Best treatment for dermal melasma?

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

Melasma needs a combination approach to get the best improvement and will need a series of treatments. In our practice, we combine Clear + Brilliant, peels, microneedling/PRP, Aerolase, and sometimes Erbium (Cool Laser) to get the best results. See an expert for a formal evaluation. Best, Dr. Emer

Melasma is one of the most difficult skin conditions to treat as it is triggered by hormones and exacerbated by heat. What this means is that while most pigmentation issues respond well to lasers such as IPL, Melasma has a tendency to get worse after heat is exposed to the area. Here are my recommendations for treating Melasma, good luck.
------Chemical Peels- Peels such as the Melanage Peel or the Reve Peel offer safe results for patients with Melasma. A combination of acids and non-acids penetrate the skin to lift micropigmentation. You will also be sent home with an at-home care regimen to maintain your results.
-------Lasers- The safest way to treat melasma via laser is with a laser that fires in Picoseconds. This is to insure a careful heating of the skin not to further exacerbate the melasma. Here in my office we use the Piqo4 Laser by Lumenis. It is the only laser proven to treat melasma safely and effectively.Using a skin brightening topical like our Luminoso cream is great to help lighten pigmentation and promote an even skin tone.

It is important to know that melasma is a moving target and requires patience and diligence to treat.
Best,
Anil Shah

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

Thank you for your question.
Melasma is very difficult to treat and at times it may not clear completely even after treatment. You should start by using a physical block daily to prevent further pigmentation changes and darkening. If you noticed the Derm Eclat mask helped then continue with lightening topical agents to maintain, such as hydroquinone, Kocic acid and Arbutin.  Some lightening products can be aggressive, so talk to your specialist to make sure they give you the appropriate routine for use to prevent further pigmentation and promote improvement. You could also benefit from Laser Toning to help lighten the pigmentation, even out the skin one and brighten your overall skin tone. Discuss with your specialist if you would be a candidate for this laser if available and talk about risks and side effects. 
I hope this helps.
Regards,
Sheetal Sapra, MD, FRCPC

Unfortunately dermal melasma is very challenging to treat. Pico is certainly an option, however the most effective treatment is time, as well as T.Acid. Adjunctive therapy such as topical and lasers can be marginally effective.Melasma can not be completely cured, however effective treatment are possible. Melasma patients have skin that is very sensitive to UV light. Even the smallest amount can stimulate your pigment cells to produce colour. The mainstay of treatment is strict UV protection- hats, sunglasses and SPF every 4 hours. 
I prefer to use a combination of creams and laser for melasma. My most frequently prescribed topicals include hydroquinone, along with vitamin A creams and botanical extracts. The exact percentages will depend on your skin sensitivity, clinical presentation and your current skin care routine. 
I usually start my patients on a series of lasers (low dose Q switch or Picosure), along with medical therapy. Another laser I use is the Clear and Brilliant in the Permea setting. In some cases I combine glycolic AHAs, TCA low strength single coat peels, and in other cases I use a tablet called Tranexamic acid to help modulate the blood vessels that are associated with melanocytes (pigment cells). Melasma treatments should be tailored to each patient. 
All the best, Dr Davin Lim. Laser, surgical and aesthetic dermatologist. Brisbane, Australia. Cutis International 

you need to pre-treat with 4-8% Hydroquinone for 10-14 days before staring the Picosure laser. You need to use an excellent sunblock since you cannot be treated if you are tanned. you should plan at least 3 sessions, each spaced a month apart. The Picosure laser fires 1,000 times faster than any other laser, so it is very unlikely to cause hyper-pigmentation (unlike other lasers or deep peels). The Picosure laser is expensive to buy so you will only find them in plastic surgeons and dermatology offices that treat a lot of melasma. 
I have treated my own wife's significant facial hyperpigmentation with the Picosure laser with great results.david berman md