No, lasers are not painful. I use lasers to stun pigment cells & not blow pigment up. Hence treatments are comfortable with zero downtime. 

In resistant cases of melasma, I may elect to use Thulium lasers, these require numbing & do have a recovery of 24 to 48 hours

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.

My second line laser is a pico (see below). 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.

Last line treatment is with the Fraxel 1550 or Hybrid 1570 to aid in transepidermal exfoliation of deeper dermal pigment in resistant cases. This is termed the melanin shuffle.

Pico lasers are useful to treat PIH or post inflammatory hyperpigmentation. They are useful in darker skin types, especially Asian, Latino & Middle Eastern skin, in the context of photo rejuvenation.

Pico lasers can be used to treat melasma, however in my hands nano lasers give more predictable results, with less side effects, downtime & costs. Just for reference I have & am using pico lasers for the past 7 years, so I am not against them.

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.

Picosure especially has focused on aggressive marketing of their laser. This means this device is sold to anyone. I do like the device for addressing mixed pigmentation as it can give good results in non-melasma patients.

Used incorrectly, or without pigment inhibitors, Picosure can worsen most cases of melasma. The same goes for any laser. The settings & mode of delivery is what counts when employing laser energy.

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.

Lasers for melasma do one of 5 things-

1. 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.
2. Increase absorption of topical creams. These creams reduce melanin output from pigment cells.
3. Repair the leaky basement membrane. This establishes the barrier between the top skin (epidermis) & the bottom dermis.
4. Reduce the blood vessels that communicate with melanocytes. This is the job of vascular lasers & yellow light lasers.
5. 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.

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.

The most important aspect of lasers for melasma is consistency with power delivery & not absolute or peak power. Powerful lasers flare up this condition. Hence the marketing of Picoway is irrelevant.

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.

About 80 to 90%. 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.

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.

For basic pigmentation, book a consultation with my nurses. You will save a consultation fee. 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.