Is tattoo removal laser the only option for removing my melasma?

Thank you for your question.   I would recommend to start using triluma morning and night six weeks prior to laser treatment. Fractional treatment is very effective for suppressing discoloration and evening out skintone.  Skinpen which is a microneedling device that would also be beneficial for getting rid of melasma.  The microneedling treatment helps to wake up your natural growth factors, shrink your pores, fade discoloration and acne scars, and help increase collagen and elastin production. You would do a treatment every 4 weeks and stay out of the sun as much as possible and always wear spf 50 broad sprectrum.  Always consult with your physician first before starting a treatment.

Our office specializes in melasma treatment. Start with Melarase creams, apply sunscreen, avoid sun exposure, control hormone activity, and consider definitive laser treatments. Best, Dr. KaramanoukianLos Angeles

In my experience, melasma is a challenge to treat but great results can be maintained.  I suggest Pico Way laser treatments combined with hydroquinone therapy twice daily with Lytera and broad spectrum mineral based sunscreen like Elizabeth Arden Pro Factor SPF 50.Pico Way laser uses safe and gentle hollographic 3-D fractional technology to reduce appearance of pigment over the course of multiple treatments.  Pico Way also does tattoo removal and the Resolve laser facial state of the art fractional hollographic technology safely improves the appearance of pigment, lines and wrinkles.  I like to start my patients off with a microdermabrasion or VI Peel Precision Plus to prep the skin.  This, coupled with home care regimen is an excellent treatment protocol that results in happy patient outcomes.

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. I recommend getting a formal evaluation with a cosmetic dermatologist. Best, Dr. Emer

You need  PicoSure Focus lens as opposed to regular PicoSure. This treatment  is amazing and does treat melasma, but it will take a few treatment sessions as well. To find an expert in your area I recommend visiting Picosure.com or cynosure.com and locating a physician near you.  Your results will depend on the laser, how the laser is used and the experience of the physician providing it.  The laser is simply a tool and every provider has their own way of using  this tool. I am a top PicoSure provider in NYC and develop new treatment protocols and share them with Cynosure. I absolutely love this laser. It really changes lives. Hope this helps. Best, Dr.Avaliani

Referrals from your family doctor are not necessary for laser hair or tattoo removal unless you suffer from certain conditions that would require consultation with an expert as well as with your family doctor. Nevertheless, if wanting to have laser or hair removal done, it is necessary to consult an expert and have it done by certified provider. Either way, cosmetic procedure such as laser hair and tattoo removals are not covered by insurance. Best of luck! 

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. H Karamanoukian MD FACS

Dr. Obagi- pioneered treating melasma- even resistant cases. Rarely do we ever treat melasma with a laser. Sometimes- we might use this as a last resort. A good 50% of our patients see us for some type of pigmentation problem including melasma. BUT we have significant success with treating melasma. Remember, no matter what treatment you do- melasma will come back but once you get rid of it or remove enough of it- its just a matter of maintenance. Most dermatologists, unfortunately, do not understand melasma and do not know how to treat it. IN fact, from seeing so many patients with melasma, I have found that most dermatologists do not know how to use hydroquinone. I disagree with the other recommendations that are encouraging laser devices.  

You are correct that melasma is very difficult to treat. Even if the pigment is removed, it will likely come back and you would need to go through additional treatments each time. Generally speaking combination therapy works best for melasma including topical bleaching creams at home, routine chemical peels, and light based treatment (Laser/Pixel treatment and Intensed Pulse Light Therapy). It is best to have an in-office evaluation to determine your skin type and the best treatment plan for your melasma. Jumping into overly aggressive treatments can make your melasma worse. Hope this helps!Johnson C. Lee, MD Plastic Surgery

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