- Best Results2-4 months
- Treatment Recovery0 days
- Procedure Time5 to 10 minutes
- Skin SpecialistNurse, dermal therapist
- Duration of ResultsMonths to years
- AnaestheticNot required
- Back to WorkImmediately
Lasers can be useful as adjunctive therapy for melasma. I use specific wavelengths to slowly reduce pigment production from melanocytes. Pigment inhibitors, chemical peels, vessel modifying tablets & laser wavelengths can effectively treat the majority of melasma cases. The best laser for melasma is the Picosure Pro, read more to find out why.
FactsFacts on Melasma Lasers
- Lasers are part of the multimodality approach to treat melasma
- Other super important treatment includes creams, sun protection & tablets
- Laser work by reducing the output of pigment from cell known as melanocytes
- Pico lasers work by clearing pigment in the superficial & deep layers of the skin
- Pico provide the fastest clearance of melasma, my go to is the Picoway
- In Sydney I use the CuRAS laser, Picosure is due in 2024
- I do use thulium 1927 including Fraxel, LaseMD & Clear & Brilliant as last line lasers
What is melasma?
Melasma is an extremely complex pigment disorder that has been better understood with medical science over the past decade. It affects mainly women & presents as persistent patches of pigmentation under the eyes, on the forehead, & upper lips.
The cause is multifactorial. This includes radiation (UV, visible & IR), genetics, hormones & other triggers (lasers, IPL, microneedling). The most important factor to understand is that treatments are aimed at reducing pigment output.
Are lasers the answer for treating melasma?
No, but they are very useful. The answer for treating this condition is a combination of topical creams, absolute sun protection, tablets to modulate cytokines & lasers. The target is the melanocyte (pigment cell), however the answer is addressing all the factors that contribute to increased melanin production.
Lasers such as the Picosure Pro can markedly speed up pigment clearance in most patients.
What are my commonly used lasers to treat melasma?
I prefer pico lasers over older Q switch lasers & fractional lasers for melasma.
My goto laser is the Picosure Pro.
Older lasers include the Spectra & updated Spectra Hollywood laser. I also use the C6, CuRAS (in Sydney), RevLite, & Pastelle lasers. It’s the laser parameters & way it’s delivered, and not the laser that counts.
I also use the 1927 thulium laser, namely the LaseMD, Clear & Brilliant & Fraxel Dual. For super resistant melama I may consider the pico laser. For vascular melasma I also use V Beam Prima & Perfecta.
Will lasers make my condition worse?
No, not in the usual context of primary melasma treatment. The reason is that we use conservative settings to stun the melanocytes, & not beat the living sh*t out of them.
If I use other lasers such as thulium Fraxel & pico, there is a chance I will worsen the condition. You will be warned if we need to go down this route.
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Is laser painful & what is recovery like following treatment?
No, lasers are not painful. I use lasers to stun pigment cells & not blow pigment up. Hence treatments are comfortable with zero downtime.
Picosure Pro is super comfortable, with a treatment time of 2-3 minutes.
In resistant cases of melasma, I may elect to use Thulium lasers, these require numbing & do have a recovery of 24 to 48 hours.
Can lasers be used on all skin types & colours?
Yes. In the context of lasers & melasma I am using a different setting. My aim is not to blow up the pigment, but to put your melanin producing pigment cells asleep. Hence in this setting, lasers are super safe.
With a short pulse durations, pico laser including the Picoway & Picosure Pro can safely & effectively treat pigment in all skin types.
When will I see the results from laser?
With Picosure, most patients will notice lightening at 2 weeks. The best results may take up to 10 weeks as pigment needs time to shed from the upper layers of skin.
Nano or Q switch lasers take a lot longer to notice results.
What is the cost for Pico laser melasma treatment?
Treatments are cost effective and start at only $312 (for a series of 4 sessions at $1248).
Individual pico laser sessions are $440.
*Above applies to nurse led treatments. POA for laser by Dr Davin Lim.
What other lasers are used to treat this condition?
My second line lasers include older nano Q switch lasers such as the CuRAS (in my Sydney clinic). I also use vascular lasers & yellow light lasers to treat the vascular component of melasma.
In resistant cases I use the 1927 laser, namely thulium LaseMD, Clear & Brilliant & 1927 Fraxel dual. The settings are very gentle with the primary aim directed at increasing topical absorption of HQ, T.acid & antioxidants. In truth, Fraxel is not a great laser for melasma, but an excellent one to address sun damage & solar keratosis.
Last line treatment is with the Fraxel 1550 to aid in transepidermal exfoliation of deeper dermal pigment in resistant cases.
Are pico lasers the bomb?
Picolasers are brilliant at treating most forms of pigmentation, including melasma. As compared to other lasers, the Picosure Pro gives-
- Faster results
- Safer results
- More collagen stimulation
*Even though we rock the most advanced laser systems, 20% of melasma maybe resistant to treatment.
Can LED Blue-Red-Yellow / Healite or Omnilux help clear melasma?
No. LEDs can make melasma worse. The action spectrum of melasma ranges from UVB, UVA, visible through to the IR or infrared (heat) spectrum. Light sources including LED or low level laser emission devices make melasma worse.
What are other Pico lasers that we use to treat pigment?
The intermediate wavelength of Picosure gives faster & more predictable results compared to Picoway, at least in my hands. The settings & mode of delivery is what counts when employing laser devices.
*Picoway is better for other forms of pigment such as post inflammatory hyperpigmentation, Hori & Ota pigment.
What are other more important considerations?
50 percent of pigmentation can fade with proper sun protection. This means hats, umbrellas, tinting as well as sunscreens. Use a high factor SPF 50+, minimum of four mls a day. You should use a 50ml tube within 2 to 3 weeks.
If you don’t take sun protection seriously you are wasting your time, effort and money trying to fix your pigmentation.
What is the exact science behind lasers in the context of melasma?
Lasers for melasma do one of 5 things-
- They reduce pigment transfer from the pigment cell to the skin cells. It is called selective photothermolysis, in other words putting the pigment cell to sleep & not beat the sh*t of out if.
- Increase absorption of topical creams. These creams reduce melanin output from pigment cells.
- Repair the leaky basement membrane. This establishes the barrier between the top skin (epidermis) & the bottom dermis.
- Reduce the blood vessels that communicate with melanocytes. This is the job of vascular lasers & yellow light lasers.
- Encourage trans epidermal & dermal exfoliation of pigment. This was how fractional lasers got FDA approval. It is not the brightest way of dealing with melasma, but it can be last line therapy when all else fails, especially for dermal melasma.
No. I personally love chemical peels, I use them daily, however in the context of melasma pigmentation, lasers are more precise, cost less, & are more effective. Occasionally I do use Dermamelan & Cosmelan peels in select patients.
Novel peels can give relatively faster results; however they have a higher rebound rate, cost more, & are associated with a recovery period of 1 to 2 weeks.
Are laser brands important when choosing treatment?
To a certain extent yes, but most dermatologists can work around it. Think of lasers as a pair of scissors for cutting hair. Just as long as it is sharp, the end results depend on your hairdresser.
Having said that, I firmly believe that Picosure Pro is the leading laser for the treatment of melasma.
Can I cure melasma?
No, I cannot, but chances are I can help most patients. Remission can last 4 to 18 months or longer. This is highly variable and depends on endogenous factors (your genetics) as well as exogenous factors, namely sun exposure.
*Even with the best technology, I am able to improve only 80% of melasma cases. 20% will be resistant to treatment.
What is our success rate?
About 80%. Higher success rates in primary melasma, epidermal pigment, patients who are good with sun protection.
Lower success from microneedling melasma, dermal disease. I have zero chance of improving melasma if you are not good with sunscreens.
What is the difference between IPL & pico for treatment of melasma?
IPL inevitably flare melasma pigment due to high heat. IPL (& BBL) are excellent treatment modalities for other forms of pigment.
Pico lasers work differently. They deliver powerful amounts of energy with very low heat. This enables breakup of pigment without stimulation of pigment cells.
Have you got your sunscreen application down pat?
If you are not a fan of sunscreen, don’t get your melasma treated because you will be wasting your time, effort & money. Even if you do not go out in the sun, activities of daily living will predispose you to pigment. Examples like – looking out the window, sitting next to a window, walking outside, driving & all the normal activities. Collateral UV is about.
A simple guide is – two mls or two finger lengths twice a day. This equates to 4 mls per day. A 50 ml bottle should last you 10-18 days if you are doing it right.
Who to see?
For basic pigmentation, book a consultation with my nurses.
In Sydney, consult my dermal therapist, Louise at Dr Van Park’s clinic. We have the CuRAS laser there, with Picosure coming in 2024.
Realistically, they have each treated over 2,000 cases so chances are they would have seen all melasma combinations, that includes mandibular & atypical melasma. They can also differentiate between dermal vs epidermal disease & rare causes of pigmentation. Yes, they are that good.
I do step in for complex cases where a diagnosis is in doubt, or if higher level, more complex treatments are required – about 10-20% of melasma cases.
Davin’s Viewpoint on Melasma & lasers
Lasers are useful in the management of melasma. To date, the newer picosecond lasers, in particular the Picosure Pro offer a significant advantage over older nano lasers. This means faster clearance rates & safer outcomes due to the ultra short pulse duration of these lasers. Older nano QSL using C6, Revlite, Pastelle, Spectra, Hollywood Spectra & other comparable lasers are still useful. I do believe the provide a similar outcome, albeit they take 3-5 times longer.
Treatments are conducted every 2-4 weeks, with zero downtime. To see if lasers are suitable for your skin condition, book a consultation with my nursing team at Cutis Dermatology in Brisbane, or DVP Skin Clinic in Sydney.
Though lasers are useful, they remain as adjunctive management for melasma. Medical therapy including the use of tyrosinase inhibitors & VEGF modulators are first line. Mitigation of UV, HEV & longer wavelengths of light form the foundation of melasma management.
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