Will Fraxel help these dark spots? (Photo)

Question

I’d really like to fade these dark spots. I use retinol, sunscreen regularly, and even take traxemic acid orally for melasma. Will Fraxel help or is there another treatment that would be more advisable?

Anna Chacon, MD, FAAD · Answer

This is a really common question—and you’re already doing many of the right things.

The key issue here is what type of pigmentation you have, because that determines whether Fraxel will help or potentially make things worse.

If this is melasma (which it likely is, since you’re on oral tranexamic acid), Fraxel is not usually my first choice. While it can sometimes help, melasma is very reactive, and lasers can actually trigger rebound pigmentation or make it patchier, especially if not done very conservatively.

If instead these are sun spots (lentigines) or post-inflammatory pigmentation, Fraxel—particularly the 1927 wavelength—can be quite effective.

Given your current regimen:

- You’re already on oral tranexamic acid, which is a strong systemic option
- You’re using retinol and sunscreen, which are foundational

Before jumping to Fraxel, I would usually optimize:

- A targeted topical pigment regimen (hydroquinone, azelaic acid, cysteamine, or similar)
- Tinted sunscreen (iron oxide) for visible light protection (this is huge for melasma)
- Possibly gentle chemical peels as an adjunct

If you’re considering a device, I tend to favor:

- Low-fluence picosecond lasers or very conservative settings
  over aggressive fractional treatments for melasma-prone skin

Bottom line:

Fraxel can help certain types of dark spots, but for melasma, it’s not first-line and needs to be approached very cautiously. The safest next step is confirming the diagnosis and then choosing a targeted, low-risk plan rather than jumping straight to laser.

You’re on a good path already—it’s just about choosing the right next step, not the most aggressive one.

Will Fraxel help these dark spots? (Photo)

Answers (1)

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