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. 

IPL is not a good treatment for melasma since it will recur darker than before.  Fraxel is a much better option; however, you must use sun protection and fading creams as maintenance treatment or the pigment will recur.  There is no cure for melasma but it can be controlled if you avoid the sun.

Melasma is a very complicated and chronic type of skin pigmentation.  It is more common in women and particularly in people with skin that is dark or tans easily.  It can be exacerbated by pregnancy, birth control pills, heat, and especially sun exposure.  Laser can be useful, but I don't consider it the treatment of choice for melasma.  Due to the mechanism of action of each of the lasers, I feel that Fraxel is a better treatment option compared to IPL; however, there is a risk of worsening of melasma with any type of laser therapy.  My approach to treating melasma is to use daily sun protection with a chemical-free sunscreen such as zinc, a bleaching cream or combination of bleaching creams with retinoids and/or other exfoliators as tolerated, and chemical peels.  As I mentioned, melasma is a chronic condition and can not be cured by a simple procedure.  It requires maintenance to keep it under control.  All of these treatments should be supervised by a dermatologist.