How to Treat Melasma After Fraxel Dual Laser 1927?

I had fraxel dual laser 1927 to treat sun spots and it gave me melasma. I thought it was hypo-pigmentation but have told that it is melasma. Doctor wants to place me on Revlite laser which he thinks will remove the melasma. Ella Rouge has advised to do Ominlux facials with coffeberry to treat it. Will this get better on its own or am I stuffed? I don't want to do anymore fraxal absolutely not. It made it worse. Instead of little spots I now have two bigger spots. Joined the dots into one dot.

Doctor Answers 3

Treating Melasma After Fraxel Dual Laser 1927

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Many MDs will treat post-fraxel hyperpigmentation with broad spectrum daily sunblock, hydroquinone 4% gel and one percent hydrocortisone & perhaps a retinoid.  Melasma is very difficult to treat.  I would be optimistic and go back to a dermatologist and slowly try to lighten them up with topicals. If you no longer trust the Fraxel, sometimes regular, light, Beta-Lift peels can be helpful as well.  Avoid the sun and always wear broad-spectrum SPF. If you drive a lot, put UV guards on your car windows. If you are light skinned, sometimes TCA localised peels can help.  

So go back to your dermatologist and come up with a plan. The Fraxel 1550 often has a specific melasma setting that works well if you use a bleaching agent for a month prior to using the melasma 1550 setting on the Fraxel. There is always hope & always a way for some improvement. Sometimes it helps to give the skin a long rest before trying something new. Best of luck to you.

New York Dermatologic Surgeon

Fraxel and melasma

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Melasma is always difficult to treat, especially if you have a dark complexion.  Use SPF 60 every day and re-apply it if you are outdoors.  Foundation make-up will also give your skin some sun protection.  See your dermatologist for a prescription of hydroquinone, tretinoin cream and a mild cortisone cream which will help fade the melasma.  You may be a candidate for light chemical peels as long as you stay out of the sun.

Martie Gidon, MD, FRCPC
Toronto Dermatologist


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Unfortunately a paradox does exist that treatments which are designed to improve pigmentation, especially in dark-skinned individuals, may increase the pigmentation.  Melasma is a difficult procedure to treat in general. The Fraxel Dual you had, the 1927nm wavelength laser, might have caused better results if you had been pretreated with a lightening cream or if the energy levels were different. It might be worth consulting another laser specialist.  Mild chemical peels and strong lightening creams such as prescription Tri-Luma with close followup with a dermatologist can make this so much better for some patients.  Unfortunately, some patients react with the hydroquinone and get darker! See an experienced dermatologist.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 38 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.