Melasma

Melasma treatment can be effective in the majority of patients. This type of skin pigmentation is commonly seen in Brisbane due to its high UV rating. It is a unique form of hormonal pigmentation that is mostly seen in women. Melasma can be improved by up to 80% with a combination of prescription creams, gentle chemical peels and special lasers.

  • The cause of melasma is a mix of genetics, UV exposure and hormones

  • This is a special form of pigmentation that presents on the upper lip, around the eyes, and forehead area. Melasma is often patchy, and motley in appearance

  • The majority of melasma can be improved with a combination of clinical chemical peels, compounded prescription creams and special lasers

  • The degree of improvement will depend if melasma is epidermal, mixed or dermal.

  • IPL should not be used to treat melasma, as this often can worsen skin pigmentation 

  • Lasers such as 1064 QSL and Picosure Focus can improve melasma. I prefer these gentle lasers over Fraxel laser for the treatment of this form of pigmentation

  • Melasma usually returns unless a prevention plan is undertaken after treatment

  • My melasma prevention plan is a combination of creams, TCA peels or Clear+Brilliant lasers with Vitamin A, B, C infusions

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FAQs

What Is Melasma?

Melasma is also known as hormonal pigmentation or cholasma, a condition that is very common in Queensland. It presents as patchy pigmentation on the forehead, under the eyes and on the upper lip. This pattern, together with certain clinical and microscopic findings are classic for this condition.

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

Why is melasma vital to diagnose? It is because melasma is a unique form of pigmentation and ‘sun damage’. Unlike other types of pigmentation, melasma has to be treated in a special way, namely to inactivate the pigment producing cells before any peels or laser is performed.

Failure to inactivate pigment cells worsens this condition. IPL should not be used to treat melasma as rebound is seen in nearly all cases. I use gentle lasers such as Q Switch laser and Picosure Focus to treat this unique form of pigmentation. Melasma treatment is a medical solution and not a cosmetic one, and should be treated by Specialists. 

What Is The Best Treatment For Melasma?

The optimal melasma treatment will depend on the type of melasma. 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, gentle chemical peels and laser.

  • 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 often 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.

  • Lasers- Dr Lim prefers Q Switch laser over Fraxel laser. Q Switch is ideal for dermal melasma, this forms part of the 3 C Program. I prefer Picosecond laser or Q Switch lasers over Fraxel. Never undertake IPL, as this often makes melasma worse.

The best treatment for your melasma will depend on the type of melasma you exhibit, and your skin type (skin colour).

In summary the best treatment for melasma is a regime of –

  • Creams

  • Chemical Peels

  • 3C Laser Program for skin colour, clarity and collagen

Why Did My Melasma Get Worse After IPL?

This is one of the most common reasons for melasma to worsen. Despite education of beauticians and cosmetic GPs, IPL is still performed on melasma. In 90% of cases this treatment will worsen melasma. Some cases of epidermal melasma can respond to IPL, but only if the pigment producing cells are kept at bay before treatment.

The reason why IPL worsens melasma is because of the excessive heating of skin with this treatment. IPL stands for intense pulse light. This light is converted to heat energy that in turns stimulates excessive pigmentation. Low level laser on the other hand, decreases the activity of melanocytes, namely addresses one of the causes of melasma. 

Can Lasers Be Used To Treat Melasma?

Yes, but laser melasma treatment has to be gentle and exact for cases of this form of pigmentation. Laser can also be useful for dermal melasma. Unlike IPL, the aim of laser is not to heat up melanocytes (pigment producing cells), but to decrease the transfer of pigment from these cells to the skin. This is a gentle treatment process and takes 5-6 sessions before results can be seen.

Dr Lim's melasma treatment laser of choice is the Q Switch laser. A treatment program consists of a trail of 5 sessions spaced 2 weeks apart. There is no downtime following Q Switch laser. If you respond to this trial of laser, you can continue on the program.

High density, but low energy Fraxel can be used to treat melasma, however this laser can also make this condition worse. I only reserve Fraxel for patients who fail the 3C Program or the Picosure Focus laser.

Fractional lasers such as CO2 and Erbium have been reported to improve melasma, however most of these studies are from Korea and Japan- areas where the UV index is much lower than in Brisbane. Dr Lim will never treat melasma with ablative lasers as this will always result in rebound pigmentation. The melasma treatment program spans over 10 weeks. 

Will My Melasma Return If I Stop Treatments?

The natural history of melasma is to recur over time. Part of our treatment program is to reduce or prevent recurrence with the use of creams and sun protection. Developing a melasma recurrence prevention regime is important. Dr Lim uses a combination of peels, Clear + Brilliant lasers, as well as vitamin A, B and C skin infusion to help reduce melasma recurrence.