Does Piq04 laser work for the treatment of melasma?

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 skin brightening topicals such as Luminoso is great to help lighten pigmentation and even out skin tone. 
It is important to know that melasma is a moving target and requires patience and diligence to treat.
Best,
Anil Shah

Melasma needs a combination approach to get the best improvement and will need a series of treatments. In our practice, we combine Clear + Brilliant, peels, microneedling/PRP, Aerolase, and sometimes Erbium (Cool Laser) to get the best results. See an expert for a formal evaluation. Best, Dr. Emer

however ,it is much harder to find a Picosure laser because they are expensive to buy. This laser is much better than an IPL if you have an ethnicity to your skin.you should pre-treat with 4-8% HQ for 10-14 days before starting the Picosure laser sessions. You should plan to do 3 picosure laser sessions, each spaced a month apart. you need to be religious about wearing sunblock when you are out in the sun.david berman md

Yes if used as an adjunctive modality, this laser can help reduce pigmentation from melasma. All lasers are secondary modalities to improve melasma. Medical intervention remains as the Gold Standard. 
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. Another laser I use is the Clear and Brilliant in the Permea setting combined with creams. 

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. 

All the best, Dr Davin Lim. Laser, surgical and aesthetic dermatologist. Brisbane, Australia