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

Hello and thank you for a great question.  I can tell you that Melasma is notoriously difficult condition to treat , whether it;s lasers or medications.  I will provide my unbiased expert opinion because I happen to offer both Fraxel and PicoSure treatments to my patients.   PicoSure most definitely gives much better results, is virtually pain free and has almost no downtime (1-3 hours of redness! thats it).  Over the past 2 years it has become my most favorable laser to treat melasma due to it's high safety profile as well as amazing results I can get with fewer treatment sessions compared to other laser.  When I offer both options to my patients, they all opt out for PicoSure and are left very very happy.  Melasma treatment can take up to 4 or more sessions to treat but it will most definitely improve overall skin quality in addition to getting rid of pigment or at least lightening it.  When choosing a provider you must choose someone that does this treatment al the time and can tell you an honest opinion with their expertise.  Looking at your pictures above I can say that PicoSure Focus treatment is absolutely the right treatment for you.  Hope this helps.  Best, Dr.Avaliani

Hi KSW.  You mentioned that Fraxel got rid of the Melasma, but it's back again.  This is the primary issue with Melasma is that it is not curable and will often come back when left untreated.  For this reason, we do not recommend lasers.  Lasers are a more expensive option and have yielded worse results for our patients.  We have used q-switched lasers (like the Pico) and fractional lasers (we use the Sciton Profractional), but they have not compared to the results we get with the 8% hydroquinone gel, which is much cheaper and easier to use for our patients.  To see examples of the before and after photos of topical products and melasma only (no laser), click on the link below.  

Thank you for your photos. PicoSure could be a good option for you. The PicoSure laser is very effective and works quicker than other laser skin treatments. The PicoSure laser is FDA-approved, gentle on your skin and works by sending ultra-short pulses of laser energy into the outer and inner skin layers. Please make sure you seek treatment from a board-certified dermatologist. 

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.