Fractional Laser for Melasma

The development of facial hyperpigmentation can be frustrating, as it makes us look and feel older than we truly are. Thanks to recent advancements in cosmetic dermatology, fractional lasers have become increasingly popular for treating and reducing skin pigmentation. These lasers create tiny wounds in the skin to stimulate collagen production, eliminate pigmentation, and rejuvenate the skin. In addition to hyperpigmentation, fractional lasers are also highly effective for reducing fine lines, wrinkles, acne scars, large pores, and uneven skin texture. With over 25 years of experience in cosmetic dermatology, Dr. Michele Green offers a variety of laser treatments in her dermatology practice to provide comprehensive facial rejuvenation for her patients.

Melasma is a specific type of hyperpigmentation characterized by brown or gray patches on the skin. The cause of this chronic skin condition is unknown; however, sun exposure and hormone fluctuations can trigger or worsen melasma symptoms. While melasma cannot be cured, various cosmetic procedures can help treat and manage its appearance. Though fractional lasers are excellent for treating most forms of hyperpigmentation, they are typically not recommended for the treatment of melasma, as they can worsen the condition. The best way to determine the safest and most effective treatment for your melasma is to consult with an expert dermatologist, such as Dr. Green. She will help you create a personalized combination of cosmetic treatments and topical skincare products to eliminate melasma and achieve clear, radiant skin that lasts.

Dr. Michele Green is a world-renowned, board-certified dermatologist with over 20 years of experience treating patients worldwide using non-invasive cosmetic procedures, including lasers, chemical peels, microneedling, and more. She is consistently recognized as one of NYC’s top dermatologists by Castle Connolly, Super Doctors, The New Yorker, and The New York Times for her expertise and dedication to her patients. Dr. Green adopts a holistic approach to cosmetic dermatology, tailoring each treatment plan to the patient’s specific skin type, tone, and concerns. When you consult with Dr. Green at her private dermatology practice in Manhattan’s Upper East Side, she will collaborate with you to develop a personalized treatment plan aimed at achieving clear, healthy-looking skin.

What is a fractional laser for the face?

A fractional laser is a cosmetic treatment that uses laser technology to rejuvenate the skin. Fractional lasers emit light energy in many targeted beams that penetrate the inner layers of the skin. This controlled thermal trauma stimulates new collagen production and reduces pigmentation in melanocytes, or skin cells that contain melanin pigment. Fractional lasers can be either ablative or non-ablative. Ablative lasers, like CO2 lasers, remove the epidermal layer of skin to stimulate collagen and eliminate pigmentation. These lasers are highly effective but require longer recovery times and carry a higher risk of side effects, including hyperpigmentation, hypopigmentation, and scarring. Non-ablative lasers, such as Fraxel or Clear + Brilliant, deliver laser energy to the deeper layers without damaging the epidermis, resulting in skin rejuvenation with minimal downtime and side effects. While non-ablative fractional lasers generally produce more gradual results than ablative ones, Dr. Green often prefers them because they can create clear, radiant skin with fewer risks of adverse effects.

What are fractional lasers used for?

Fractional lasers can treat a variety of skin issues, including:

• Hyperpigmentation
• Fine lines and wrinkles
• Mild skin laxity
• Uneven skin texture and tone
• Sun damage
• Enlarged pores
• Acne scars
• Surgical scars
• Stretch marks

What are some popular fractional lasers for the face?

Fraxel Dual Laser

The Fraxel Dual laser is often called a “magic eraser” by Dr. Green because of its ability to treat many skin concerns effectively. The ‘Dual’ part of this fractional laser’s name refers to the two lasers it uses: a 1550nm Erbium laser to address uneven skin texture, fine lines, wrinkles, acne scars, stretch marks, and enlarged pores, and a 1927nm Thulium laser to target sun spots, age spots, and discoloration from sun damage. During treatment, the laser delivers fractional energy deep into the dermis to stimulate collagen production and break up pigmentation. The Fraxel Dual is a non-ablative procedure, meaning the skin’s top layer stays intact afterward. Patients usually experience mild redness and swelling for 48 hours after treatment and often need three to five sessions spaced one month apart to achieve optimal cosmetic results.

Clear + Brilliant Laser

The Clear + Brilliant laser is another excellent non-invasive, non-ablative fractional laser used to treat fine lines, wrinkles, mild acne scars, enlarged pores, and uneven skin texture and tone. Similar to the Fraxel laser, Clear + Brilliant delivers fractionated energy to the skin’s dermal layer to stimulate new collagen production and revitalize the skin. The Clear + Brilliant laser is sometimes called a “mini-Fraxel” because it creates similar results, but the treatment is more gradual and has no associated side effects. Patients may need four to six treatments to achieve optimal results, depending on their specific skin concerns.

Fractional CO2 Laser

Traditional CO2 lasers rejuvenate the skin by vaporizing the outer layer, which increases collagen production and accelerates skin cell turnover. The fractional CO2 laser targets specific, controlled areas of the skin, treating only a portion at a time. However, because a fractional CO2 laser still removes layers of skin, the side effects and recovery times are usually longer than those of non-ablative fractional lasers like Fraxel or Clear + Brilliant. Fractional CO2 laser resurfacing is often used to address sun damage, fine lines, wrinkles, acne scars, surgical scars, mild skin laxity, uneven skin tone, hyperpigmentation, and stretch marks. Generally, fractional CO2 lasers are not recommended for people with darker skin tones due to the higher risk of side effects such as hyperpigmentation.

Picosecond Lasers

A Picosecond laser is a laser that delivers thermal energy to the skin with pulse durations of only a few picoseconds. The pulse duration can be tailored to suit the patient’s specific skin concerns, type, and tone. Picosecond lasers can treat a wide variety of skin concerns, including hyperpigmentation, signs of aging, and unwanted tattoos. Picosecond lasers induce a photomechanical effect in the skin, which destroys pigmentation and stimulates collagen production. Picosecond lasers can be fractional, treating a portion of the skin at a time to minimize heat damage and reduce downtime and side effects. Fractional Picosecond lasers often utilize 532 nm (Nd: YAG), 755 nm (Alexandrite), and 1064 nm (Nd: YAG) wavelengths for skin rejuvenation.

What are the side effects of fractional laser treatments?

Side effects can vary between fractional laser treatments and depend mainly on whether the laser is non-ablative or ablative. Non-ablative lasers are typically associated with minimal side effects, including mild redness or swelling that resolves soon after treatment. Ablative lasers are often associated with more side effects, including redness, swelling, tenderness, and pain. Due to their more aggressive nature, ablative lasers can also result in erythema, post-inflammatory hyperpigmentation (PIH), hypopigmentation, scarring, and burns if the wrong laser or settings are used. Additionally, patients with darker skin tones or Fitzpatrick skin types III or greater must be very careful when considering fractional laser treatments, as these patients are at an increased risk of developing unwanted and adverse side effects post-treatment. When deciding on a fractional laser treatment, it is always best to consult with a board-certified dermatologist such as Dr. Michele Green in NYC to ensure that your treatment is both safe and effective.

What is melasma?

Melasma is a skin condition characterized by brown or gray patches. These often appear on the cheeks, nose, upper lip, and forehead, but can also show up on the neck and forearms. Although the exact cause is still not fully understood, sun exposure and hormonal changes are known triggers. UV rays can stimulate melanocytes to produce excess melanin, leading to melasma patches. Even after treatment, small amounts of sun exposure can cause the condition to return. Hormonal fluctuations, especially those involving estrogen and progesterone, are key factors in melasma development. Many women notice their melasma worsens or appears during pregnancy or while using oral contraceptives, hormone therapy, or hormonal IUDs. Unlike other types of hyperpigmentation, melasma is a chronic condition with no current cure. However, various non-invasive cosmetic treatments can improve existing melasma and help prevent future outbreaks. When you see Dr. Green at her private NYC dermatology practice, she will assess your skin type, tone, and the severity of your melasma to create a personalized treatment plan aimed at helping you achieve clear, radiant skin that lasts.

How effective is laser treatment for melasma?

Laser treatments can be highly effective for addressing hyperpigmentation, including sun spots, freckles, age spots, and pigmented birthmarks. However, using lasers for melasma is not always recommended. Although melasma is a type of hyperpigmentation, it responds to laser therapies very differently compared to other forms of hyperpigmentation. When fractional lasers are used to treat melasma, the heat delivered to the skin can cause the melasma pigment to become more deeply embedded, worsening its appearance. Additionally, melasma can be very challenging to treat after improper laser procedures. Some studies currently suggest that nd: YAG lasers and low-fluence Q-switched lasers may be effective for melasma, but many of these studies have small sample sizes and often focus on patients with lighter skin tones.

Some lasers can effectively treat melasma. The VBeam laser is a pulsed dye laser that can eliminate red pigmentation in the skin. It is also highly effective in reducing post-inflammatory hyperpigmentation and inflammation linked to melasma. The Clear + Brilliant laser is a gentle fractional treatment that can reduce hyperpigmentation and improve skin texture. Both the VBeam and Clear + Brilliant lasers can be safely used on patients of all skin types and tones, including those with darker skin tones.

What are the best treatment options for melasma?

When treating melasma, it is crucial to consult with a board-certified dermatologist like Dr. Green, who has the expertise to select the best treatment modality for your skin type, tone, and the severity of your melasma. Dr. Green frequently uses Cosmelan peels, Mesopeels, and microneedling, which provide safe and effective results for patients of all skin tones. Often, a combination of treatment methods and over-the-counter topical treatments works best to clear melasma dark spots. During your consultation at her private Upper East Side dermatology office, Dr. Green will evaluate your skin type, tone, and pigmentation to develop a personalized treatment plan that can leave you with clear, radiant skin that lasts.

Cosmelan peel for Melasma

A Cosmelan peel is a professional, medical-grade treatment designed to reduce melasma and other types of skin pigmentation. It has been shown to be an effective option for treating melasma, especially in cases that haven’t responded to other cosmetic approaches. In clinical studies, the Cosmelan peel reduced patients’ Melasma Area Severity Index (MASI) scores by 67% in just 90 days, leading to very high patient satisfaction. The peel involves two steps: first, Dr. Green applies the Cosmelan 1 mask, which is left on for a time determined by Dr. Green based on your skin type, tone, and melasma severity. The second step includes using specially formulated skincare products from the Cosmelan line, such as the Cosmelan 2 depigmentation cream, Melan Recovery moisturizer, and Melan 130+ Pigment Control sunscreen. Patients return to Dr. Green’s office one month after the initial application for a follow-up, and another application of Cosmelan 1 may be done if needed. Afterward, patients should continue using the Cosmelan skincare products for several months to preserve and further improve their results. Cosmelan is safe for all skin types and tones and can help anyone with melasma achieve clear, radiant skin.

Mesopeels to help treat melasma

Mesopeels are specially designed skin peels that target hyperpigmentation. They contain skin-lightening agents like tranexamic acid, kojic acid, and azelaic acid, which help boost skin cell renewal and control melanin production for a clearer, brighter complexion. Mesopeels are safe for all skin types and tones, including darker skin. They can be applied to various areas of the body, such as the neck, chest, back, inner thighs, and buttocks. Since results come gradually, most patients need a series of five to six peels spaced about a month apart to achieve the best results.

Chemical peels for melasma

A chemical peel is a non-invasive cosmetic treatment that enhances skin tone and texture. During the procedure, a chemical exfoliant is applied to boost cell turnover, removing dead, pigmented skin cells to uncover healthy, bright cells at the surface. Chemical peels vary in strength and formulation and can be customized to a patient’s specific skin tone, type, and concerns. Multiple treatments are typically needed to achieve the best results for patients with melasma. When choosing a chemical peel for melasma, it is crucial to consult with an expert like Dr. Michele Green, as many peels may not be safe for darker skin tones.

VBeam laser to treat melasma

The VBeam laser is a pulsed dye device that targets red pigmentation on the skin, such as facial redness, rosacea, broken capillaries, spider veins, and red scars from acne or stretch marks. It also effectively reduces redness and inflammation caused by conditions like melasma and post-inflammatory hyperpigmentation. The laser operates at a 595nm wavelength to specifically break down red pigments. During treatment, only the targeted areas are affected, with no damage to the surrounding skin, resulting in no downtime. Usually, 4 to 6 treatment sessions spaced about a month apart are recommended for optimal results.

Microneedling with depigmentation serum for pigmentation

Microneedling, also called collagen induction therapy, is a non-invasive cosmetic treatment that uses tiny, surgical-grade needles to create microscopic channels in the skin. This triggers the body’s natural wound-healing response, speeds up skin cell turnover, and encourages new collagen production. By increasing collagen, microneedling can improve skin tone and texture, leading to noticeable rejuvenation. The microchannels also boost the skin’s ability to absorb products applied topically. To treat conditions like melasma and hyperpigmentation, Dr. Green applies a specially formulated depigmentation serum with key skin-lightening ingredients to reduce dark lesions and brighten the complexion. Microneedling involves minimal downtime, and patients usually need a series of treatments spaced about a month apart for the best results.

Oral tranexamic acid to treat melasma

Melasma patients who do not respond to topical treatments may consider adding oral tranexamic acid to improve their results. Tranexamic acid has traditionally been used as a topical treatment for melasma or as an oral medication for heavy or painful periods. Recent studies indicate that oral tranexamic acid could help reduce melanin production, inhibit melanocyte activity, and prevent melanin transfer to skin cells. Since oral tranexamic acid is prescribed off-label for melasma, it’s important to consult with a board-certified dermatologist like Dr. Green in NYC to determine if you are a good candidate.

Which skincare products are best for melasma?

Using the right skincare products is a vital part of any melasma treatment plan, as topical products can help treat melasma patches and prevent their recurrence. Additionally, skincare products can help maintain and boost the results of in-office treatments. Dr. Green’s proprietary skincare line, MGSKINLABs, offers a wide range of products designed to address various skin concerns, including melasma and hyperpigmentation. When you consult with Dr. Green, she will evaluate your skin concerns and develop a skincare routine to help you achieve clear, radiant skin.

Sunscreen is the first line of defense for anyone dealing with melasma. UV rays can trigger and worsen melasma and even cause dark spots to reappear after successful treatment. Patients should protect their skin from sun exposure, especially during laser treatments or chemical peels that make the skin more sensitive to light. Melasma patients should always use a broad-spectrum sunscreen with at least SPF 50 and reapply every 90 minutes or after water exposure. They should also wear a wide-brimmed hat, sunglasses, and sun-protective clothing outdoors to minimize sun exposure. For optimal protection, Dr. Green recommends layering physical and chemical sunscreens. Physical sunscreens, containing zinc oxide or titanium dioxide, create a barrier on the skin. Chemical sunscreens, with ingredients like homosalate, avobenzone, and octinoxate, absorb UV rays and convert them into heat. The Hydrating SPF 50 from MGSKINLABS is an excellent physical sunscreen with zinc oxide, along with hyaluronic acid and lactic acid to hydrate and soften the skin.

Hydroquinone is a skin-lightening agent that works by disrupting melanocytes and decreasing melanin production. It was previously available over the counter but now requires a prescription following a 2021 FDA ruling, and it should be used under the supervision of a board-certified dermatologist like Dr. Green. Patients should also avoid sun exposure because hydroquinone increases skin photosensitivity.

Some melasma patients may also benefit from topical retinol and retinoids. These vitamin A derivatives accelerate skin cell turnover, shedding dead, pigmented cells to reveal healthy, brighter ones on the skin’s surface. Over-the-counter retinols are available, while retinoids must be prescribed by a board-certified dermatologist. MGSKINLABs’ Essential Antioxidant Infusion is an excellent retinol for melasma treatment, infused with essential vitamins and nutrients to rejuvenate the skin.

Vitamin C is another powerful ingredient used to treat melasma. This antioxidant helps boost skin cell turnover, promotes collagen production, and protects the skin from free radical damage and harmful UV rays. The Vita-C Serum from MGSKINLABs contains a high concentration of vitamin C to even out skin tone and revitalize the skin.

Is melasma treatment permanent?

Melasma is a chronic skin condition that causes brown or grey patches or spots on the skin and is not curable. In-office procedures and topical skincare products can help lighten pigmentation and reduce the appearance of melasma patches; however, sun or UV exposure after treatment can cause melasma to return. After successful melasma treatment, it’s important to protect your skin from sun exposure to prevent recurrence and to maintain long-lasting results.

Is a CO2 fractional laser good for melasma?

No, it is not recommended to have a CO2 fractional laser treatment for melasma, as the heat from fractional lasers can entrench the pigmentation deeper into the skin, worsening the appearance of the melasma and making it harder to treat. Some current research has suggested that fractional CO2 laser treatment at a lower power in combination with a YAG laser may be effective in reducing pigmentation. However, these studies are often performed using very small sample sizes. Additionally, many other split-face, double blind studies have found CO2 lasers to be ineffective for treating melasma.

Can Fraxel laser make melasma worse?

Yes! Fraxel is a non-invasive laser that treats various skin issues, such as fine lines, wrinkles, uneven texture, acne scars, sun damage, sun spots, and discoloration. However, the Fraxel laser is not suitable for melasma and can worsen melasma patches. The fractionated energy delivered to the dermis by Fraxel can exacerbate the condition and increase hyperpigmentation, especially in patients with darker skin tones. Additionally, improper Fraxel treatment on melasma can push the pigmentation deeper into the skin, making it more difficult to treat later.

Is IPL laser treatment safe for melasma?

Intense Pulsed Light therapy (IPL), also known as photo rejuvenation, is a non-invasive cosmetic procedure that uses multiple wavelengths of light to target signs of photoaging, including fine lines, wrinkles, sun spots, uneven skin tone and texture, broken blood vessels, and skin laxity. IPL employs photothermolysis technology to focus light absorption on pigmented cells or tissue, destroying them. Usually, IPL is not recommended for treating melasma because the treatment can worsen its appearance and make it more prominent. Research indicates that while IPL may initially improve melasma, it can also cause post-inflammatory hyperpigmentation and repigmentation in the treated area (Dermatol Surg, doi: 10.1111/j.1524-4725.2004.30371). Dr. Green also observes that melasma becomes much harder to treat after improper IPL treatments, as the pigmentation becomes deeply entrenched in the skin. Instead, Dr. Green suggests using chemical peels like the Cosmelan peel or targeted topical creams and skincare products that are proven to be safe and effective for treating melasma.

What is the cost of laser treatment for pigmentation?

The cost of laser treatments for pigmentation depends on several factors, including location, the type of laser used, the size of the treated area, the number of sessions needed, and the experience of your healthcare provider. When choosing a laser treatment for hyperpigmentation, it’s important to consult with an experienced, board-certified dermatologist such as Dr. Michele Green in NYC. While treatments at a Med Spa may be more affordable, Dr. Green has the expertise to select and perform your laser procedure safely and effectively, reducing the risk of side effects. During your consultation, Dr. Green will assess your treatment area and recommend the most suitable laser treatments or other cosmetic options based on your skin type, tone, and pigmentation. At that point, an estimated cost can be provided.

Which laser is best for melasma?

Unfortunately, many lasers are not ideal for treating melasma. While Fraxel, CO2, and IPL lasers can reduce sun spots, age spots, and other hyperpigmentation, they might actually worsen melasma pigmentation within the skin. Improper laser treatments for melasma can lead to side effects such as increased hyperpigmentation, burns, and scarring. Once laser treatment has been done, melasma can become even more difficult to remove. Two lasers effective for treating melasma are the VBeam and the Clear + Brilliant. The VBeam is very good at reducing post-inflammatory hyperpigmentation and redness or inflammation related to melasma, while the Clear + Brilliant can help gradually lighten pigmented spots. However, Dr. Green often uses Cosmelan peels, Mesopeels, or microneedling to treat melasma safely and effectively without worsening hyperpigmentation. Melasma treatment is challenging, and no single method is best for every patient or skin type. During your initial consultation, Dr. Green will examine the area and create a personalized plan that is safe and effective for your specific skin type.

How to get started with effective melasma treatment today

Melasma is a persistent skin condition that can be very difficult to treat and manage, even with in-office procedures and targeted over-the-counter skincare. While fractional lasers can treat various types of hyperpigmentation, they are not suitable for melasma. Often, these lasers can trigger its development, worsen existing patches, and make them more challenging to treat. Instead of fractional lasers, Dr. Green uses Cosmelan peels, Mesopeels, microneedling, and active skincare ingredients to provide safe and effective melasma treatment with minimal downtime and no side effects. With many options available, it can be hard to determine which treatments will best meet your needs. When you consult with Dr. Green in NYC, she will help you create a personalized melasma treatment plan focused on helping you achieve a clear, radiant, melasma-free complexion.

Dr. Michele Green is a world-renowned, board-certified dermatologist with over 25 years of experience treating patients worldwide with innovative, non-invasive cosmetic procedures for melasma, including Cosmelan peels and Mesopeels. She is consistently recognized as one of New York’s top dermatologists by Castle Connolly, Super Doctors, New York Magazine, and The New York Times, thanks to her expertise and dedication. Dr. Green takes a holistic approach and follows a less-is-more philosophy for facial rejuvenation, tailoring each patient’s treatment plan to their individual needs and aesthetic goals. To schedule a consultation with Dr. Green and learn more about the best treatment options for melasma, please contact us online today or call our New York City-based dermatology office at 212-535-3088.