Melasma. What would help if laser didn't?

Regarding Melasma, I recently got fraxel laser and my face completely cleared up. However, after 2 months my melasma is back in full swing. Does heat really affect Melasma that much or could it be stress related? As soon as we moved from Chicago to NYC, my melasma flared up severely. What would help if laser didn't? My dermatologist said a chemical peel every 6 weeks, but is that worth it?

Doctor Answers 7

Melasma Expert NYC

I treat hundreds of patients every year for Melasma and no two cases are alike.  I don't use Fraxel for Melasma but rather Cosmelan and chemical peels, deepening on each individual case.  Strict sun avoidance is necessary otherwise the melasma will quickly recur.  Please consult an expert in melasma.  Best, Dr. Green

Melasma expert in Los Angeles

I would begin Melarase AM and Melarase PM, Melapads, Replenish cream, and light chemical peels to help reduce your pigmentation. Best, Dr. KaramanoukianLos Angeles

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 93 reviews

Melasma and Fraxel

Melasma 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. I prefer to use a combination of creams and laser for melasma. Hydroquinone can be used (5-8%), along with vitamin A creams. I usually start my patients on laser (low dose Q switch or Picosure) a few weeks after they commence on creams. Gentle Fraxel like Clear and Brilliant is the way to go not Fraxel itself. In some cases I combine glycolic AHA peels, and in other cases I use a tablet called Tranexamic acid to help. All the best, Dr Davin Lim. Laser, surgical and aesthetic dermatologist. Brisbane, Australia 

Davin Lim, MBBS, FACD
Brisbane Dermatologist
4.7 out of 5 stars 56 reviews

I am not a fan of laser treatment for melasma. Best treatment = Obagi Skincare

While I have tried Fraxel a few times back around 10 years ago when it came out, my experience was exactly what you had:  It got better and then went back to how it was.  Not a great thing considering the cost involved.  For this reason, I don't do it any more and feel that any money spent on expensive lasers is pretty much wasted.On the other hand, an ongoing usage of the Obagi regimen (NuDerm with 4% hydroquinone) is about the best we have now.  Still looking for something better but it hasn't come yet.  Good luck!

Joel Schlessinger, MD
Omaha Dermatologic Surgeon
4.8 out of 5 stars 34 reviews

Melasma. What would help if laser didn't?

Melasma is a tough problem.  It can be treated successfully but often comes back.  The best way to maintain a result after successful treatment is diligent sun protection.  That's a particular challenge down here in South Florida.  A high quality sunscreen such as Avene 50 mineral sunscreen is mandatory, with frequent re-application throughout the day.  Even with good sun protection, other factors, such as hormones, can trigger recurrence.  Adding in a system such as Obagi Nu-derm can help keep the pigmentation under control, we've seen great results with our patients (and staff!).  If you decide to re-treat, I'd suggest treatments with the pico-second enlighten laser rather than chemical peels or fractional.  This is the state of the art tattoo laser that has profound effect on most pigmentation.  Many practitioners are finding that the enlighten can clear up melasma that has failed to respond to other approaches.

Adam Gropper, MD
Aventura Radiologist


Melasma is an inflammatory skin condition. lasers and other procedures help a lot. but whats most important is sun protection and topical skin care regimen that your dermatologist can recommend for your skin. 

Misbah Khan MD, FAAD, FACMS
New York Dermatologic Surgeon
4.9 out of 5 stars 27 reviews

Melasma. What would help if laser didn't?

Sunlight is the main contributor to melasma. Unfortunately, the battle with melanoma is ongoing. If you do a peel or laser it will go away, but then you go into direct sunlight again and it comes back. 

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