What is the best treatment for melasma?

Melasma is one of the most frustrating pigmentary conditions to treat because it’s not just about clearing pigment, it’s about calming the underlying cellular chaos that causes it. The most effective approach is multi-modal treatment, layered strategically over time.‍

‍Because heat is a trigger for melasma, we prefer to use low energy devices to clear unwanted pigmentation. Our go-to devices for stubborn melasma are the Moxi laser, a non-ablative fractional laser, which allows us to target superficial pigment with minimal risk of hyperpigmentation, making it safe for all skin tones. Tixel on a low energy, short contact setting and SylfirmX RF microneedling are also excellent options. My new favorite technique for melasma is adding topical or intradermal Botox with Tixel, Moxi, or pulsed wave RF microneedling, especially when there’s a vascular or inflammation-driven flare. ‍

‍Generally, we will ask the patient to pretreat with oral tranexamic acid or 6-10% hydroquinone so we get the most out of the device treatments. After 2 months on hydroquinone we will switch them to a lower strength treatment, like SkinMedica’s Even & Correct Brightening Pads. 

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What’s the fastest way to treat melasma?

The fastest results come when we approach melasma on four fronts: suppress melanocytes, exfoliate pigment, reduce inflammation, and block UV/heat triggers.

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How long before results are seen?‍

Using a combination of treatments we outline above, along with strict sun protection/avoidance will lead to noticeable fading by week 4, and full results by 8–12 weeks. 

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Does melasma ever fully go away, or is it more about ongoing management to keep it under control?

Melasma doesn’t go away forever, but it can go into remission with diligent maintenance and symptom management. Once we clear visible pigment, we shift patients to a maintenance plan with antioxidants, light peels, and laser touch-ups every few months. It’s similar to managing acne or rosacea, less about cure, more about control.

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If left untreated, can melasma get better naturally, or is it likely to get worse?

It will likely get worse without treatment. At best, it may fade seasonally. At worst, it can deepen and spread, especially with sun, heat, or hormonal triggers. That’s why we recommend early intervention and long-term skin barrier support.

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What causes melasma to come back after it begins to fade?

Melasma is triggered by a plethora of factors including UV light, blue light, hormones, inflammation and heat (like hot shower and saunas). Even distant sun can trigger melasma, meaning if you have sun exposure on your legs without SPF, melasma on your face can reappear. 

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Best skincare products for melasma:

• Alastin A-luminate: This is a newer product in our office, but already becoming a patient favorite for pigment correction. Its formulated with antioxidants and niacinamide.  It applies nicely and isn’t too harsh or irritating. 
• SkinMedica Even & Correct Brightening Pads: This product is gentle enough for everyday use, and perfect for maintaining clear skin. It’s not strong enough alone to reduce most melasma cases, but once you are treated by a professional, it’s the perfect solution to keep up your results. 
• Skin Medica E&C Spot Correct Cream: While this is a spot corrector, i actually like it for full face melasma treatment. It’s powerful and effective. Patients should taper on to prevent irritation or flaking skin. 
• Benev Exobalm: I recently saw some great data on exobalm for melasma come out of AMWC Monaco. I’ve had this in my clinic for a while now, and it feels fabulous post-procedure, with a very rich and hydrating formula. It is prepared at the clinic with exosomes and should be stored in the refrigerator. 

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For additional information on melasma, visit the the AAD website.

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For personalized recommendations, schedule a consultation at SOM Aesthetics to learn how we can help you break free from melasma.