Hormonal changes from pregnancy, birth control, or genetics can lead to melasma—brown patches of uneven pigmentation that often appear on the face. Affecting an estimated six million American women, melasma can create a mask-like appearance and significantly impact self-confidence and emotional well-being.
Top Asked Questions About Melasma
- I have melasma. Can I still spend time outside?
At Reflections, we want to help you look and feel your best, and that means being able to do the things you love. As part of your treatment plan, our team will recommend a top-grade sunblock for daily protection and strategize with you about other ways to protect your skin from the sun and keep melasma from reappearing.
- What is the best way to treat melasma?
The best way to treat melasma depends upon the individual, but all treatment needs to include both active treatments to remove the pigment in the skin and a proactive skincare and medication routine to prevent new pigment from developing. An example of this might be Clear + Brilliant laser treatment to remove the spots you have, plus tranexamic acid prescription to use everyday, plus sunscreen used daily.
- Can melasma be cured permanently?
No - currently melasma cannot be cured. However, we can usually manage it with ease when patients are consistent with their prevention using medications and skincare at home.
What Causes Melasma?
Melasma is a chronic skin disorder that is affected by hormonal fluctuations. Most women notice melasma is triggered when they undergo a large fluctuation in hormones from pregnancy, the use of birth control pills, or hormone replacement therapy. It also seems to run in families and is more prevalent among Latina and Asian women.
What are the Best Treatments for Melasma?
Melasma can be challenging to manage, as pigmentation may occur at different depths within the skin and is often influenced by factors such as hormones, sun exposure, and heat. Because certain devices and treatment settings can worsen pigmentation when used improperly, careful evaluation and thoughtful treatment selection are essential.
Effective melasma management requires an individualized approach that takes into account skin type, pigment depth, and underlying triggers. When treatments are carefully selected and performed thoughtfully, patients can achieve meaningful improvement while minimizing the risk of flare-ups.
Our treatments focus on two goals:
- Reduce new pigment formation through medical-grade skincare, strict sun protection, and prescription therapies when appropriate.
- Address existing pigmentation by selecting treatments that target pigment at the appropriate depth while minimizing heat and inflammation—known triggers for melasma.
Everyone Needs Great Prevention of Future Melasma Pigment
We mentioned above that melasma is chronic, meaning there is no known cure and it will continue to return throughout your life. Prevention is key – but it won’t guarantee that you never have any issues again. You’re very likely to see melasma flare up anytime there are hormonal fluctuations, as well as any time you get sun exposure or are in the heat – both sun exposure and heat are big triggers for melasma.
Daily sun protection is essential for managing melasma. Broad-spectrum sunscreen helps prevent pigment stimulation caused by UV exposure and heat. We typically recommend mineral or hybrid sunscreens containing zinc oxide and/or titanium dioxide, as these are well tolerated and effective for many patients. Consistent daily use—along with protective clothing and avoiding sun exposure during peak hours—plays a critical role in preventing flare-ups.
Topical Creams & Prescriptions for Melasma
Topical therapies are often the first step in managing melasma. When started early and used consistently, these treatments can help improve existing pigmentation. Certain medications are not appropriate during pregnancy or breastfeeding and should only be used under medical supervision.
Depending on the individual case, topical therapies may be used alone or combined with in-office procedures. Commonly recommended options include hydroquinone 4%, azelaic acid, retinoids such as tretinoin, and combination prescription creams like Tri-Luma®. These treatments are selected based on skin type, pigment depth, and overall treatment goals.
Agents such as hydroquinone work by reducing melanin activity in the skin rather than altering natural skin tone. Retinoids help improve pigmentation by increasing skin cell turnover and enhancing the penetration of other topical ingredients, supporting gradual improvement in the appearance of melasma over time.
While topical treatments can be effective for some patients, more persistent or deeper melasma often requires a combination approach. In these cases, topical therapy is typically paired with procedural treatments and long-term maintenance strategies to achieve more meaningful improvement.
Removing Existing, Stubborn Spots
While microdermabrasion, microneedling, and chemical peels can also be used for treating melasma, we have found that lasers make for the best melasma treatment.
Clear + Brilliant Laser
Clear + Brilliant is the latest innovation in fighting melasma. This laser treatment penetrates the skin at a shallow depth, targeting the layers where much of the unwanted pigment from melasma resides. Clear + Brilliant is a good choice for both initial treatments and maintenance therapy, with treatments usually spaced about one month apart4. We do safely use this treatment on darker skin tones.
Fraxel Re:Store Dual Laser
For the more aggressive treatment of melasma there’s the Fraxel Re:Store Dual laser, which is the gold standard for sun-damaged skin. Its energy penetrates deep into the skin, eliminating the skin cells that cause melasma while protecting the skin’s outer layer. Fraxel Re:Store Dual laser treatments are usually performed monthly for a three- or four-month period3. However, this treatment is not appropriate for patients with dark skin tones.
Q-Switched Nd:Yag
The Q-Switched Nd:YAG laser can target melanin in the deep dermis, making it another option for the treatment of melasma. This laser is especially useful when treating patients with darker skin, as its long wavelength provides a safer and more effective treatment. Q-Switched Nd:YAG treatments are usually provided in a series of visits, spaced two to three weeks apart, and are often used to supplement the great results from Clear + Brilliant and the Fraxel Re:Store Dual laser1. This laser is safe for all skin types.
Intense Pulsed Light (IPL)
Intense pulsed light (IPL) treatments can also be helpful in some cases where the pigment from melasma is found in the epidermis, the upper most layer of the skin2. Unfortunately, what we often see is patients with skin of color who were mistreated with this modality and whose melasma has been made worse. This is the treatment we use the least because it’s only appropriate for a very small percentage of patients – but unfortunately, it’s a cheaper system to buy and it’s widely misused in other practices.
Tranexamic Acid Pills or Micro-Injections – Not the Creams and Serums!
Tranexamic Acid (TXA or TA) is a god-send for patients with the most stubborn melasma. This is a 6-12 month course of treatment.
However, this medication is a pill, which means it goes throughout your entire body and it is a medication that can create some problems for certain patients, so it’s not something to take lightly. We reserve it for patients with the most severe and stubborn cases of melasma who have failed other treatments, and who our doctors can clear medically.
We are aware there are a host of new skincare products that have topical tranexamic acid in them. TXA is a big molecule and cannot make it to the melanocytes deep within your skin through a topical. Unfortunately, these skincare products with tranexamic acid are a waste of money.
We also offer a micro-injection treatment with TXA – like microneedling, but with medicine being delivered through those needles – so that the TXA is not going throughout your entire system, but can reach the right depths for effective treatment. We call this treatment TXA Restore.
Learn More About Tranexamic Acid TreatmentCompare the Best Melasma Treatments
Fortunately, there are several ways of treating melasma, starting with topical treatments, chemical peels, and microdermabrasion, and usually ending with cosmetic lasers. So even if you’ve tried treatments in the past and not gotten the full results you’re after – and especially if any treatment you’ve had has made your melasma worse – we’ve got the physicians and the treatments to help you turn it around and get your melasma under control. This is a specific condition that we have invested very heavily in being able to provide the very pinnacle of care for because we know how emotional and upsetting it is.
| Treatment | Cost | Invasiveness | Downtime | How it Works |
|---|---|---|---|---|
| IPL (Intense Pulsed Light Therapy) | $300 - $450 Per treatment, multiple sessions recommended Reduced package pricing available | Low-mid intensity pulsed light treatment. No anesthetic required | Mild redness the evening of treatment, but no true downtime | Targets dark spots by selectively heating them. Not applicable for darker skin types |
| Clear and Brilliant Laser | $475 - $825 Per treatment, multiple sessions recommended Reduced package pricing available | Low-intensity laser with topical numbing cream used | Redness the evening of treatment, but no true downtime | Targets dark spots by selectively heating them, not applicable for darkest skin types |
| Q Switched Yag Laser | $300 - $450 Per treatment, multiple sessions recommended Reduced package pricing available | Medium intensity laser. No anesthetic required | Mild redness which quickly resolves, no scabbing or crusting. No downtime. | Targets and reduces dark spots by selectively heating them. Safe for all skin types, even darker skin |
| TXA Restore™ (Micro-injected Tranexamic Acid) | $900 per treatment | Micro-injection treatment with injection numbing used (expect pinpoint bleeding during procedure) | Redness and mild swelling for few days, coverable by makeup. Potential for bruising | Tranexamic acid acts to inhibit pigment production and directly on blood vessels in a way to inhibit melasma |
| Fraxel Restore Dual Laser | $450 - $900 Per treatment, multiple sessions recommended Reduced package pricing available | Medium intensity laser with topical numbing cream used | Redness for few days, coverable by makeup. Flaking for several days | Targets and reduces dark spots by selectively heating them |
| Microneedling Dermapen | $950 - $1400 Per treatment, sometimes, concentrated platelet solutions are added to procedure. Multiple sessions recommended Reduced package pricing available | Low depth microneedling | Some minor redness, coverable with makeup | Microneedling initiates healing mechanisms that improve pigmentaion in skin |
| Chemical Peels | $150 - $250 Per treatment, multiple sessions recommended Reduced package pricing available | Low-strength chemical peel | Minimal to no downtime | Topical agent causes shedding of upper layer of skin |
Prescription Medications |
Varies, depending upon your insurance coverage and pharmacy pricing | Pills and topical/skincare options available | No downtime | Most patients will need topical agents to maintain results from treatments and help reduce future flare ups |
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Before and Afters
More Before & Afters
“I did try topical medications and they worked for a while, and then they stopped. Then lasers, which worked, and my face looked great for about 2 weeks but then it would come back..... and then I started this pill and everything changed.”
View My Story
“I had the treatment on a Thursday and I had a wedding to go to on Saturday, and I was very concerned about it. I went there (to the wedding) and it was like nothing had happened - I just had a rosy glow to my cheeks.”
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“ "To hear it from other people, to be comfortable myself, and to be able to not wear makeup - it's lifechanging. I saw a result after the first treatment with the laser. He also gave me a topical...”
View My Story
Choose Reflections Center as Your Melasma Treatment Specialists
With Reflections’ approach to melasma treatment and management, you will look like yourself again. Best of all, you’ll have a new confidence when you’re out and about, knowing everyone can see the real you.
Prescribing the right combination of medications and lasers is critical to successful melasma treatment. Therefore, it is critical to choose a physician who has the complete array of laser technologies for melasma treatment that is best for your particular type of melasma. It’s also important to choose a physician that has lots of experience treating melasma with lasers, as being too aggressive can often make the condition worse. Please give us a call if you have questions about the best way to approach treating your melasma – consultations are complimentary, and our physicians are always happy to help!
*Results may vary: Melasma is hormone-related and can be resistant to treatment. Usually, patients can expect to see a dramatic improvement in skin tone after laser therapy, but there may be need for additional future treatments, particularly if hormones fluctuate in the future such as with an additional pregnancy.
Frequently Asked Questions
Which vitamin is good for melasma?
How can I get rid of melasma naturally?
Which cream is best for melasma?
What is the best way to treat melasma?
Can Melasma be cured permanently?
What are the major risk factors of melasma?
What type of melasma is most difficult to treat?
Can melasma spread to other parts of the body?
What kind of treatment helps with melasma?
What triggers a melasma flare up?
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Sources:
- TSE, Y., LEVINE, V. J., MCCLAIN, S. A. and ASHINOFF, R. (1994), The Removal of Cutaneous Pigmented Lesions with the Q-switched Ruby Laser and the Q-switched Neodymium: Yttrium-Aluminum-Garnet Laser. The Journal of Dermatologic Surgery and Oncology, 20: 795–800. doi: 10.1111/j.1524-4725.1994.tb03707.
- Babilas, P., Schreml, S., Szeimies, R.-M. and Landthaler, M. (2010), Intense pulsed light (IPL): A review. Lasers Surg. Med., 42: 93–104. doi: 10.1002/lsm.20877
- Lawrence S. Bass MD; Rejuvenation of the Aging Face Using Fraxel Laser Treatment; DOI: http://dx.doi.org/10.1016/j.asj.2005.03.003 307-309 First published online: 1 May 2005
- Amir M Karam, Mitchel P Goldman; Rejuvenation of the Aging Face; JP Medical Ltd, Aug 28, 2015; pages 91-104
Dr. Mitchell Chasin
Dr. Mitchell Chasin is a Cosmetic & Laser Physician at Reflections Center. Dr. Chasin believes strongly that the best cosmetic physicians are those who are dedicated to mastering their craft through continuing education and collaboration with the industry’s top doctors.
