Melasma & Brown Spots

Melasma develops from a complex combination of hormonal influences (pregnancy, birth control, hormone replacement therapy), ultraviolet sun exposure, heat exposure, genetic susceptibility, and sometimes underlying inflammation. These triggers stimulate melanocytes (pigment-producing cells) to produce excessive melanin, leading to the characteristic patchy discoloration on the face. Unlike simple sunspots, melasma has a hormonal and inflammatory component that makes it more reactive and challenging to treat. Understanding your specific triggers is essential to creating an effective treatment plan and preventing recurrence. Our board-certified dermatologists conduct thorough evaluation to identify which factors are driving your melasma.

Lasers can be safe and effective for melasma when used carefully by experienced dermatologists who understand the complexity of treating reactive pigmentation. However, aggressive or improperly selected laser treatments can worsen melasma by triggering post-inflammatory hyperpigmentation. This is why physician expertise is critical. Devices like Clear + Brilliant, PicoWay, and carefully calibrated Fraxel DUAL can improve melasma when performed with conservative settings by fellowship-trained physicians. Our dermatologists select laser options, energy levels, and treatment intervals that gently improve pigmentation without overstimulating melanocytes or causing inflammation that could darken melasma.

Melasma behaves fundamentally differently than typical sun-induced brown spots. Melasma is often deeper in the skin (dermal component), hormonally driven, more reactive to light and heat, and has an inflammatory component that makes it prone to rebound darkening if treated too aggressively. Brown spots from sun damage are typically superficial (epidermal), respond more predictably to treatment, and are less likely to return once treated. Melasma requires a gentle, steady, multi-modal approach with careful attention to avoiding triggers, while brown spots often respond quickly to targeted laser treatment. This fundamental difference is why specialized expertise matters so much in treating melasma successfully.

Melasma cannot be permanently cured because the underlying triggers (hormones, genetic susceptibility, heat and light sensitivity) remain present. However, melasma can be managed extremely well with the right treatment approach and diligent maintenance. Many patients achieve and maintain clear, even-toned skin long-term through a combination of appropriate laser treatments, physician-grade skincare, strict sun protection, heat avoidance, and periodic maintenance sessions. The key is understanding that melasma is a chronic condition requiring ongoing management—similar to conditions like rosacea or acne. With proper care guided by experienced dermatologists, most patients can keep their melasma beautifully controlled.

PicoWay uses ultra-fast picosecond energy pulses (trillionths of a second) to shatter pigment into tiny particles that are easily eliminated by the body’s immune system. This “photoacoustic” effect breaks up pigment mechanically rather than through heat, significantly reducing the risk of inflammation and post-inflammatory hyperpigmentation. The minimal heat generation makes PicoWay particularly excellent for treating stubborn brown spots in darker skin tones or heat-sensitive skin where traditional lasers might trigger complications. Many patients see dramatic fading of brown spots after just one or two PicoWay sessions with minimal downtime.

Yes, if used incorrectly or too aggressively, certain laser treatments can darken melasma by triggering post-inflammatory hyperpigmentation or stimulating melanocytes. This is precisely why physician expertise and fellowship training in laser technology matter so much. Our board-certified dermatologists carefully choose laser wavelengths, energy levels, treatment intervals, and supportive protocols to ensure safe improvement without triggering inflammation or rebound pigmentation. We also prepare skin properly before treatment and provide comprehensive post-treatment care to minimize any risk of darkening. This conservative, sophisticated approach is what separates experienced dermatologists from technicians at medspas who may not understand the complexities of treating reactive pigmentation.

Home care is critical to melasma management and maintaining your results. Essential components include: strict daily sunscreen (broad-spectrum SPF 50+, reapplied every two hours), sun avoidance during peak hours, wearing wide-brimmed hats, avoiding heat exposure (hot yoga, saunas, steam rooms), using physician-prescribed pigment-inhibiting serums (hydroquinone, kojic acid, tranexamic acid, vitamin C), maintaining a gentle skincare routine that does not cause inflammation, and taking oral antioxidants if recommended. Your dermatologist will provide a personalized homecare protocol designed to support your in-office treatments and prevent pigmentation from returning.

Results vary significantly based on the type of pigmentation. Sun-related brown spots may lighten noticeably after just one or two treatments. Melasma improvement is more gradual, typically requiring a series of treatments over several months with progressive brightening. Most patients with melasma notice their skin appearing brighter and more even within four to six weeks of starting treatment, with continued clarity developing over several months. Patience is essential, treating melasma successfully requires a gentle approach that prioritizes long-term stability over quick results that might trigger rebound darkening.

Yes, when performed by experienced physicians who understand how to adjust laser parameters for melanin-rich skin. Our board-certified dermatologists choose pigment-safe lasers and conservative settings that work effectively for a wide variety of skin tones while minimizing the risk of post-inflammatory hyperpigmentation. Devices like PicoWay and carefully calibrated Clear + Brilliant are particularly safe for darker complexions. Proper pre-treatment preparation, appropriate energy levels, and comprehensive post-treatment care all contribute to safe outcomes in patients with darker skin. Our physicians have extensive experience of treating diverse skin tones and understand the unique considerations required.

During your comprehensive consultation, your board-certified dermatologist will evaluate your specific type of pigmentation (melasma vs. sun damage vs. post-inflammatory), identify triggers (hormones, sun, heat), assess your skin’s reactivity and tone, review your treatment history, and discuss your goals and commitment level. Based on this thorough evaluation, you will receive a personalized treatment plan designed to safely improve your clarity while maintaining long-term stability. For melasma, this typically involves a combination approach: carefully selected laser treatments, physician-grade skincare, strict sun protection protocols, and trigger avoidance strategies. Your dermatologist will create a roadmap for both initial improvement and long-term maintenance.