Is Fraxel or Picosure more effective in the treatment of melasma? (photos)

Thanks for your question and posting pictures.  Melasma is one of the most difficult things that we treat.  There is not one treatment that works on everyone.  Your skin is extremely photosensitive.  Sometimes, the melasma gets worse and we have to try a different approach.  Based on your apparent skin type, we would probably recommend a series of IPL PhotoFacials or PicoSure FOCUS and/or Flat Lens treatments.  Either treatment would be better tolerated and less downtime than a Fraxel 1540.  Find an experienced provider that has multiple options.  Best of luck.

PicoSure is considered the new gold-standard in treating melasma. The unprecedented speed in which the PicoSure fires significantly limits the amount of heat build up in the skin while still shattering and eliminating pigment. This is just one key advantage in treating melasma, as the build up of heat with most lasers, Fraxel included, can actually be a trigger for the condition.
Fortunately, the PicoSure is also significantly more comfortable than the Fraxel, needing no topical numbing with the use of cryo cooling, and in most cases is more affordable, ranging from $450-$600 per session. There is also no downtime -- just minimal pinkness to the skin for less than 24 hours. You can expect noticeable improvements after a single session, but optimal results likely in 2-4 treatments.
I highly recommend PicoSure for the treatment of melasma in patients of all skin types. I would recommend a consultation with a Board Certified Plastic Surgeon or a provider who is experienced in the treatment of melasma with PicoSure. Be sure to ask for and see before and after photos of patients he or she has treated, because this is a very delicate condition to address safely and effectively with laser therapy.