Treating melasma: what lasers can do and where their limits lie
Melasma is the pigmentation disorder in which lasers can help but can equally do harm. The brownish, diffuse patches on the forehead, cheeks and upper lip respond to hormones, sun, visible light and heat. Here you will find out which types of melasma exist, why too much energy makes the patches worse and how a gentle treatment is structured.
The SIACSKIN devices featured are the non-ablative TULIX with 1927 nm, the PICOLO XL and the PICOLO L for laser toning with 1064 nm, and the Skin Analyzer Pro. Also covered: the mask of pregnancy, dark skin types, sun protection, relapses and honest expectations.
How do I recognise melasma, and how does it differ from sun spots?
Melasma appears as a patchy, poorly defined, brownish to grey-brown discolouration, almost always similar on both sides of the face. Typical sites are the forehead, cheeks, bridge of the nose, upper lip and chin. Sun spots, by contrast, are individual, sharply outlined spots without symmetry. Melasma becomes darker in summer and paler in winter, usually begins between the ages of 20 and 50 and mainly affects women. The distinction matters because a sun spot is removed with a powerful pulse, whereas melasma can respond to exactly that by getting worse. If it is unclear what is present, the dermatologist makes the diagnosis.
The Skin Analyzer Pro from SIACSKIN captures the face with white light, UV and polarised light and makes the distribution of the pigment visible. The TULIX, which lists melasma as an application, is intended for the treatment.
Epidermal, dermal or mixed melasma: what does the type mean for treatment?
The type describes how deep the pigment lies, and that determines how well the melasma responds. In the epidermal type the melanin sits in the epidermis: the patches tend to be light brown, stand out with much greater contrast under UV light and respond best. In the dermal type, pigment lies in the dermis, the colour appears grey-brown to bluish, and lightening takes a long time. The mixed form is the most common. Realistically, the superficial component can then be lightened well, the deep component only slowly.
The TULIX has a wavelength for each level: 1927 nm thulium for the epidermis and 1550 nm erbium glass for the dermis. For melasma, 1927 nm takes priority, and 1550 nm is dosed cautiously. The images from the Skin Analyzer Pro help with the assessment.
What role do the pill, the hormonal coil and the menopause play in melasma?
Oestrogens and progestogens stimulate the pigment cells, which is why hormonal contraception can trigger or sustain melasma. This applies above all to combined preparations, less often to hormonal coils, and equally to hormone replacement therapy during the menopause. Not every woman reacts to them; predisposition is a contributing factor. If the hormonal trigger persists, treatment does lighten the melasma, but it returns more easily. Whether a preparation can be changed is a matter for the gynaecologist, not the studio. The thyroid and some medications can also be contributing causes.
For treatment this means: ask about triggers, align expectations accordingly and work gently. The TULIX, as a non-ablative fractional laser with little downtime, is designed for this.
Does the mask of pregnancy (chloasma) disappear on its own, and when can it be treated?
In many women, a mask of pregnancy fades of its own accord in the months after the birth; in some it persists. As hormone levels fall, the pigment cells settle down, which can take up to a year. No laser treatment is carried out during pregnancy and breastfeeding; during this time, what counts is consistent sun protection, preferably tinted. Treatment makes sense if noticeable pigment is still present after weaning and a waiting period of several months. Anyone who starts earlier is treating something that might have resolved by itself and is working against fluctuating hormones.
A gentle course with the TULIX is then suitable. In addition to melasma, the PICOLO L explicitly lists chloasma as an application.
Why do heat and visible light make melasma worse, even without sunburn?
In melasma, the pigment cells respond not only to UV radiation but also to visible light, especially the blue component, and to heat. Visible light passes through window glass and is not blocked by conventional UV filters. Heat dilates the blood vessels and releases messenger substances that drive pigment formation. Saunas, hot yoga, working at a hob or oven and very hot showers can therefore darken melasma even though no sun was involved.
The same rule follows for laser treatment: introduce as little heat as possible into the skin. The TULIX works non-ablatively, its energy can be finely dosed from 0.5 mJ, and the device works with air cooling.
Why is IPL or BBL usually the wrong choice for melasma?
In melasma, broadband light introduces too much heat into skin whose pigment cells respond to heat by producing new pigment. IPL and BBL heat melanin and blood vessels across the whole area. For sun spots that is desirable; in melasma it often lightens briefly and then darkens more strongly after a few weeks. There is also the risk of confusion: an unrecognised melasma among sun spots frequently responds to a course of light treatment with widespread darkening. That is why every light treatment must be preceded by a look at the symmetry, location and history of the pigment spots.
The DERMAFORCE BBL PRO is the right device for sun damage, hyperpigmentation and redness in skin types I to IV. For melasma, the TULIX is the intended device at SIACSKIN.
What is laser toning with 1064 nm, and how gentle is it for melasma?
Laser toning is a treatment with very low energy, a large spot and 1064 nm, in which the whole area is covered in several passes. The pulses are so weak that no crust forms. They break up melanin gradually without destroying the pigment cells, and afterwards the skin is at most briefly reddened. It only remains gentle in moderation: too many sessions at too short an interval can leave patchy lightening. Usually 3 to 6 sessions are planned, and with intervals of about 4 weeks the skin stays on the safe side. The shorter the pulse, the lower the heat.
The PICOLO XL works with 280 ps and 1064 nm, the PICOLO L as a Q-switched laser in the nanosecond range. Both list melasma as an application and have spot sizes of up to 10 mm.
Why is melasma treated with low energy rather than one strong session?
With melasma, what counts is not how much pigment a session removes but how calm the skin remains in the process. A strong session takes away a lot of melanin but triggers inflammation, and that drives the pigment cells to renewed production. In practice, low dosing means: low energy per pulse, low density of the microzones, few passes and, as the aim, only slight redness, no swelling and no crusts. The effect accumulates over the course. If little is visible after two sessions, do not increase the energy; stick to the plan.
On the TULIX the energy can be set from 0.5 to 300 mJ, and the spot measures 50 to 200 µm. That gives scope for very fine settings. The usual course is 3 to 6 sessions at intervals of about 4 weeks.
What should you do if melasma has become darker after laser treatment?
First, pause: no further session until the skin has settled completely. Darkening in the first week is normal with non-ablative lasers and flakes off. If it lasts longer than 3 to 4 weeks or the area is larger than before, the skin has reacted with post-inflammatory hyperpigmentation. What then helps is strict tinted sun protection, avoiding heat, exfoliants and irritating skincare, and a pigment-inhibiting treatment prescribed by the dermatologist. The darkening usually regresses over weeks to months.
After that, treatment is restarted with significantly less energy and longer intervals, for example with the finely adjustable TULIX. The Skin Analyzer Pro records the progress in the before-and-after comparison.
What is different about melasma on dark skin (skin types IV to VI)?
In darker skin types, melasma is more common, more persistent and reacts more sensitively to any irritation. The pigment cells are naturally more active; after heat or inflammation dark pigment spots develop more quickly, and with overly frequent treatment light patches too. The rule is therefore: first several weeks of preparation with sun protection and pigment-inhibiting skincare, then a test patch, low energy, low density and an interval of 6 rather than 4 weeks. Broadband light and short wavelengths such as 532 nm are out of the question. The aim is visible lightening, not a completely even complexion.
The TULIX is specified for all skin types, and its wavelengths target water rather than melanin. For laser toning, the PICOLO XL offers 1064 nm with 280 ps.
Do men get melasma too, and is it treated differently in them?
Yes, men also get melasma, only much less often than women, and treatment follows the same rules. In men, sun and predisposition are the main triggers, and hormones play a smaller role. The cheeks, nose and forehead are frequently affected, often in those who work outdoors. Two things are different in practice: men are less likely to wear sun protection daily, and tinted products are unpopular. Without this protection, no result lasts. Shaving and aftershave containing alcohol or fragrances cause additional irritation and are adjusted around the sessions.
Treatment is the same as for women: gentle, as a course, with maintenance. The TULIX works non-ablatively and with little downtime. The images from the Skin Analyzer Pro make the progress easy to follow.
How do you prepare the skin for laser treatment of melasma?
Preparation begins 4 to 6 weeks before the first session with daily sun protection and skincare that slows pigment formation. This means the pigment cells go into the treatment in a calmed state, and the risk of darkening falls. Suitable active ingredients include vitamin C, niacinamide or azelaic acid; prescription-only preparations are determined by the dermatologist. Irritating exfoliants and retinoids are paused a few days before the appointment. In addition, there is a baseline photo, a discussion of triggers and a test patch, the reaction to which is assessed after 2 to 4 weeks.
The Skin Analyzer Pro documents the baseline condition. Only then does the course begin, for example with the TULIX. The SIACSKIN range includes the Serum Vitamin C and the Suncream Sensitiv SPF50.
What sun protection is needed for melasma, and why should it be tinted?
What is needed every day is broad-spectrum protection with sun protection factor 50, and it should be tinted because only colour pigments also block visible light. UV filters protect against UVB and UVA but let the visible component, especially the blue part, through. Iron oxides in tinted products close this gap. The amount matters: about two finger lengths for the face and neck, reapplied every 2 hours outdoors. Add a hat and shade, even in winter and under an overcast sky. Without this protection, the result of a laser course is usually lost after the first summer.
SIACSKIN's skincare range includes the Suncream Sensitiv SPF50 for aftercare. If a top-up session becomes necessary despite protection, the TULIX is suitable because of its low downtime.
Does melasma go away completely with laser treatment, and how long does it take to lighten?
No, melasma can be lightened considerably and kept calm for a long time, but it cannot be eliminated permanently. The predisposition of the pigment cells remains. Initial lightening usually appears after 2 to 3 sessions, that is after 2 to 3 months, and the result of the whole course after about six months. A good outcome means: visibly paler, less sharply demarcated and easy to even out with make-up. Relapses after summer, holidays or hormonal changes are to be expected. That is why 1 to 2 top-up sessions a year are part of the plan, ideally in autumn and winter.
The TULIX lists melasma as an application and is planned as a course of 3 to 6 sessions. The Skin Analyzer Pro documents the progress with comparable images.
Can melasma and age spots on the same face be treated at the same time?
Yes, but not with the same settings and preferably one after the other. Many faces show both: sharply defined sun spots with patchy melasma in between. First the melasma is calmed with sun protection, skincare and gentle sessions. Only once it is stable are the individual age spots treated precisely, with a small spot size that spares the melasma area. Anyone who starts the other way round and treats the whole area aggressively risks the melasma darkening and masking the gain again.
The TULIX takes on the gentle, full-area work and lists both melasma and age spots as applications. For the individual age spots afterwards, the PICOLO XL and the PICOLO L have spot sizes from 2 mm and the 532 nm wavelength.
