Melasma Treatment for olive tone skin

Greetings, please see below. 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 not 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

In our office, we utilize the Melarase AM and Melarase PM creams as the most effective modality for skin lightening related to melasma on the face. Raffy Karamanoukian MD FACS

Hi Joana.  If you are on 8% HQ now, we would not go any higher.  In addition, there is some concern about long term uninterrupted use of high strength HQ.  In our practice, when patients use any HQ over 4%, we require that they take 1 month off after being on the product for 3 months.  As an option for a short term fix, there are some peels out there, VI, Cosmelan, BLUe, etc that may be able to help you prepare for the wedding.  None of these are permanent solutions, but it may be possible to help you look better short term.  It would not be advisable to do these closer than 2 weeks from the wedding just in case you have a bad reaction.Regarding lasers, we would not advise that you use any lasers for Melasma at any time.  We know from having treated hundreds of Melasma patients that many have tried Fraxel, Q-switched lasers, IPL and the like.  A full 50% of these patients end up having their Melasma worsen, even in situations where it improved initially.  We do not recommend lasers or IPL for Melasma for this reason.

Pigmentation is difficult to treat especially for olive skin;
you have to be careful because if something too aggressive is done it can cause
more damage. I have found great success with the Cosmelan and Cosmelan MD
treatment in my office. It is very effective on Asian, Hispanic, Caucasian,
Indian and African American skin, it is usually the first step I take before
moving on to more aggressive treatments like lasers.

For you I would recommend a Cosmelan MD treatment, it consists
of a mask that is worn on the skin for 6-12 hours this mask includes Retin-A, Hydroquinone,
and 15 other lightening agents like Kojic Acid. After the initial mask there is
a maintenance cream that is applied to the face starting 3-5 days after the
mask.

This maintenance cream is used for 1 month and then my patients
come in for an evaluation. If the patient is happy they continue with the
maintenance cream to prolong the benefits and to improve their skin. If the
patient would like additional improvements then at this point their skin is
prepped to receive a laser with a lower possibility of causing more pigment.

It is important to keep in mind that pigmentation can be
improved and controlled with the use of maintenance creams however new pigmentation
can be created depending on your lifestyle. For best protection from new
pigmentation; try to stay out of the sun between 10-3, wear a hat and sunblock
of SPF 50 should be worn daily.

Treating melisma in individuals with darker skin is always delicate.  I believe using stronger than 4% hydroquinone with tretinoin is not likely to produce better results.  First and foremost is daily sunblock with greater than a 50 SPF, even a small amount of sun will undo the best efforts.  Secondly there are other agents that can be added such as Elure and Niacin which inhibit pigment formation.  Lastly things can be sped up by very cautious use of Intense Pulsed light on low energy settings about every 3-4 weeks.  Peels can sometimes worsen matters by causing post inflammatory pigmentation.