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

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.