Best form of laser resurfacing for Melasma.

Question

I would like to have laser resurfacing to treat leftover superficial acne scars and pigmentation. My skin is very reactive and I have responded poorly to peels and hydroquinone. I have also have some leftover discolouration from a peel that was too deep for me.

Raffy Karamanoukian, MD, FACS · Answer

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best,
Dr. Karamanoukian 
Realself100 Surgeon

James R. Gordon, MD, FACS, FAAO · Answer

Thank you for sharing your question. Melasma is very difficult to treat. There is no clear answer to your question. See a facial specialist who has multiple treatment modalities try on your condition and has a lot of experience. Good luck,

Scott Trimas, MD · Answer

The CO2 laser or Fractionated CO2 laser is likely going to be your best bet if you have tried less aggressive means of improvement such as skin care products, chemical peels and topical creams. I would suggest that before your treatment, you pre-treat your face with a retin-a type of product with hydroquinone in order to lessen the post-inflammatory response that can happen after the laser treatment. Good luck in your area.

Andrew Campbell, MD · Answer

Melasma is a tricky thing to treat with a laser. Often times, the laser injury can actually make the melasma worse. We have used the Halo laser by Sciton to successfully treat melasma. Nothing will make melasma go away, but the Halo can make it look better. The Halo can also improve acne scars, but just like melasma, acne scars will never be "cured", only improved.Andrew Campbell, M.D.
Facial Rejuvenation Specialist
Quintessa Aesthetic Centers

John J. Martin, Jr., MD · Answer

There is no laser that works well for melasma.  The pigment in melasma is deep and any light/laser treatment to this may initially improve it.  But several weeks later it usually returns and can be darker than before.  
There are some new creams and even a pill that may help - traneximic acid.  Bleaching creams also are helpful and sunblock every day.

Jason Emer, MD · Answer

This is difficult to answer without pictures and needs an in-person evaluation. Melasma can be improved with a combination of lasers, Aerolase, microneedling/prp, skin lightening, peels, and skin care. Sun protection is essential. I recommend getting a formal evaluation with an acne scarring expert. Best, Dr. Emer

Robert G. Aycock, MD, FACS · Answer

If you had a bad reaction to peels then you may not be a candidate for laser. there are other lightening topicals treatments that will help reduce the hyperpigmentation but I would recommend working with a dermatologist to see which products your skin agrees with.

Michael A. Kurzman, MD · Answer

The treatment of melasma is challenging. Typically prior to laser treatment the condition should be treated with a bleaching agent along with a retinoid and sunscreen, preferably with iron oxide as a component. If there is no significant improvement, IPL or Q-Switched laser may provide some benefit.

Louis W. Apostolakis, MD · Answer

Hello,I respond here to reinforce what others have said.  Melasma is a condition that is difficult to treat and can easily be worsened by any inflammatory event.  Laser resurfacing is very much an inflammatory event.  I suspect you would be trading some modest improvement in your acne scars for worsening of your melasma.  You may look at it from the perspective that melasma can be covered with makeup and acne scars only look worse with makeup.  The trouble is that you can't be certain how much improvement you will get in your acne scars and it might not turn out to be enough to warrant the risk of worsening your melasma.Best Regards,Dr. A

Shobhan Manoharan, MBBS, FACD · Answer

I appreciate that your acne scars may benefit with laser resurfacing, however melasma is a very challenging condition that may be worsened by laser resurfacing.  To treat melasma, we often use a combination of topical and oral medications, high level sunscreens, chemical peels and low-level Q-switched or Picosecond lasers or non-ablative lasers such as Fraxel.  For resistant cases we sometimes even consider PRP these days. This needs to be done with care and maintenance is essential.