What Works Better or Best for Malasma? IPL or Fraxel?

Hello Russ.  We do not agree with either one of the practitioners you have visited.  Lasers and IPL are expensive, time consuming and often lead to worsening of the condition.  We have run trials with Q-switched lasers and many of them have gotten worse.  We have heard the same from patients regarding IPL and Fraxel.  While short term results may be achieved, Melasma cannot be cured and so expensive laser treatments are a worse option than hydroquinone.

Hydroquinone is the standard for treating Melasma, but there are better products than others.  We use 8% hydroquinone in a solution form applied with cotton pads.  The product works very well even for severe Melasma.  We limit our patients to 3 months consecutive use before a 1 month break.  Results of this type of treatment can be seen at the link below.  

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 (Cool Laser) to get the best results. See an expert for a formal evaluation. Best, Dr. Emer

I usually do not recommend the IPL or Fraxel laser as first line treatment for melasma.  In my Los Angeles office, I treat melasma with a combination of creams (Melarase AM and Melarase PM) followed by once monthly MelaPeels.