could even get worse.  I strongly recommend the Melanage chemical peel for melasma.  For this indication, it is reliably safe and effective.  For the last several years, this is the only treatment that I have used for melasma and I'm very pleased with the results.  Good luck.

Chemical peels and Melarase

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Our office specializes in melasma treatments and Fraxel is not a first line therapy. We would recommend pretreatment with Melarase creams followed by light chemical peels.


Dr. Karamanoukian

Melasma and Best Treatment

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Many patients consult with me about their melasma.  I usually advise against lasers for their skin since I have seen many conditions worsen from laser treatments with Fraxel.  Please look into Cosmelan treatment.  I find it highly effective for treating facial Melasma.

Melasma Treatment

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Melasma is very difficult to treat and can be triggered by irritation and heat; because of this I would not recommend you treat your skin with Fraxel.

If you have not tried Cosmelan it is something I would recommend. Cosmelan (non hydroquinone) and Cosmelan MD (hydroquinone and Retin-A) are very on even the toughest cases of Melasma.

Treatment consists of a mask that is worn on the skin for 6-12 hours this mask includes 15 lightening agents like Kojic Acid, Azelaic Acid, Phytic Acid and Salicylic Acid. After the initial mask there is a maintenance cream that is applied to the face starting 3-5 days after the mask. The maintenance cream is used 1-2 times a day for 1 month and then every night and can eventually be dropped down to 2-3 times a week.

The cause of Melasma is unknown but pregnancy, birth control pills, cosmetics, hormone therapy, and sun exposure often trigger Melasma. The more pigmentation your skin has the more melanocytes you have. Production of melanocytes is increased when the skin is irritated or exposed to rising hormones and the sun. In fact, even a small amount of sun exposure is the main reason Melasma returns after fading.

It is best to consult with a Board Certified Dermatologist to see which treatment if this treatment is appropriate for your skin type.

For more information click on link below:

Hydroquinone for Melasma

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Hi Kristi.  Fraxel is one of the few (or only) FDA approved lasers for the treatment of Melasma.  The problem is that even though it's FDA approved, it does not work well for this condition, and neither do other lasers.  

Melasma is a hormonal condition and there is no cure.  In most cases, once you have it, the best you can do is try to control it with medications.  We happen to believe that 8% hydroquinone in liquid form is an excellent option.  It is at home, cheaper that Melanage, Cosmelan, Obagi and others, is higher strength than these products and works better because it is in liquid form.  

Lasers will make Melasma worse about 50% of the time and they do not offer a cure for the condition.  So, along with the risk of worsening the condition, you will pay a lot more and spend a lot of your time for a service that will not give you any long term benefit.  

We suggest sticking with a high strength custom HQ product if you can find it in your area.  Check the photo link below for before and after pictures of Melasma patients in the Los Angeles and Orange County area.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 reviews

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.