Will Pixel CO2 Treat Melasma?

Question

Hello! I've been recommended the Pixel CO2 by an aesthetician in Manhattan. I've heard mixed reviews about this and am concerned I'll have adverse effects. What are your preferences with regards to Pixel vs. Fraxel Dual (which from my research seems to be one of the frontrunners). Pros and cons of each? Thank you! I'm desperate for help.

Harold J. Kaplan, MD · Answer

Hi Chloe.  We would not recommend either of the lasers you are suggesting.  As compared to a good hydroquinone program, lasers are more expensive, more time consuming, cannot "cure" the condition and have the potential to make the Melasma worse.  

	We use many different lasers, including q-switched lasers, which are commonly used in Asia for Melasma.  We have had some success with the treatments, but in about 50% of cases, the Melasma gets worse.  Lasers take a lot of treatments, get very expensive and do not work better than our 8% hydroquinone program.

	It's important to understand that Melasma is typically a chronic (non-curable) condition that requires constant treatment.  An at home program like hydroquinone can work very well.  Our program is 8% liquid format that penetrates very easily without the irritation caused by Retin A.  It works well over a three month period, and because it is high strength, we take our patients off of it one month out of every four.  Good luck.

Raffy Karamanoukian, MD, FACS · Answer

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.  Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. 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

Joshua L. Fox, MD · Answer

I would strongly advise against having a Pixel procedure done if you have melasma because of the risk of worsening your melasma or having persistent skin discoloration after the procedure.  There are much safer treatment options for melasma with minimal risk of skin discoloration or worsening your melasma afterwards.  One of those alternatives would be conservative treatments wtih the 1927nm setting with the Fraxel DUAL, which is a non-ablative laser, as well as chemical peels, conservative Q-switched laser treatments and topical hydroquinone.  Daily use of sunscreen is also critical to help prevent exacerbation of melasma.  Often, we recommend a combination of the above for patients with melasma, but caution them that in some cases, energy-based treatments such as lasers may sometimes worsen melasma.  Since significant risks are involved with the Pixel procedure and suboptimal results may be obtained in experienced hands, it should only be performed by board-certified dermatologists or plastic surgeons who are experienced with the procedure.

Will Pixel CO2 Treat Melasma?

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Will Pixel CO2 Treat Melasma?

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Everything you need to know about Pixel Laser

Our mission is to create a world where every investment in modern beauty is Worth It.