Which laser Picosure or Picoway is more effective for melsma treatment for Asian skin type?

I recommend seeing a cosmetic dermatologist for a formal evaluation. 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 (Cosmelan), Microneedling/PRP, Aerolase, and sometimes Erbium laser (cool laser) to get the best results. I suggest seeing an expert for a formal evaluation. Best, Dr. Emer

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 micropigmentiaton. You will also be sent home with an at-home care regimen to maintain your resutls.
-------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.
It is important to know that melasma is a moving target and requires patience and diligence to treat.
Best,
Anil Shah

Thank you for your question.   I would recommend
to start using triluma morning and night six weeks prior to laser
treatment. Fractional treatment is very effective for suppressing discoloration
and evening out skintone.  Skinpen which is a microneedling device that
would also be beneficial for getting rid of melasma.  The microneedling
treatment helps to wake up your natural growth factors, shrink your pores, fade
discoloration and acne scars, and help increase collagen and elastin
production. You would do a treatment every 4 weeks and stay out of the sun as
much as possible and always wear spf 50 broad sprectrum.  Always consult
with your physician first before starting a treatment.

Pico way, Picosure and even older C6 Nano lasers are all excellent at reducing melasma pigmentation. The MOST important factor is not the laser but your treating Specialist experience in melasma management. 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.