What is the Best Laser Treatment for Dermal Melasma?

Dermal melasma is the most difficult to treat. One needs a laser that can penetrate into the dermis, so I typically use the QS-Nd:YAG lasers at low fluence.

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. 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

Greetings, please see options below. Melasma is a condition which requires multiple steps and treatments to effectively improve the condition consistently over time.  In our office, here are steps which are effective:
-Pico lasers- The best type of laser for improving the condition.  Please not it takes multiple steps to improve melasma safely
-Nd:YAG Nano lasers with toning- Here a laser is used for deeply resistant melasma to break up particles without generating excessive heatWhile melasma is common, patients must understand a multi pronged approach is often the best strategy and controlling this condition.
Best, 
Anil Shah MD

Thank you for asking that, in my opinion, I prefer a multi-modality approach. We typically like to pre-treat with Hydroquinone products (we prefer ZO) 2-4 weeks before any laser procedure. In our office, we find that the Clear & Brilliant's Permea works most effectively at clearing up Melasma when done in a series of 3-4 spaced 4 weeks apart. Typically, you will use numbing cream 30 minutes prior to treatment, and the procedure itself only takes about 15 minutes. Afterwards, it is common to be very red, this will subside in 12-24 hours. The next day and day after your skin will feel like "sand paper" as it begins to slough off. Sun damage and Melasma may appear darker during the next week, which is also very normal, and will continuously flake off and fade over the next 3 weeks. Good luck to you!#melasma    #clearandbrilliant    #permea

Melasma is a difficult skin condition to treat.  Constant sun avoidance is necessary to prevent recurrence.  There are many lasers that have been used and I have used the Fraxel, Clear and Brilliant, among others with success.  I also love Cosmelan which is a topical peel originally from Brazil.  There is a medical grade Cosmelan treatment which is combined with hydroquinones with great results. Please find an experienced dermatologist for the best cosmetic results.

Melasma is difficult to treat; you have to be careful because if
something too aggressive is done it can cause more damage. I have found great
success with the Cosmelan and Cosmelan MD treatment in my office. It’s usually
the first step I take before moving on to more aggressive treatments like
lasers.

I do however
use lasers on patients that are also using lightening creams like the Cosmelan,
in this instance I like to use the Clear and Brilliant Permea. This treatment
is gentle yet very effective for Melasma and pigmentation. Best results are
seen after a series. I recommend 6 sessions done once every 3 weeks with use of
a vitamin c anti-oxidant and SPF 50 in the morning and a lightening cream at
night. Consult with a Board Certified Dermatologist to see which option is best
for you.

Dermal melasma is very difficult to treat, but I've used the 1927 nm laser (commonly known as Fraxel Dual or Clear & Brilliant) with great success. I always use the lasers with lightening medications (creams) or natural lightening products. This will enhance the results and prevent side effects. Make sure you go to a dermatologist who is experienced in treating melasma with lasers, especially if you have darker skin. "This answer has been given without seeing the patient and cannot be held as true medical advice, only opinion. Seek an in-person evaluation with a trained medical professional for appropriate care and advice."