Does high frequency treatment make melasma worse or better?

Greetings, please see below for treatments. 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 heat
-Melanage peels- A variety of peels can work and melanage is one of the best for melasma
-Skin topicals- A variety of products including use of lighteners (we prefer natural lighteners such as arubtase found in our product Luminoso) as well as sunscreens can help improve the condition
-Lifestyle choices-Avoiding the sun, hormonal changes (we have a hormone expert in Dr. Chughtai in our office) can all impact melasma.
While melasma is common, patients must understand a multi pronged approach is often the best strategy and controlling this condition.
Best, 
Anil Shah MD

The studies may be limited on this question. I would suggest not doing UV treatments as it may increase your risk of pigmentation. Start with Melarase creams first. Best, Dr. KaramanoukianLos Angeles

Melasma needs a combination approach to get the best improvement. In our practice, we combine Clear + brilliant, peels, microneedling/PRP, aerolase, and sometimes erbium laser (coollaser) to get the best results. Radiofrequency is safer than laser, but i UV (ultraviolet) will make it worse.  See an expert for a formal evaluation. Best, Dr. Emer

HIFU is probably safe. However, UV radiation is not for melasma. 
Try a topical regimen like Melarase and also one of two of these oral supplements for pigmentary control: Scler-X PIH Relief Complex from VenaSmart or Pigmentation Correction Complex from KareSkin.
You will need wide spectrum UV protection with SPF 30+ sunblock as well. 
H Karamanoukian MD FACS

Depends on the wavelength. I would avoid UV, however high frequency ULTRASOUND will not worsen melasma. 
Melasma can not be completely cured, however effective treatment are possible. This is because your skin is extremely sensitive to UV and 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. Hydroquinone can be used (5-8%), along with vitamin A creams. I usually start my patients on laser (low dose Q switch or Picosure) a few weeks after they commence on creams. Another laser I use is the Clear and Brilliant in the Permea setting combined with creams.

In some cases I combine glycolic AHA peels, and in other cases I use a tablet called Tranexamic acid to help. Melasma treatments should be tailored to each patient.

All the best, Dr Davin Lim. Laser, surgical and aesthetic dermatologist. Brisbane, Australia