Picosure laser for Melasma, ok to use AHA topical gel after that?

Question

Hi, I am on my 3rd Picosure laser treatment for my Melasma. Recently I started using Neo Strata's 15% AHA Gel Plus at home, in hope of lightening the melasma further while i'm on Picosure. But after 2 weeks, I noticed the Melasma darkening slightly... I read up that AHA and Retin-A are meant to assist in lightening Melasma. So can we actually use it in conjunction with Pico lasers? Or should i only use them after I've completed Pico? Please advise, Thank you very much.

Raminder Saluja, MD · Answer

Thank you for your question.  Melasma is a strange bird to treat.  With that being said, the best modality that I have found for treatment is the Picosure Focus Lens.  I do tell patients that they should use tretinoin (generic retin A) along with a bleaching agent such as hydroquinone/or azaleic acid, starting a month before and continuing through treatment (with holidays from the hydroquinone).  
Your alpha hydroxy acid, will help to increase cell turnover similar to some degree as a retinoic acid and can be utilized post treatment.  Post picosure focus lens treatment, the pigment will absorb the laser energy and turn darker for 1-3 weeks and then begin to lighten.  The one aspect I watch for is post inflammatory hyperpigmentation as some melasma patients can experience this.  We recommend treatments every 4-6 weeks to watch for any development of PIH.  
Please wear your sunscreen as well (tinted is the best for melasma patients).
Hope that helps!
Dr. Saluja

Bernard Tan, MBBS, MRCSB · Answer

After a laser treatment, the skin is distressed and inflamed. Best to avoid AHA and retinols for a week until the skin has fully healed. Excess inflammation increases the risk of melasma flare up and post inflammatory hyperpigmentation

Monika Soni, MD · Answer

Thank you for your question! Melasma is difficult condition to treat. Picsure can help with your scars and dark spots, but I usually advise combination of treatments. Picosure treatment will not prevent further spots from occurring. I would suggest you to make an appointment with an expert when it comes to treating melisma so you can get examined and receive personalized treatment. Best of luck!

Hardik Soni, MD · Answer

Thank you for your question. I believe that Picosure laser is the best laser to treat melasma. I would suggest stop using this medication 3 days before your treatment. Remember that temporary darkening after treatment can occur, but should fade. It is important to use sunblock, because with sun exposure there is a chance of the melasma returning. I recommend having a consultation with an expert to determine the best treatment plan for you. Best of Luck!

David E. Berman, MD (retired) · Answer

the Picosure laser is the best laser on the market for melasma. you should stop them 3 days before a laser treatment at least. You can get a temporary darkening after the Pico treatment that should fade but keep an eye on it and let your dr know if it is behaving differentlysuper important that you use a good sunblock because no matter what treatment you use, if you get much sun exposure, there is a good chance that the melasma could return.david berman md

Picosure laser for Melasma, ok to use AHA topical gel after that?

Answers (5)