Melasma & Pigmentation

Melasma is a complex pigment condition influenced by hormones and sun exposure, and it does not behave like ordinary sun damage. It shows up most often across the cheeks, the forehead, and the upper lip. It is driven primarily by hormones, which is why it shows up in pregnancy, after starting oral contraceptives, or alongside hormone therapy, and why it affects women far more often than men.

Sun makes it worse, and so can excessive heat, which is why heat-based treatments deserve caution in pigment-prone skin. Melanin-rich skin is more reactive to inflammation and heat, which makes it especially vulnerable to discoloration after a procedure. Because melasma is complex and prone to recurrence, it calls for a conservative, ongoing strategy rather than the aggressive resurfacing that clears ordinary sun spots.

The other honest framing is that melasma is managed rather than cured. The goal is to bring the pigment down and then hold it there with maintenance and daily protection, knowing that a pregnancy, a medication change, or one bad summer can bring it back. Depth matters too: pigment sitting high in the epidermis responds well, while pigment that has settled into the deeper dermis responds slowly and only partially, and that is worth understanding before you start.

The most common way this goes wrong is melasma being treated as though it were sun spots. The treatments that clear age spots efficiently work by heating pigment, and melasma calls for a more conservative approach than that. If you have been treated elsewhere and the pigment returned worse than before, that is usually what happened, and it is why we ask a great many questions before recommending any device.

For most people the sequence is straightforward. Cosmelan first, to bring the pigment down, then Chemical Peels and daily topical maintenance to hold it, with Pico Laser or Clear + Brilliant sometimes combined from the start for a faster or more effective reduction in pigmentation. Sometimes Cosmelan is the first line treatment on its own, and the home routine is part of the plan either way.

Sun protection here is not general advice, it is part of the treatment. Daily sun protection is critical here, because it is what maintains the result and prevents new pigmentation from forming. Shade, a hat, and staying out of midday sun are doing real work. Without it, pigmentation can return no matter how well the in-office work goes.

A consultation settles three things: how deep the pigment sits, what is driving it hormonally, and whether it is melasma at all, since post-inflammatory hyperpigmentation left by acne, a burn, or a skin injury is a separate condition and is treated differently. If hormones are a factor, it is worth a conversation with whoever prescribes them, because pigment that keeps being fed will keep coming back. We would rather say that at the start than after three treatments.