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Developing dark patches on your skin can be both frustrating and alarming. Despite our daily use of sunscreen, sometimes sun spots, age spots, hyperpigmentation, and melasma seem unavoidable. The damaging effects of ultraviolet light can lead to the appearance of dark patches of skin even despite our best attempts at limiting sun exposure. Many of us have tried an array of topical skin lightening products such as tretinoin, hydroquinone, and varying other forms of skin care in order to remove the brown patches which characterize facial melasma.

Melasma is one of the most common skin conditions associated with brown or gray-brown patches of skin that are darker than the rest of the face. The dark patches of skin that are related to melasma are typically found on the forehead, cheeks, and the upper lip. Melasma has been found to be linked to an overproduction of melanin in concentrated cells of the skin via melanocytes (melanin-producing cells). This skin condition can be exacerbated or triggered by a variety of factors. Regardless of gender, skin tone, and skin type, patients with melasma often tend to feel self-conscious about the cosmetic appearance of concentrated pigment patches. Thankfully, Dr. Green provides the best in-office treatments which can help to diminish the appearance of melasma, including chemical peels, Mesopeels, Dermamelan, and Cosmelan peel treatments.

If you’re frustrated by the appearance of melasma or other forms of hyperpigmentation, board-certified cosmetic dermatologist, Dr. Michele Green, is here to help. Dr. Green is an expert when it comes to treating melasma and hyperpigmentation, with over two decades of experience helping her patients to achieve clear, smooth, even-toned, beautiful skin. Dr. Green is consistently voted one of the best cosmetic dermatologists in NYC for her skin rejuvenation treatments, including chemical peels, laser treatments, cosmetic injectables, and non-invasive skin tightening procedures.

What causes melasma?

Unfortunately, the exact cause of melasma is still unknown. Melanin is the component of skin which is responsible for pigment. Melanocytes are the skin cells which are responsible for producing melanin. Melasma has been found to occur when melanocytes are overstimulated and produce too much melanin. The result is the appearance of blotchy, discolored patches of skin which are darker than the rest of the face. Melasma patches typically appear on the forehead, upper lip, and cheeks. While the underlying cause of melasma is unknown, there are some groups of people who tend to be more affected by the appearance of melasma than others. The majority of those who struggle with the appearance of melasma are women. While there are men who may experience melasma, according the American Academy of Dermatology, just 10% of individuals who develop this skin condition are men.

Melasma is also more commonly found in those who have a light to medium brown skin tone (Fitzpatrick skin types III and IV) and darker skin tones (Fitzpatrick skin types V and VI), than those patients who have fairer skin tones. This is due to the fact that there are more melanocytes present in brown skin, meaning that there is a greater potential for making a larger amount of melanin than there is in lighter skin. Additionally, those who have a family history of melasma or facial hyperpigmentation are more likely to develop this skin condition. A family history of pigmentation or melasma indicates that there may be a genetic component involved in developing melasma.

While there has yet to be a precise, identifiable cause of melasma, there are some factors that contribute to an increased likelihood of developing the notifiable dark patches of melasma on the skin. Exposure to the sun and fluctuations in certain hormones are two of the largest contributing factors to the onset of melasma.

Sun exposure is by far the most common trigger in regard to the onset of facial melasma. Ultraviolet light, both the UVA and UVB rays from the sun, stimulate the melanocytes to produce more melanin. This is one of the many reasons as to why it is so important to practice complete sun protection and use a broad spectrum sunscreen daily, with an SPF of 50 or higher. It is also critical to avoid the damaging effects of these UV rays in order to best prevent the recurrence of melasma after it is treated. Even small amounts of sun can cause a recurrence of your melasma.

Hormones that are in flux, particularly a surge in the levels of the female sex hormones, estrogen and progesterone, have also been linked to the development of melasma. It has been found that the use of birth control pills, oral contraceptives, pregnancy, and hormone replacement therapy can all cause melasma to flare, since they impact estrogen and progesterone levels in the body. This is why melasma is often referred to as the mask of pregnancy, due to the increased amount of melanin and hyperpigmentation occurring on the faces of pregnant women. Dr. Green often recommends discontinuing oral contraceptive pills in patients with melasma in order to improve the appearance of this skin disorder.

Thyroid disease and melasma have also been shown to be linked. Currently, it is thought that thyroid disease may be a cause of melasma in some patients, as many patients with melasma are also diagnosed with thyroid disease. Studies have shown an elevated serum TSH, and anti-thyroid peroxidase, and anti-thyroglobulin antibodies in patients who are suffering from melasma. In fact, the frequency of thyroid disease is four times higher in patients with melasma compared with the general population.

Cosmelan: 10 weeks before & after

Laser and Melasma

Melasma should be approached in a different manner than other varieties of facial hyperpigmentation. Too often, patients have laser treatments to try and remove melasma, only to result in worsening the appearance of the melasma and hyperpigmentation. Melasma can be even more difficult to remove after a laser has been used to treat it. This is because the laser causes the hyperpigmentation to become even more entrenched in the deeper layers of the skin.

Dr. Michele Green specializes in treating patients whose melasma and hyperpigmentation have been worsened by ablative and non-ablative laser treatments. Dr. Green prefers to treat melasma with Mesopeels, chemical peels, VBeam laser treatment, and Cosmelan peels in order to prevent any exacerbation of the already existing hyperpigmentation. Cosmelan treatment was initially developed to treat melasma exclusively, however, Dr. Green has expanded its use to incorporate the peel into the treatment of acne scars, post-inflammatory hyperpigmentation (PIH) from lasers, sun spots, sun damage, and other discoloration on the face, neck, chest, back, and other areas of the body, including the arms and legs.

Do Birth Control Pills Cause Melasma?

Hormones, and specifically the female hormones estrogen and progesterone, have been linked to the development of melasma. Oral contraceptives commonly contain these hormones in order to aid in the prevention of pregnancy, and may contribute to the development of melasma. Melanocytes (the skin cells which are responsible for producing melanin), as a result of increased levels of estrogen and progesterone, increase in number and make one even more sensitive to the ultraviolet rays of the sun.

While the sun’s UV rays trigger melanocytes to produce more melanin, other factors such as medications and other hormonal imbalances, can worsen melasma. Additionally, the hormones that are the basis for oral contraceptives are involved in direct exacerbation of melanocytes, working to increase the total amount of pigment produced. This results in the overproduction of melanin and the appearance of hormone-related melasma.

Discontinuing the use of oral contraceptives often helps to lighten existing melasma and improve your clinical appearance. Non-hormonal methods of birth control are much less likely to trigger the development of melasma. It is always important to use sunscreen while on birth control pills as this medication, like other photosensitizing medications, can exacerbate underlying pigmentation.

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Cosmelan 11 months before and after

Does Melasma Go away? Is Melasma Permanent? 

Will melasma ever go away on its own? Or is it there to stay? The answer varies from patient to patient, depending largely on what triggered the onset of the melasma and its development. For patients who experience melasma during pregnancy or as a result of taking oral birth control pills or other hormonal therapies, melasma may naturally subside either after pregnancy or once the hormonal medications have been stopped, respectively. However, for many patients, melasma is a condition that will require some type of treatment intervention in order to fully resolve the patches of hyperpigmentation on the skin. If you are seeking a solution to the appearance of your melasma, Dr. Green can help.

Is Melasma Curable? How to Cure Melasma Permanently?

Melasma is treatable, not curable. The melanocytes in the skin which produce melanin have memory. If the melanocytes are triggered, they will return to the overproduction of melanin, resulting in the reappearance of the melasma. For this reason, strict sun avoidance is imperative for individuals who have been treated for dark patches of melasma. Melasma treatment is an investment, and since melasma is not permanently curable with any combination of products and treatments, prevention is the best method for keeping melasma at bay.

What is the Best Treatment for Melasma?

Since melasma can be an incredibly challenging skin condition to address, one of the best treatments for melasma is preventative treatment. Preventative treatment typically comes down to avoiding too much sun exposure and discontinuing the use of any medications and skincare products that may be contributing to melasma. These methods of prevention can help stop the development of melasma as well as age spots, sun spots, and other forms of hyperpigmentation. Dr. Green always recommends wearing a daily broad-spectrum sunscreen with an SPF of 50 or higher. The best way to prevent the formation of unwanted pigmentation and signs of premature aging, as well as to lower the risk of developing skin cancer, is to protect the skin from the sun’s harmful UV rays.

When unwanted melasma or hyperpigmentation does appear on the skin, the best treatment available is often a unique combination of topical treatments and in-office procedures. Dr. Green takes the time to develop a custom treatment plan to appropriately and effectively treat your melasma, incorporating specialized skincare routines and non-invasive treatments to reduce the appearance of the melasma and prevent any further hyperpigmentation. When you work with Dr. Green, she will carefully assess your medical history, evaluate your current skin condition, and create a comprehensive treatment plan that serves your individual needs and goals.

There are a number of different treatment options available for treating the appearance of melasma. Topical skin lightening products, chemical peels, microdermabrasion, microneedling with depigmentation serums, and Cosmelan peel treatments are just a few of Dr. Green’s favorite ways to address dark patches of skin caused by melasma. Ultimately, the right treatment for your melasma will depend on your skin type, skin tone, and the type of melasma which you are experiencing. There are three different categories of melasma: epidermal melasma, dermal melasma, and mixed melasma.

There used to be a diagnostic test called the Wood’s lamp examination technique in which a black light was utilized to determine the depth of the pigment. Now, there is no such lamp required to determine which form of melasma a patient is experiencing, and Dr. Green is able to use clinical evaluation exclusively to diagnose melasma. In cases of epidermal melasma, the pigment is in the superficial layer of the skin- the epidermis. In dermal melasma, the excess pigment is located in the middle layer of the skin- the dermis. In mixed melasma, the most common type of melasma, the pigment is present in a combination of dermal and epidermal melasma. Dr. Green takes the time required to understand you and your unique skin concerns, family history, and cosmetic goals in order to develop a treatment plan that best caters to your needs and results in long-lasting, clear, beautiful, skin.

Cosmelan 8 months before and after

Cosmelan Peel for Melasma

Dr. Michele Green is an expert in dermatology with over two decades of experience treating melasma and other forms of hyperpigmentation on the face and the body. She takes a special interest in depigmentation treatment that, in part, stems from meeting with patients who in the past were incorrectly treated with laser treatments such as Fraxel laser, IPL, and Picosure laser, resulting in a worsened appearance of the original hyperpigmentation. Dr. Green finds that most cases of melasma and hyperpigmentation are best treated with procedures such as chemical peels, Cosmelan, Mesopeels, and other more appropriate cosmeceuticals and skincare. In addition, dark spots or post-inflammatory hyperpigmentation from acne can be treated effectively with Cosmelan and chemical peels. The following list are the main conditions which Cosmelan treats:

  • Melasma
  • Sun spots
  • Sun damage
  • Acne scarring
  • Age spots
  • Post-Inflammatory hyperpigmentation
  • Skin discoloration on chest, neck, and back
  • Blemishes
  • Uneven skin tone
  • Discoloration from laser treatments such as Fraxel, IPL, and Picosure laser

The Cosmelan® peel is a professional-grade mask that is applied by board certified dermatologist, Dr. Michele S. Green, in her practice on the Upper East Side of Manhattan. The mask is left in place for a number of hours, the total of which is determined by Dr. Green depending the degree of your pigmentation and your skin type. The cream mask is easily removed at home by the patient, using a gentle facial cleanser. Cosmelan® produces an initial “peeling” of the skin, which will leave the skin smooth and also work to dramatically decrease the signs of facial hyperpigmentation. Dr. Green loves Cosmelan® because it is a simple and safe treatment with minimal down time that provides phenomenal results, helping patients feel and look like the best version of themselves. The patient then returns three weeks after their initial treatment for a touch-up of Cosmelan® in order to treat any residual hyperpigmentation.

A series of creams, including kojic acid, azelaic acid, hydroquinone, hydra-vital factor K (Vitamin K cream), and sunscreen are used at home after the Cosmelan mask is removed in order to maintain the effects of the procedure and keep the skin clear and free of excess pigment. Strict sun avoidance is imperative and patients must use a sunscreen with an SPF of 50 or higher. Dr. Green recommends layering two different sunscreens on the skin to her patients with melasma. She recommends using a chemical based sunscreen, such as one that contains oxybenzone, as well as one that contains a physical block, such as zinc oxide or titanium dioxide. Sunscreen use is paramount throughout the treatment of melasma and afterwards in order to avoid the recurrence of dark patches of melasma and hyperpigmentation.

Typically, the most common side effects of the Cosmelan peel include a mild amount of facial redness, dryness, and minimal peeling. These side effects normally resolve on their own within several days of treatment. Dr. Green’s Anti-Wrinkle Recovery cream, combined with the unique Vitamin K cream, will both effectively help minimize any

A question that patients with melasma often present to Dr. Green is: can Cosmelan treatment make melasma worse? The answer is no, Cosmelan will not make melasma worse. Dr. Green considers Cosmelan treatment the best depigmentation treatment available to improve melasma. Laser treatments such as Fraxel laser, Intense Pulsed Light Therapy (IPL), Picosure, and CO2 or other fractionated lasers, however, can make melasma worse. It can be more difficult to remove melasma after having an inappropriate laser treatment, but Dr. Green has had remarkable success using Cosmelan to correct the appearance of exacerbated melasma.

Chemical Peels for Melasma

A chemical peel is a type of skin resurfacing treatment. During a chemical peel, Dr. Green applies a chemical solution to the skin in order to gently, effectively remove the outer layers of discolored, dead skin. This method of chemical exfoliation stimulates skin cell turnover, resulting in unclogged pores and the correction of discolored skin, revealing a vibrant, healthy glow. Dr. Green is able to tailor a chemical peel treatment to the needs and goals of each of her patients. Depending on the strength and type of chemical peel used, it is possible to achieve an improvement in skin texture, minimization of an acne breakout or appearance of acne scars, or diminishment of sun damage, fine lines and wrinkles, and melasma.

For her patients who experience sun damage and irregularities in pigment, such as hyperpigmentation or melasma, Dr. Green often recommends a TCA peel. In her Upper East Side office, TCA peels, or trichloroacetic acid peels, are offered in a range of strengths and combinations. Dr. Green frequently incorporates chemical peel treatments, in conjunction with hydroquinone creams and tretinoin, into the treatment plans of her patients with melasma. This combination approach helps to exfoliate the skin and enhance the results from a chemical peel treatment.

Chemical Peels  can be used to target specific skin care needs by carefully adjusting the range in depth and intensity of treatment. Board-certified dermatologist, Dr. Michele Green, has over 25 years of experience treating some of the most discerning men and women from around the world with chemical peels to provide them with smooth, clear, beautiful skin. During your consultation with Dr. Green, you will have the opportunity to discuss your specific skin concerns and cosmetic goals. When developing a treatment plan for you, Dr. Green will customize your protocol based on your skin type, skin tone, and the degree of your hyperpigmentation.

NP 45 yrs Cosmelan 6 weeks FRONT MGWatermark

Cosmelan 6 weeks before and after

Topical Skincare for Melasma 

For her patients with melasma, Dr. Green often recommends a combination of in-office procedures and at-home skincare products to achieve an overall diminishment in visible dark patches and produce a clear, beautiful, long-lasting complexion.

Sunscreen for melasma

Sun protection plays an essential role in both preventing melasma from forming in the first place and controlling the appearance of melasma after it has been treated by Dr. Green. Dr. Green suggests always choosing a broad spectrum sunscreen. Broad spectrum sunscreen offers protection against both UVA and UVB rays from the sun that may trigger melanocytes in the skin to produce melanin. Dr. Green’s very own Advanced Formula SPF 50, from her MGSKINLABs Inc. line or products, provides broad spectrum coverage and a smooth, silky finish to ensure sun protection and comfort.

It is imperative that sunscreen is reapplied every hour and a half to two hours in order to ensure proper coverage and protection. Additionally, you can layer your sunscreens to provide maximum protection. First, apply a chemical sunscreen that will absorb into the skin. Chemical sunscreens work by absorbing heat energy from the sun’s rays and undergoing a chemical reaction within the skin. Next, layer on a physical or mineral sunscreen. These sunscreens will normally include ingredients such as zinc oxide or titanium dioxide and work by sitting atop the surface of the skin, acting as a barrier against harsh UV rays. By layering both a chemical and then a physical sunscreen, one can ensure that they are doing their best to protect their skin from the sun and prevent the development or exacerbation of melasma.

Hydroquinone for melasma treatment

Hydroquinone is an ingredient in skin bleaching creams that helps to lighten areas of hyperpigmentation and melasma.  Hydroquinone is no longer available in any over-the-counter products. However, Dr. Green is able to provide her patients with prescription strength Hydroquinone creams, from a specialty compounding pharmacy, as part of your melasma and pigmentation treatment plan. Hydroquinone creams can be compounded with Retin-A or other active ingredients, in different strengths. The strengths of hydroquinones vary from 4% up to10% to treat some difficult pigmentation.

Tretinoin cream for melasma

Tretinoin (Retin-A) is a topical cream which may be prescribed by Dr. Green in order to help with hyperpigmentation. Corticosteroids can  should only be used for a short period of time because topical steroid creams can cause thinning of skin. Tretinoin is a derivative of vitamin A that increases the rate of skin cell turnover, sloughing off discolored, dark, dead skin cells and encouraging young, healthy, new skin cells to reach the surface of the skin more quickly than they would on their own.

Vitamin C Serum for facial pigmentation

Vitamin C is a powerful antioxidant skincare ingredient. Dr. Green’s MGSKINLABs has its own highly concentrated Vitamin C formulation, the Vita-C Serum, which is designed to promote skin cell renewal as well as collagen synthesis. The result is a decreased appearance of brown spots and improvement in overall skin tone and texture. Dr. Green’s Vitamin C serum is the number one most popular product in her office. Other skincare ingredients such as azelaic acidkojic acid, and glycolic acid are available in a wide array of products (cleansers, serums, moisturizers, and toners) over-the-counter and can also be beneficial in minimizing the appearance of melasma.

Can one treat melasma from the inside?

Treatment of melasma can take time, and using topical treatments on their own may not be the answer for every patient with melasma. For those who are struggling to tackle their melasma with topicals exclusively, there is an oral medication called tranexamic acid which can be used as a supplement for topical melasma treatment. Tranexamic acid, which is typically used to treat women with heavy or painful menstrual cycles, also works to treat melasma by directly interfering with melanocyte action. Tranexamic acid prevents melanocytes from producing excess melanin and also from transferring the melanin to keratinocytes. This in turn prevents the development of melasma, and when used in tandem with topicals, can result in a clear, even-toned complexion. To learn more about whether or not oral tranexamic acid is appropriate for treating your melasma, schedule a consultation with board-certified, expert cosmetic dermatologist, Dr. Michele Green.

Does Melasma From Pregnancy Go Away?

It is extremely common for pregnant women to develop what is often referred to as chloasma or “the mask of pregnancy.” In pregnant women, melasma tends to appear on the cheeks, forehead, upper lip, and chin, giving the appearance of a mask. This form of melasma is caused by a significant increase in the female hormones estrogen and progesterone that occurs during pregnancy. Typically, melasma that develops during pregnancy resolves on its own sometime after giving birth, as the levels of estrogen and progesterone in the body return to normal. During pregnancy, there is a limited number of treatment options available for melasma, as the safety of many topical skincare ingredients and chemical peels has not been tested for pregnant women. While one is pregnant, cosmetic treatments designed to treat melasma and facial hyperpigmentation, such as the Cosmelan peel and trichloroacetic acid chemical peels, can not be used. Additionally, the majority of topical skin lightening products (such as hydroquinone) are not to be used when pregnant.

The best way to manage any facial hyperpigmentation or melasma that you have during pregnancy is to use the proper sunscreen (with an SPF of at least 30) and avoid sun exposure. After pregnancy, more treatment options become available to diminish the appearance of the melasma. Dr. Green is a board-certified dermatologist with over 25 years of experience treating some of the most discerning men and women from around the globe. In her discreet New York City dermatology office, she uses her expertise and experience to customize a treatment approach for each of her patients. Once you are ready to treat the melasma that developed during your pregnancy, Dr. Green is here to help.

Can Melasma be confused with skin cancer?

Trying to determine whether discolored skin is facial hyperpigmentation or something more serious, such as skin cancer, can be a challenge when one isn’t sure of what to look for. Whether pigmentation is triggered by too much sun exposure or other causes, it’s important to carefully observe any dark-colored or brown patches on the skin to ensure that there is no risk of melanoma or skin cancer. Additionally, even when pigmentation is not a sign of something more insidious, inconsistencies in skin tone can make patients feel self-conscious about how their skin has changed. The best thing to do when you notice a dark patch of skin is to schedule an appointment with a board-certified dermatologist, like Dr. Green. This way, more dangerous skin conditions such as skin cancer may be ruled out and an appropriate treatment plan can be established.

How to Get Rid of Melasma on the Upper Lip

Hyperpigmentation of the upper lip is a typical symptom associated with melasma. Dr. Green loves the results that the Cosmelan peel treatment provides her patients who are struggling with melasma, and often suggests a Cosmelan treatment to anyone who is dealing with stubborn hyperpigmentation on the upper lip area. Having two Cosmelan peels, three weeks apart, provides outstanding results with essentially no downtime. In addition, using skin lightening products, either with or without hydroquinone’s and light chemical peels, can hasten the removal of stubborn upper lip hyperpigmentation.

How Can I Cover my Melasma?

Visible skin problems such as melasma can seriously affect ones overall quality of life and make one feel self-conscious about their appearance. Dr. Michele Green is an internationally renowned cosmetic dermatologist with more than two decades of experience customizing the treatment plans of her patients, helping them to look and feel like the very best versions of themselves. In her New York City office, you will have the opportunity to discuss with her concerning the most appropriate and effective in-office treatments and specially formulated skincare products to diminish the appearance of your melasma. However, in the meantime, it can even be a challenge to just cover the hyperpigmented skin with makeup! In order to cover up melasma, there are a few tips to keep in mind.

Moisturize your skin prior to applying any sunscreen or makeup to the face. By moisturizing, you are not only helping to nourish and protect your skin, but also creating a strong foundation for makeup application to hide visible melasma. Then, apply your chemical and physical sunscreens to guarantee best sun protection. Next, use a facial primer in advance of any foundation or concealer. This helps makeup last longer and create a smooth, silky look. Dr. Green recommends choosing a full-coverage foundation and concealer to best cover the appearance of visible melasma, then setting the liquid makeup with a translucent powder. These steps can become tedious when trying to cover melasma on a daily basis. In order to take care of your melasma once and for all, and feel confident going makeup free, schedule a consultation with Dr. Green.

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Cosmelan 1 year before and after

Is Melasma Dangerous?

No! Melasma itself is not a dangerous skin condition. Melasma is an incredibly common skin disorder that Dr. Green has over 25 years of experience treating. There is no potential for melasma to evolve into a skin cancer or otherwise harmful skin condition. However, there are some skin cancers that exist which may resemble melasma in some way. If you are concerned about a brown patch or dark patches of skin, and are unable to discern as to whether it is a skin cancer or patch of melasma, schedule an appointment with a board-certified dermatologist, like Dr. Green. In your appointment, Dr. Green will first thoroughly discuss with you your medical and family history, then proceed to clinically evaluate the areas of hyperpigmented skin to rule out any dangerous skin conditions. A skin biopsy may be performed and sent to the laboratory for further examination, as part of a routine check to rule out melanoma and other varieties of skin cancer, should it be necessary. Additionally, should you notice any other symptoms that onset at the same time that you develop visible melasma, reach out to your healthcare provider for proper evaluation.

How to get started with melasma treatment

Dr. Michele Green is a world renowned expert in cosmetic dermatology with over 25 years of experience treating melasma as well as other varying types of facial hyperpigmentation, among other skin conditions. Whether you are struggling with melasma, post-inflammatory hyperpigmentation, sun spots, sun damage, or another form of hyperpigmentation, Dr. Green is here to help. Dr. Green has been consistently voted as one of the best healthcare professionals and cosmetic dermatologists in New York by Castle Connolly, the New York Times, New York Magazine, and Super Doctors. To schedule a consultation to learn more about how to best treat your melasma, sun damage, or facial hyperpigmentation, please contact us online today or call our New York City based dermatology office at 212-535-3088.

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