Which laser treatment works better on hyper pigmentation and melasma?

Greetings, see treatment 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 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

Laser treatments have limited efficacy unless you use topical creams such as Melarase, avoid direct sunlight, and control hormone exposure. Best, Dr. KaramanoukianLos Angeles

I recommend getting a formal evaluation with a cosmetic dermatologist. Keep in mind, 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 laser (coollaser) to get the best results. Melasma will need life-long maintenance. Hyperpigmentation also needs a combination approach and can be improved with a combination of lasers, Aerolase, microneedling/prp, skin lightening, peels, and skin care. Sun protection is essential. Don't let distance dissuade you, see an expert for a formal evaluation. Best, Dr. Emer

Although lasers have efficacy for melasma care, it is best to have a good regimen for skin care incuding topical creams along with avoiding sun exposure, consideration given to reduce hormonal exposure, if any, and using 30+ SPF sun block. I recommend the Brightening Kit from Kare Skin. 

Thank you for your question.  It's difficult to make recommendations without assessing you in-person or reviewing your photos - I would recommend that you schedule a consultation with a cosmetic dermatologist to discuss your concerns.  Melasma often requires a combination of treatments, including strict sun protection, prescription-strength skin lightening creams (like hydroquinone and Retin A), and in-office procedures like chemical peels, microneedling, and lasers.  I typically reserve lasers for patients who have not responded to other treatment modalities, as I find that in many cases the heat from the laser energy can actually exacerbate melasma.  I hope this helps.

We rarely use laser for melasma because lasers can make melasma worse. I prefer to treat melasma with creams and peels. I have had great success with this approach. 

Treating melasma with lasers can worsen the melasma. Melasma ideally should be treated with creams and chemical peels with strict sun control. 

The MOST important aspect of melasma is not the laser, it is the education and the operator behind it. I do use many laser for melsama depending on the type and the patients history- everything from Pico, to Revlite, to Pastelle, C6 and even Clear and Brilliant Permea 1927. All work well in a particular setting. 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 

the Picosure  is a more difficult laser to locate because it is newer and an expensive laser. However, it fires 1,000 times faster than other lasers. you don't get the redness that you get with an IPL, Fraxel or CO2 laser. Most people have NO DOWNTIME. You should expect to need at least 3 treatments and you need to use a sunblock when you are out in the sun.david berman md