Which is a better treatment for melasma: microneedling or a chemical peel?

Melasma is one of the most difficult skin conditions to treat as it is triggered by hormones and exacerbated by heat. What this means is that while most pigmentation issues respond well to lasers such as IPL, Melasma has a tendency to get worse after heat is exposed to the area. Here are my recommendations for treating Melasma, good luck.
------Chemical Peels- Peels such as the Melanage Peel or the Reve Peel offer safe results for patients with Melasma. A combination of acids and non-acids penetrate the skin to lift micropigmentation. You will also be sent home with an at-home care regimen to maintain your results.
-------Lasers- The safest way to treat melasma via laser is with a laser that fires in Picoseconds. This is to insure a careful heating of the skin not to further exacerbate the melasma. Here in my office we use the Piqo4 Laser by Lumenis. It is the only laser proven to treat melasma safely and effectively.
Using a skin brightening topical like our Luminoso cream is great to help lighten pigmentation and promote an even skin tone.
It is important to know that melasma is a moving target and requires patience and diligence to treat.
Best,
Anil Shah

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

Hyperpigmentation from any type needs a combination approach of peels like cosmelan,  lasers like clear and brilliant and aerolase or laser genesis, radiofrequency like venus viva, and constant skin care and sun protection.  Bimontly facials with silk peel dermalinfusion is essential to hydrate, exfoliate and infuse vitamins and antioxidants into the skin.  If you have acne you can do additional treatments and peels to get more improvement.  I suggest a formal consultation with an expert in lasers and peels. Best, Dr. Emer

Cosmelan is by far the best treatment for your melasma, especially with your skin type.  I would not recommend microneedling as a treatment for melasma.  Cosmelan is a series of two chemical peels which is designed with a bleaching cream and Retin-A product to treat your skin at home between peels.  Please consult an expert in Melasma and Cosmelan treatments for the best cosmetic results.  Best, Dr. Green

Both treatments can help pigmentation issues however you will get better results with a targeted peel treatment coupled with a home topical facial regimen. 

If I only had two choices, it would be a very dilute peel. If you seek Gold Standard treatment, it is neither. I agree with Dr Green as we see an extraordinary mount of iatrogenic PIH and dermal drop out with microneedling.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 by decreasing the activity of the cells that produce pigment. Laser itself is not aimed at ‘blasting’ pigment, but to slow down the rate of melanin 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 according the type of melasma. Majority of patients will have mixed dermal and epidermal melasma. Approach melasma as a medical condition and not a cosmetic concern, and the success rate will be much higher. 

Consult a Board Certified Laser dermatologist with a special interest in disorders in pigmentation as well as one who has experience in treating all skin types, including darker Ethnic skin. 



All the best, Dr Davin Lim. Laser, surgical and aesthetic dermatologist. Brisbane, Australia. Real Self Advisory Board