How many layers of blue peel do I need to get rid of melasma? Will three layers be enough?

Blue peel is a good choice for melasma but it will take more than one peel and continued use of hydroquinone and retin A in between. Sun protection is also a must. If your skin tolerate it up to four layers each time is ideal.

Controlled depth peel with Obagi Blue is important and an experienced provider can determine this best with in person examination. Post treatment care and maintenance is also important and I recommend melarase creams (see link).

I work with Dr. Zein Obagi as his associate. The original blue peel has been replaced by the ZO controlled depth blue peel. This peel isn't based on layers but rather on depth signs. It is must more precise than the original blue peel and is exceptional for melasma when used in conjunction with a skincare program designed to rid the skin of melasma. Nu-derm is an outdated program now- I would take a look at the ZO line which is much safer and can be changed regularly for melasma treatment. 

Can a Blue peel remove melasma? Yes, however in 99% of cases the condition will rebound. The before and after pictures at week two look amazing, but once its past week 3-4 rebound melasma usually occurs. I prefer a series of low concentration TCA, coupled with low dose laser and HQ to treat this condition. 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