- 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.
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
- Contrary to popular belief, shedding of pigment is not the primary aim of laser
- My favoured lasers include nanosecond Spectra, Spectra Hollywood, C6 & Revlite
- Pico Lasers including Picoway & Picosure are not the answer to melasma
- 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.
What are my commonly used lasers to treat melasma?
In the vast majority of times, I prefer nano lasers over pico & fractional lasers for melasma.
My goto QSL is the Spectra & updated Spectra Hollywood laser (don’t laugh, I know it’s a corny name). I also use the C6, 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.
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.
What other lasers are used to treat this condition?
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.
Are pico lasers the bomb?
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.
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.
Why does Picosure flare up most cases of melasma?
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.
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.
Are peels better than lasers for treating 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.
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.
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.
What is our success rate?
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.
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. 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.
Davin’s Viewpoint on Melasma & lasers
Lasers are useful in the management of melasma. To date, the older nano lasers offer a significant advantage over newer pico lasers. I don’t think pico is the way, at least at the time of writing (2022). There may be newer settings & wavelengths in the future. The most important concept to understand is that lasers are not employed to destroy pigment or pigment cells. If you use lasers in this role, melasma will definitely get worse.
Nano QSL using C6, Revlite, Pastelle, Spectra, Hollywood Spectra & other comparable lasers still offer the best ‘bang for your buck’, with very little risks & costs.
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.
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