Laser Treatment Insights for Melasma: What You Need to Know

Melasma is a common skin condition known for causing brown or grayish-brown patches, typically on the face. These patches are often triggered by sun exposure or hormonal changes, but they can also be due to genetics. In most cases, melasma can be challenging to treat. While laser treatment for melasma is a common option, topical agents and chemical peels also offer hope. Professional guidance from your dermatologist can help you choose the best approach for your skin to minimize risks and optimize results. 

Today, we’ll look deeper into laser treatments, including their benefits and risks, as well as alternative therapies and combination approaches. We’ll also examine the recovery process, how to minimize risks, and lifestyle changes you can make to help prevent or at least delay the recurrence of melasma.

What Is Melasma and Why Is It Difficult to Treat? 

Melasma is a form of hyperpigmentation caused by overactive pigment-producing cells called melanocytes. Several factors can trigger it, including hormonal changes such as during pregnancy or with the use of some birth control. It can also be due to UV exposure over time or simply your genetic lottery—for good and bad. 

One of the biggest reasons melasma can be difficult to treat is because of its chronic nature. Even after effective treatment, external triggers can cause it to recur. That can include spending time in the sun or fluctuating hormones. In addition, melasma can affect both the surface layer of the skin (epidermis) and the deeper layers (dermis). The deeper the increased pigmentation, the harder it is to address. 

Fortunately, there are several types of treatments available, starting with laser treatments. 

Laser Types: Targeting Melasma with Precision

Laser treatments have become a popular option for addressing melasma. However, they aren’t a one-size-fits-all solution. Different lasers work in distinct ways. The effectiveness of each option depends on the skin type, melasma depth, and treatment settings. 

Types of lasers include: 

1. Q-Switched ND: YAG Laser, which is best for darker tones and melasma found in epidermal or surface layers. It works by delivering high-intensity light in short bursts to target the melanin without damaging the surrounding skin. It has a lower risk of post-inflammatory hyperpigmentation or PIH and may be highly effective when combined with topical treatments.

2. Fractional Lasers (e.g., Fraxel Dual): This method creates microscopic zones of thermal (heat) injury in the skin to stimulate collagen production and reduce pigmentation. It’s recommended for stubborn or dermal melasma, particularly for those with lighter skin tones. While these treatments can be effective, they must be used with caution by a qualified cosmetic dermatologist as they can sometimes make melasma worse due to increased inflammation from the heat.

3. Picosecond Lasers: By delivering ultra-short pulses of energy, this method breaks down the pigment into smaller particles the body can more easily eliminate. It’s a popular option as it’s useful for treating both epidermal and dermal melasma with minimal downtime and fewer side effects than Q-switched lasers.

4. IPL (Intense Pulsed Light): Delivering a broad-spectrum light to target pigmentation and vascular components of melasma, this option is best for lighter skin tones or mixed-type melasma that includes vascular components. It can be effective. However, it can also exacerbate melasma in darker skin tones, making it a less favorable choice for those with darker skin types (Fitzpatrick skin types IV-VI).

While lasers can significantly improve pigmentation, they require numerous sessions (typically 6 to 8) and careful maintenance. They aren’t “one and done” options. For the most effective results, they should be combined with pre- and post-treatment skincare routines. 

Latest Innovations in Laser Technology

Skincare, in general, has continued to evolve dramatically over the last several years. And cosmetic dermatology has seen some significant advancements in laser technology for treating melasma. 

Some of the latest innovations include Low-Fluence Laser settings, which use minimal heat to decrease the risk of side effects. These settings have been particularly effective with Q-switched Nd:YAG lasers for promoting gradual improvements.

Modern lasers now come equipped with cooling technologies. This is important as they help minimize heat damage and inflammation, which can reduce the risk of PIH and make treatments safer for people with darker skin tones. 

Another innovation is nanosecond pulsed lasers that offer a gentler approach to removing pigment as they lead to minimal inflammation. 

Robotic systems are also beginning to emerge to help deliver to targeted areas precisely. This may reduce the risk of uneven treatments or improve consistency. 

Contraindications: When to Avoid Laser Treatments for Melasma

Yes, laser treatments can be an effective tool for melasma. However, that doesn’t mean it’s the best or even a suitable option for everyone. Certain skin types, conditions, and external factors can make laser treatments less effective or even potentially harmful. 

Here are some of the situations when you may want to reconsider laser treatments for melasma and choose another option: 

• Active infections or skin conditions, such as cold sores, bacterial infections, or acne flares. When the skin is inflamed or infection could spread, you’ll want to avoid laser treatments.

• Pregnancy or breastfeeding due to the potential hormonal changes that can make melasma worse and possibly reduce the efficacy. Plus, there’s limited research on laser use during this time, and it’s always better to be safe than sorry.

• Uncontrolled triggers, such as unprotected sun exposure, hormonal imbalances, or ongoing use of hormonal medication, including oral contraceptives.

Unfortunately, if those types of triggers aren’t first addressed, laser treatments are unlikely to afford long-lasting results. Worse, they may worsen pigmentation. So, before considering laser treatment, it’s important to have an action plan in place to avoid melasma triggers.

Even sun-exposed or tanned skin can increase the likelihood of burns, uneven results, or PIH. So, it’s important to avoid direct sun exposure for at least 2 weeks before and after treatment. 

Darker skin tones (Fitzpatrick Skin Types IV and above) and those with a history of PIH have a higher risk of PIH or worsening the condition, especially with lasers that use heat, such as IPL or fractional lasers. People with darker skin types should only use lasers shown to be safe for darker skin, such as Q-switched Nd:YAG or picosecond lasers. Those who have previously experienced PIH would do better to choose topical or non-invasive treatments instead. 

If prescribed photosensitizing medications, such as Accutane (isotretinoin), antibiotics like doxycycline, and certain anti-inflammatory drugs, patients should discontinue use for an appropriate amount of time, according to their dermatologist, before considering laser treatments. These types of medications can increase the risk of burns, scarring, or abnormal pigmentation after treatment. 

Other cosmetic procedures, such as chemical peels, microneedling, or dermabrasion, can also make the skin more sensitive and prone to damage. If you’ve recently had other procedures, a waiting period of at least four to six weeks is typically recommended before considering laser treatments. 

Skin conditions, such as keloid scarring or severe dermal melasma, may also make laser treatment inadvisable. For example, those prone to keloid scars are at a higher risk of developing additional scarring from laser treatment. And those with dermal melasma may not respond as well to lasers. Overuse of certain lasers can cause pigmentation to worsen. In these cases, alternative treatments are recommended. 

Preparing for Your Laser Treatment Session

Proper preparation is key to ensuring effective results and minimizing side effects. 

Before beginning any treatment, your dermatologist will assess your skin type, using the Fitzpatrick skin type, to select the appropriate treatment, determine the depth of pigmentation, and rule out contraindications. Be prepared to discuss any medications or supplements you’re using, your skincare routine, and any lifestyle concerns (such as working outside or a high-stress job). 

Sun protection is always important, but it’s even more important when considering laser treatments. It’s important to use sunscreen like it’s a religion, as strict sun protection is vital to long-term success. Ensure you’re using a broad-spectrum sunscreen with an SPF of at least 30 for 2 to 4 weeks at minimum before any treatment. Physical blockers, such as zinc oxide or titanium dioxide, are especially useful. You’ll also want physical protection, such as a broad-brimmed hat and sunglasses.

Next, you’ll likely need to adjust your skincare routine before treatment. For example, your dermatologist will ask you to stop using retinoids and exfoliants for at least a week or two before treatment to avoid excess skin sensitivity. 

Switch to mild, non-irritating cleansers and moisturizers and ensure you hydrate the skin, as dry skin is more prone to irritation and can delay healing. That includes drinking plenty of water.

Your dermatologist may recommend oral tranexamic acid as it’s been shown to help improve results. They’ll also ask you to avoid blood thinning medications and supplements, such as fish oil, vitamin E, and aspirin, for at least 7 to 10 days before treatment, as these can increase the risk of bruising. 

Be prepared for multiple sessions—usually 6 to 8, which are spaced out 4 to 6 weeks apart—before you see any noticeable improvements. Improvement is often gradual and takes several months, so patience is crucial.

You’ll also likely experience some side effects, such as redness, swelling, or slight darkening (known as “micro crusting”), which should subside within a few days to a week. Fortunately, serious side effects, such as burns or scarring, are very rare when the procedure is performed by an experienced professional.

Even after the treatments, while lasers can significantly reduce pigmentation, they may not completely erase it. Laser treatments also aren’t a permanent solution. Melasma is a chronic condition that requires ongoing maintenance, lifestyle changes, and strict sun protection. In addition, you may want to consider maintenance treatments every 3 to 6 months to control your melasma long-term.

Navigating the Recovery Process

The recovery process after laser treatment for melasma varies depending on skin type, laser intensity, and individual healing speed. Below is a detailed timeline of the recovery journey, the healing stages, and how to support skin repair while minimizing setbacks. 

Exploring Alternative Treatments for Melasma

While laser treatments can be effective for melasma, they aren’t the only option. And for many, they’re not the best first-line approach. Topical agents, chemical peels, microneedling, and oral medications may provide excellent results, either on their own or in combination with laser and other therapies. 

Topical Agents

Topicals are often the first option as they offer safe, gradual improvements. Some of the most effective include: 

• Hydroquinone (HQ): This gold standard depigmenting agent works best when used in cycles to prevent resistance.
• Tretinoin: Speeds cellular turnover to help fade pigmentation.
• Azelaic Acid: A gentle option for sensitive skin as well as pregnant or nursing moms.
• Niacinamide: Reduces melanin transfer and strengthens the skin barrier.
• Tranexamic Acid (Topical or Oral): Targets vascular inflammation and hormonal triggers.
• Combination creams, such as the Kligman formula (HQ + tretinoin + corticosteroids), can provide effective results, but they are only for short-term use.

Chemical Peels

Peels can be used to exfoliate the skin, which can speed pigment removal. 

• Glycolic Acid (AHA): Best for mild, surface-level pigmentation
• TCA Peels: Effective for deeper dermal melasma
• Jessner’s Peel: A combination of salicylic acid, lactic acid, and resorcinol for stronger exfoliation.

Microneedling

Especially when paired with brightening agents (like tranexamic acid or Vitamin C), microneedling may enhance product penetration and promote renewal, especially for dermal melasma. 

Oral Therapies

• Tranexamic Acid (TA): Often prescribed for hormonal melasma, reducing vascular triggers.

• Polypodium Leucotomies: A fern extract supplement that may provide antioxidant and UV protection.

For the best outcomes, dermatologists often recommend combining treatments. For instance, they may suggest: 

• Topicals + Laser: Start with pretreating the skin with hydroquinone or azelaic acid to enhance laser results while reducing risks.
• Chemicals + Lasers: A mild peel can prepare the skin for laser treatment or help maintain results after laser treatment.
• Oral Tranexamic Acid + Microneedling: To help address resistant melasma with vascular components.

Combining therapies ensures a multifaceted approach to address melasma from different angles. Timing is important, and so is working with a qualified dermatologist to maximize results while minimizing side effects and the risk of recurrence. 

In addition, some simple lifestyle changes can support skin health. Remember, melasma is a chronic condition. Long-term maintenance is essential. That includes:

• Sun protection: In addition to using sunscreen daily, avoid peak sun hours and wear hats and sunglasses.
• Balancing hormones: Consult with your doctor to help manage hormonal triggers.
• Consuming a nutrient-rich diet that’s loaded with antioxidant-rich leafy greens, berries, and fatty fish.
• Managing stress: Chronic stress makes melasma and skin health in general worse. Practice self-care and incorporate mindfulness, yoga, daily walks (with sunscreen), or other types of exercise to reduce stress.

Deciding When to Consult a Dermatology Expert

Successfully treating melasma requires a professional and personalized approach. While there are many treatment options available—from various laser treatments to chemical peels to topical agents to oral medications—choosing the right combination depends on your skin type, depth of pigmentation, and potential triggers, such as sun exposure or hormonal changes. 

Seeking the guidance of a qualified skincare specialist is critical. A dermatologist or licensed skincare professional can accurately assess your skin, help identify the root causes, and recommend a tailored treatment plan to minimize risks and maximize results. With professional oversight, you’re less likely to experience side effects, including PIH or scarring. Plus, you’ll benefit from the latest innovations in skincare. 

Laser Treatment for Melasma Takeaways

Melasma treatment is a journey. There are no overnight or quick fixes. However, the right combination of therapies, a thoughtful recovery plan, and long-term maintenance make significant improvements possible. Work with a qualified professional and trust the process to achieve healthier, radiant skin and keep melasma under control.

Author: Larry Norris

Dr. Don Mehrabi is a board-certified dermatologist providing medical care to patients in the Beverly Hills, California area at BH Skin Dermatology.