Melasma Treatments

Melasma At A Glance

  • Best Results2-10 treatments
  • Treatment Recovery0-7 days
  • Procedure Time5 min
  • Skin SpecialistDermal therapist, nurse
  • Duration of ResultsMonths to years
  • AnaestheticNil Required
  • Back to WorkImmediately
  • Cost$-$$

Melasma Treatments

Melasma is a unique form of hormonal pigmentation that is mostly seen in women. Cutis Dermatology treats over 80 melasma patients per week using a combination of prescription creams, sunblock, chemical peels & special lasers. Our success rate is over 85%. Our dermatologists are capable of providing advanced treatments & cosmeceuticals to quickly, safely & cost effectively reduce pigmentation in as little as 10 days.

FactsFacts on melasma treatment

  • The cause of melasma is a mix of genetics, UV exposure & hormones
  • This is a special form of pigmentation that presents on the upper lip, around the eyes, & forehead area
  • Picosecond lasers can improve melasma within a 10 days
  • The majority of melasma can be improved with a combination of SPF, tablets, creams & laser
  • Fraxel HD is a good treatment for pigmentation, however Fraxel should not be used to treat primary cases of melasma
  • IPL often flares up melasma & should be avoided
  • Microneedling is an awesome treatment, but NOT for Melasma
  • Our specialists have over 85% success rate in treating melasma pigmentation

What is melasma?

Melasma Treatments

Melasma is also known as hormonal pigmentation or cholasma. It presents as patchy pigmentation on the forehead, under the eyes & upper lip.

Melasma is caused by a combination of genes, UV rays, and hormones. It is more common in pregnancy & may occur after taking the birth control pill.

This is Melasma. This from of pigmentation requires a different laser to treat.

Why is melasma vital to diagnose?

Melasma is a unique form of pigmentation, unlike other types of pigmentation, melasma has to be treated in a special way or treatments can worsen.

Patchy pigmentation and upper lip darkening are signs of melasma.

In most cases we can markedly improve Melasma within weeks.

What is the best treatment for melasma?

The optimal treatment will depend on the type of melasma you have. The majority of patients will have mixed melasma– this means your pigmentation lies on the surface as well as deeper in the dermal layers of your skin. The best method of treating this form of melasma is with a combination of creams, tablets & lasers.

  • Sun protection and sunscreen forms the basis of treatment. If you are sun exposed for 20 minutes without sun block, all the work you may have accomplished to fade your melasma will be undone.
  • Creams- we use a mixture of fading creams, including bleaching agents, Vitamin A, as well as Vitamin C creams.
  • Peels– our favourite peels include AHA or glycolic, VITA peels, or lactic acid peels. TCA at very low concentration can also be used. Novel peels such as Dermamelan or Cosmelan can give FAST results, however they have 4-9 days of downtime.
  • Tablets include VEGF-1 modulators
  • Lasers- I employ both nano, pico & thulium lasers. Never undertake IPL, as this often makes melasma worse.
    In over 85+% of patients we can make a significant difference in melasma pigmentation.

    Both Dermamelan & Cosmelan comes as pre-packed kits, which includes your home routine & even sunscreen.

Why is sun protection essential in the management of melasma?

Without good sun protection, even the best lasers & creams will have no chance of improving melasma. This is because the pigment cells are super sensitive to UV, visible light & infrared light sources.

A high factor SPF 50+ sunscreen is best. As a daily sunscreen I like La Roche Posay 50+ Anthelios or Invisible Zinc. For outdoor activity, Sunsense or Cancer Council makes great sunscreen.

Picosure Pro Treatment

Sunscreens only form one part of sun protection- sun avoidance and a broad brimmed hat is essential.

The correct way to use sunscreen in melasma patients is as follows-

  • Two types of sunscreen. Daily & activity.
  • Iron oxide is essential for protection against VL or visible light. Tinted sunscreens or mineral make up contain iron oxide. This is a must.
  • Use twice a day.
  • Use 2 finger lengths.

Why do some Brisbane Skin clinics treat melasma with Fraxel?

Because Fraxel laser has more profit to the provider, as each treatment ranges from $890 to $1690 per session. I do use Fraxel for resistant melasma, however as first line therapy, I prefer precision Pico lasers as they are more effective, have less side effects & cost 1/5 that of Fraxel.

What can I try at home before seeing a dermatologist?

Sun protection will give you the biggest improvement by far. Once you get this right you can try the following before seeing a dermatologist.

Fading creams: Try this combination- Azelaic acid 10-20% in the am. Superfade 2% Hydroquinone in the evening. You do not require a prescription of these creams.

The combination of correct sunscreen use & bleaching creams can reduce pigment by up to 30-50%. For further improvement, book a consult with my team of therapists & nurses at Cutis Dermatology.

This natural mix can provide good outcome, safely.

Davin’s View on Melasma Management

This is one of the hardest skin condition to treat. There is an expression in dermatology that melasma will humble even the most experienced dermatologist. My teams hit rate is about 85%, by definition we can improve the MASI or melasma area severity index by 50% or more in over 85% of cases. 

The 15% failure rate? Combination of recalcitrant disease, deep dermal melasma, poor photo protection- compliance or contraindication to topicals (sensitive skin) or medical C/I to oral t.acid.

Despite continue education to the cosmetic industry, including beautician and cosmetic GPs, hundreds of cases of IPL & Pico lasers are performed for melasma pigment. The vast majority of cases will worsen. Melasma MUST be treated medically, with lasers or peels as adjunctive therapy.

Hybrid lasers including 1570 & 1550 non-ablative lasers can treat deep stubborn melasma.

Treating melasma is a marathon & not a sprint. The most successful treatments are gentle, over a period of weeks to months. 

Not all melasma can be treated or improved. Deep melasma or dermal melasma will not improve with creams or peels. Fortunately the majority of cases are ‘mixed’, namely superficial and deep, and hence the majority of cases can be improved. The key to treating this condition is with a mixture of tablets to reduce vascular input, appropriate lasers in the correct settings, & also creams that ‘turns off’ the pigment producing cells. 

If laser is performed, it has to be gentle and not agitate the pigment cells known as melanocytes, or melasma will worsen. My laser of choice is now the pico laser, namely the Picosure Pro. A series of treatments spaced 3-4 weeks apart can yield early clearances of pigment, without a flare up. More on the Picosure Pro Series. 

We also employ shorter PD nano lasers in Brisbane & at DVP Skin Clinic in Sydney. Though they provide equally good results as Picosure Pro, they do take longer to see a reduction in pigment. I tend not to use Fraxel for this condition because of the fact that some cases can worsen with this treatment. In some cases I use the LaseMD Thulium 1927 laser with topical therapy such as t.acid. For deep melasma I also employ the 1570 Hybrid laser to help exfoliate pigment in the dermal layer. This is called the ‘melanin-shuffle’ theory.

New lasers such as Picoway & Picosure Pro has shown great promise in the treatment of melasma & sun induced pigmentation. These lasers are most useful to treat Asian or ethnic patients who have combination pigment, including Hori, freckles, sun spots, macular seb keratosis & generalised dyschromia. 

The aim of melasma treatments is to find the correct formulation for each patient & to treat them with rotational therapy. The duration of each treatment cycle is individualised. 

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