Best treatment for dermal melasma?

It is difficult to provide a formal assessment without seeing you as a patient in my clinic. Melasma is extremely unique, and your treatment will depend on your individual case. Melasma typically requires a combination approach of laser treatments with microneedling and topical medications/cosmeceuticals. I recommend scheduling a consultation with a board-certified dermatologist who is an expert in melasma and hyperpigmentation treatments for a formal assessment. In my practice, we have over 45 lasers that we use in combination with IPL and microneedling to customize treatment plans for each of our melasma patients. Be sure you are using a vitamin C-based antioxidant and broad-spectrum sunscreen SPF 30 or higher every day.

Thank you for your question.  It can be very difficult to treat and heat often makes it worse.  We would not recommend fractional Co2 or IPL PhotoFacial.  Start by looking for prescription strength 4% Hydroquinone (HQ).  Do not buy it over the counter or off the internet.  Laws vary by state.  In Texas, physicians can prescribe and dispense in office.  We have been very successful using the PicoSure laser with the FOCUS and / or Flat Lenses eliminating hyperpigmentation with a series of treatments.  Our Melasma protocol is a series of very low pulse count combined with using our chiller unit blowing cold air.  FOCUS lens treatments have the extra benefit of reducing fine lines, wrinkles and scars.  This is one of our go to treatments for patients older than 40 and worried about the signs of aging.  The PicoSure laser is SAFE for ALL SKIN TYPES.  Start with sunscreen every day!  Once you have treated your hyperpigmentation to your satisfaction, you will probably need a follow treatment every 6 to 12 months depending your level of re-pigmentation.  Best of luck