Melasma Laser Treatment

Melasma is a common skin condition that most often affects patients who were assigned female at birth and is characterized by patches of darker skin that appear most commonly on the upper lip, cheeks, bridge of the nose, and forehead. Melasma can be triggered by various risk factors, including sun exposure, hormonal changes, thyroid disease, and family history, and occurs when the melanocytes in the body overproduce melanin. With many triggers that can worsen the condition, the treatment of melasma is complicated. Some treatment options that commonly work for other forms of hyperpigmentation, like laser treatment, can worsen melasma. That is why the best first step in melasma treatment is to schedule a consultation appointment with an expert board-certified dermatologist, such as Dr. Michele Green.

When addressing melasma, the first line of treatment is typically topical therapies, such as hydroquinone cream, tranexamic acid, kojic acid, tretinoin, corticosteroids, glycolic acid, and vitamin C serum. Skin-lightening creams are highly effective treatments that reduce skin pigmentation associated with melasma breakouts. Additionally, since sun exposure is the most common risk factor for triggering melasma, Dr. Green recommends the application of both chemical and physical sunscreen with an SPF of at least 50 for complete sun protection. Dr. Green will turn to chemical peels, such as the TCA or Cosmelan peel, to help with skin cell turnover and pigmentation correction as a second-line treatment. If topical bleaching treatments and chemical peels are ineffective at reducing the signs of melasma, Dr. Green may turn to laser therapy. While Dr. Green has many types of lasers available at her dermatology office — including Intense Pulsed Light (IPL), Fractional lasers like Fraxel, Q-switched lasers like the nd: Yag, Picosecond lasers like Picosure and the Helios, Vascular lasers like V-Beam, and CO2 lasers — laser treatment for melasma must be approached with caution. Studies have shown that laser therapy can worsen melasma, especially for patients with darker skin types, often resulting in side effects such as post-inflammatory hyperpigmentation. It is essential to consult with an expert dermatologist like Dr. Green before undergoing melasma treatment.

Experienced board-certified dermatologist Dr. Michele Green has been masterfully treating patients in her Upper East Side New York City dermatology office for more than 25 years. With her proprietary range of skincare products, MGSKINLABs, Dr. Green is an expert in providing patients with individualized treatment plans tailored to their skin type and aesthetic goals. Whether you are concerned about sensitive skin, hyperpigmentation, dark spots, melasma, or signs of the natural aging process, Dr. Green has plenty of treatment options. In addition to generating individualized skincare plans, Dr. Green has a range of in-office treatments that can help with melasma management and treatment, including chemical peels, mesopeels, microneedling, microdermabrasion, laser treatments, and Cosmelan peels. Well-known for high patient satisfaction, Dr. Green has been voted one of New York City’s best dermatologists by publications such as Castle Connolly, Super Doctors, and New York Magazine.

What is Melasma?

Melasma is a skin condition in which cutaneous pigmented lesions appear due to increased melanin production in the melanocytes. The pigmentation of melasma is not associated with pain, itchiness, or skin cancer. Still, the brown spots often appear in highly visible areas, such as the forehead, upper lip, bridge of the nose, and cheeks, causing many patients to seek treatment. Three main types of melasma may occur: epidermal melasma, which appears in the superficial layer of skin known as the epidermis; dermal melasma, which is located in the middle layer of the skin known as the dermis; and mixed melasma, which occurs when there is a combination of epidermal and dermal melasma. The condition is most common in women and people assigned female at birth, with only 10% of all melasma cases attributed to men. It is also more common in patients with darker skin tones and patients of East Asian, Indian, Hispanic, Middle Eastern, and Mediterranean descent due to the already high prevalence of melanin and melanocytes in the skin. Common triggers for melasma include sun exposure, hormonal changes due to pregnancy or birth control, thyroid problems, and genetic predisposition.

What are the best treatment options for Melasma?

Melasma is a complicated skin condition, and many more traditional methods for treating hyperpigmentation on the skin’s surface can exacerbate it. Typically, Dr. Green will first turn to topical melasma treatments, which include hydroquinone, kojic acid, tretinoin, vitamin C, and azelaic acid. Crucially, all melasma treatments should involve daily application of sunscreen with an SPF of at least 50, as sun exposure is the most common trigger for the worsening of melasma. Dr. Green may combine topical treatments with chemical peels, such as the Cosmelan or TCA peel. Chemical peels increase skin cell turnover, improving skin tone and texture and reducing signs of hyperpigmentation. If the melasma pigmentation does not respond to topical treatments or chemical peels, Dr. Green may turn to forms of laser therapy. The Helios 785 is a newer laser on the market that received FDA approval in 2022 for treating freckles and other skin pigment conditions. The Helios 785 laser employs a Q-switched Nd: YAG laser, utilizing Pico and Nanotechnologies to treat various skin concerns, including melasma. Its multitude of handpieces and wavelengths make it easy for providers to tailor each treatment to a patient’s skin tone and type. Clinical research has shown the Helios 785 laser to be safe and effective for sensitive Asian skin and individuals with Fitzpatrick skin Type III-IV. It is essential to consult with a board-certified dermatologist, such as Dr. Green, when seeking treatment for melasma to ensure that the condition does not worsen.

What topical treatments are most effective for Melasma?

Topical treatments are often the first line of defense when addressing melasma and are often recommended post-treatment following laser therapies. Some products and ingredients can be acquired over-the-counter (OTC), while others require a prescription from a dermatologist. The most effective ingredients for topical melasma treatment products are as follows:

Azelaic acid – Available in over-the-counter products and prescription-strength medications, azelaic acid is a topical tyrosinase inhibitor. Tyrosinase is an enzyme that is key in the melanin production process, and by inhibiting its function, azelaic acid helps to decrease hyperpigmentation on the skin’s surface.

Hydroquinone is available only in prescription medications; it is no longer FDA-approved in over-the-counter creams. The ingredient is often found in skin-lightening and bleaching products and is not designed for extended use. Dr. Green may prescribe cysteamine or tranexamic acid as a bleach-free alternative to hydroquinone.

Tretinoin is a topical retinoid derived from vitamin A that Dr. Green may prescribe to reduce areas of hyperpigmentation. When applied to the skin’s surface, tretinoin helps increase skin cell turnover, boost collagen production, and reduce signs of hyperpigmentation.

Vitamin C Serum – Vitamin C is a powerful antioxidant that promotes collagen production and skin cell renewal to decrease hyperpigmentation in the outer layer of the skin. Dr. Green’s very own MGSKINLABs sells a Vita-C serum that can be used twice daily for best results.

Sunscreen – UVA and UVB rays from the sun are common triggers for melasma, so sunscreen is the most critical topical product for preventing and reducing melasma. For patients with a history of melasma, Dr. Green recommends applying chemical and physical sunscreen with SPF 50 or higher every day – even when it’s cloudy. For chemical sunscreens, Dr. Green recommends oxybenzone products; for physical sunscreens, look for products with zinc oxide or titanium dioxide.

Do chemical peels work for Melasma?

Chemical peels are a highly effective treatment option for melasma. The severity and scope of the present hyperpigmentation and the patient’s skin tone will determine the best strength and type of chemical peel. Typically, Dr. Green turns to TCA and Cosmelan peels to treat melasma. During the treatment session, Dr. Green applies the chemical peel to the treatment area and instructs the patient to leave it on for an individualized amount of time. The peel can then be removed at home with a gentle cleanser. The downtime following the treatment session will depend on the strength of the peel, but patients will start to experience peeling and exfoliation soon after the solution has been removed. In the days following the treatment, patients will experience improved results from the chemical peel treatment.

Cosmelan Peel for Melasma

The Cosmelan peel is a specialized, medical-grade chemical that treats melasma, hyperpigmentation, and skin discoloration. By inhibiting tyrosinase, an enzyme responsible for producing melanin pigment in the skin, the Cosmelan peel reduces the accumulation and the new creation of melanin. The first step of the Cosmelan peel entails an expert, such as board-certified dermatologist Dr. Green, applying the Cosmelan 1 mask to the hyperpigmented areas. The mask is left on for a time determined by Dr. Green based on your skin type and tone. Afterward, the mask can be removed with a gentle facial cleanser. Dr. Green will review specific skin care products to use following treatment to maintain and enhance the results from the peel. The Cosmelan 2 cream contains kojic acid, azelaic acid, vitamin C, and hydroquinone to brighten the skin. As with any chemical peel, it is essential to practice proper sun protection, using a broad-spectrum sunscreen with a minimum SPF of 50 and avoiding excessive sun exposure.

Is laser treatment good for Melasma?

Melasma is a tricky skin condition to treat, and certain types of treatment commonly used for other forms of hyperpigmentation, including laser treatment, can exacerbate it. Some forms of laser therapy can make melasma worse, resulting in additional side effects like post-inflammatory hyperpigmentation (PIH). However, if topical treatments and chemical peels are ineffective in treating melasma, Dr. Green may turn to certain types of laser therapies to treat melasma.

Is laser treatment safe for all skin types?

Not all laser treatment options are safe for all skin types. Patients with darker skin tones should be aware that specific lasers can cause permanent scarring, hyperpigmentation, or hypopigmentation (skin lightening) when used on their skin. For example, Intense Pulsed Light (IPL) laser treatment, which uses different wavelengths of light to reduce pigmentation in the skin, can be damaging to patients with darker skin. Fractional lasers, such as the Fraxel laser, should also be avoided. Dr. Green is an expert in treating patients of all skin types and will be sure to choose laser treatments that are safe and effective for skin of color.

Can laser treatment remove Melasma?

Some laser treatment options, such as the PicoWay PicoSure laser and the 1550nm fractional laser, have been FDA-approved for treating melasma. These laser therapies have been demonstrated to improve the appearance of melasma. However, other types of lasers, including intense pulsed light (IPL) and CO2 lasers, can worsen the appearance of melasma. When the laser energy is emitted at the treatment site, the laser beam causes the pigmentation to become entrenched deeper in the layers of skin, making the melasma even more challenging to treat.

Is the Helios Laser suitable for Melasma?

Yes! The Helios laser is a fractional, non-ablative, Q-switched Nd: YAG laser with a dual wavelength of 532nm and 1064nm. With its dual-wavelength capabilities, the Helios laser is an excellent option for treating melasma in patients who are not seeing results with topical creams and chemical peels. The Helios laser is particularly advantageous due to its ability to address both epidermal and dermal melasma, as the laser emissions can penetrate the deeper layers of the skin to dispel pigmentation. The results are a notable reduction in pigmentation associated with melasma, improved skin tone and texture, and overall facial rejuvenation. Most patients will require multiple treatment sessions for the best cosmetic results.

Is the pico laser good for Melasma?

Picosecond lasers use photoacoustic energy rather than light and heat energy to break apart areas of pigmentation. They emit extremely short pulses of photoacoustic energy that last a trillionth of a second to treat skin pigmentation. Well-known for tattoo removal, PicoSecond lasers, such as the PicoWay laser, can be safe and effective for reducing melasma. The FDA approved the PicoWay laser for melasma treatment, providing an additional avenue for a challenging condition. However, some cases of melasma are exacerbated by lasers, including the Picosecond laser. Each case must be examined individually, and strict sun avoidance is needed throughout treatment and after.

Is the CO2 laser good for Melasma?

Patients often ask, “Is carbon laser good for Melasma?” The answer is that the CO2 laser is not the best treatment option for melasma. CO2 lasers, also known as carbon dioxide lasers, are a type of laser resurfacing treatment that can be ablative, meaning they remove the outer layer of skin, or fractional, meaning they use micro-beams of laser energy to address skin concerns while leaving the surrounding skin undamaged. Laser resurfacing with CO2 lasers effectively addresses skin conditions, such as skin cancer, acne scars, deep wrinkles, and sun spots. However, according to a split-face, double-blind comparative study, CO2 lasers were ineffective at providing long-term reduction in melasma conditions. They are also associated with unwanted side effects, such as post-inflammatory hyperpigmentation (PIH), scarring, and hypopigmentation, especially in darker skin tones.

Is the Intense Pulsed Light (IPL) laser good for Melasma?

Intense Pulsed Light (IPL) laser treatment emits wavelengths of light energy to reduce pigmentation and discoloration that is visible on the skin’s surface. The laser emits a broad spectrum of light absorbed by the pigment in the skin and converted into heat, which destroys the melanin. This makes it a highly effective treatment for eliminating sun spots, age spots, and visible blood vessels. However, IPL is unsafe for melasma treatment and can worsen the condition. Additionally, IPL is unsafe for patients with darker skin tones.

Can laser treatment make Melasma worse?

Specific laser treatments can worsen melasma, so it is essential to consult an expert board-certified dermatologist, such as Dr. Green, when seeking treatment. Typically, Dr. Green will only turn to FDA-approved forms of laser treatment for melasma if other treatment methods are not working. IPL, Fraxel, and some types of PicoSecond lasers can exacerbate the appearance of melasma by causing the pigment to become further entrenched in the skin. This can make other forms of treatment for melasma, such as topical treatments and chemical peels, less effective.

Does Melasma come back after laser treatment?

Various risk factors, including sun exposure and hormonal changes, can trigger melasma. The best way to avoid new or worsening incidences of melasma and pigmentation is to wear sunscreen with SPF 50 or higher. Dr. Green recommends applying chemical sunscreen and physical sunblock for the best results. Patients should always apply sunscreen in the morning, even when it’s cloudy or they are inside. A car or office window can still let in enough UVA and UVB rays to cause sun damage. Especially when patients are outside, they should reapply sunscreen every hour and a half to two hours. Patients reduce the risk of melasma returning by reducing exposure to risk factors.

What is the best laser treatment for melasma?

It is always important to exercise caution when undergoing laser treatment for melasma, as laser therapy can worsen the condition. If laser therapy is included in your melasma treatment plan, it is often paired with other treatment options to improve the likelihood of success. Even so, laser treatments are often not the best method for treating melasma and post-inflammatory hyperpigmentation. Although there have been literature reviews, such as those from the Indian Journal of Dermatology (Indian J Dermatol) and Journal of Aesthetic Surgery (J Aesthet Surg), of studies conducted on laser treatment for melasma, often sample sizes are small, and research has not taken into account all skin types. However, if topical creams and chemical peels are ineffective at reducing melasma symptoms, Dr. Green may recommend laser treatment. The best laser treatment option will depend on each patient’s skin type and treatment area, though Dr. Green will often turn to a Q-switched Nd: YAG laser like the Helios laser or PicoSecond laser.

How much does laser treatment for Melasma cost?

Patients often wonder, “How much is Melasma laser treatment?” The answer is that it depends on various factors, including geographic location, the size and scope of the treatment area, and the type of institution at which you receive treatment. Melasma treatment will vary from patient to patient depending on the type of melasma present – dermal melasma, epidermal melasma, or mixed melasma – the patient’s Fitzpatrick skin type and their treatment history. Some patients may require a combination approach combining topical creams with chemical peels or laser therapies. When you have your initial consultation with Dr. Green, she will determine the treatment plan that will be most effective for you, and her office will provide an estimate of the total cost of treatment. Depending on how well the first line of treatment works, follow-up treatment may be necessary, contributing to the total cost of treatment.

Can you treat Melasma with a laser? How to get started with Melasma laser treatment today

Melasma is a skin condition characterized by uneven brown patches of skin most frequently found on the face, such as above the lip, forehead, nose, and cheeks. With melasma so commonly found on the face, a highly visible area of the body, many patients wonder how to reduce skin condition symptoms and prevent flare-ups from occurring. Unlike other types of hyperpigmentation, such as age spots, sun spots, freckles, and uneven skin tone, melasma does not respond well to laser treatments. Many laser therapies can make symptoms of melasma worse and the condition more difficult to treat with topical creams and chemical peels. That is why the best first step for treatment is to schedule a consultation with expert dermatologist Dr. Michele Green, who will examine the treatment area and generate a treatment plan that best meets your needs.

Dr. Michele Green is an internationally renowned board-certified dermatologist with over two and a half decades of experience providing her patients with the best non-invasive treatment options. Dr. Green takes a holistic approach and embraces a less-is-more philosophy, creating customized skincare routines and treatment plans that cater to her patient’s unique concerns and aesthetic goals. She is consistently identified as one of New York’s best dermatologists by Castle Connolly, New York Magazine, and Super Doctors for her dedication to her patients and expertise. Please call us at 212-535-3088 or email our New York City-based office today to schedule a consultation with Dr. Michele Green and determine the best treatment for your melasma.