Laser, LED Light Treatments, and IPL for Melasma
If you have melasma, you know how tough it can be to treat. Skin care products can take months to work and melasma recurs when you go into the sun and heat. This is why laser, LED lights, and IPL treatments for melasma on the face are so tempting. But are laser treatments for melasma safe? Are they worth the money?
I say no.
The incidence of post inflammatory hyperpigmentation is high.
Melasma often comes back worse after laser.
Using the right skin care products for melasma is a better strategy.
Let me back up a bit – because I know that not all dermatologists will agree with me.
You need to know that I am a dermatologist in Miami Beach, Florida and the sun is very strong here and it is hot all year around. It is well established that sun and heat make melasma worse. So- it is possible that my experience is different than doctors that are not near me and are in communities with less sun exposure.
The point is- I can treat melasma with skin care products and get a better result than laser without the side effects. It all comes down to educating my patients about lifestyle habits and making sure that they have 2 skin care routines for melasma: a Treatment Routine and a Maintenance Routine.
Two to three times a week I have a patient with melasma who has had a laser treatment for melasma (by someone else- not me) and is now much worse. They are often very upset. Not only is their skin worse, but they wasted money on laser treatments. Tears are shed because it is very stressful to feel self-conscious about these dark spots on your face. It makes me upset too – because this would not have happened if they had been educated to use the right skin care routine and adjust their lifestyle habits.
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The reason some skin care routines do not work is that skin lightening ingredients can be unstable, and they get inactivated by other ingredients in the skin care routine. The fatty acids in moisturizers will also affect how well the skin whitening products work. The cleanser you choose also plays a role. It is important to realize that every single skin care product in the routine must work together to block the production of pigment. So- you need the correct skin care routine for melasma. And- you need to be patient. It can take 12- 16 weeks.
If you really insist on getting laser for melasma- talk to your doctor about getting on the right skincare routine to prevent side effects.
There are many lasers used to treat melasma. Vascular lasers target the blood flow to the skin and are mostly used to treat melasma in Asia. In the US, the lasers most commonly used to treat melasma are Q- switched lasers and non-ablative fractional lasers.
Q-switched lasers used to treat melasma are:
Red Light: Ruby laser (694 nm)
Red Light: Alexandrite (755 nm)
Neodymium-doped yttrium aluminum garnet (Nd:YAG; 532 nm)
Near- Infrared Light: Neodymium-doped yttrium aluminum garnet (Nd:YAG; 1064 nm)
Pulsed Dye Lasers for melasma:
Green light flashlamp-pumped pulsed dye laser (PDL) (510 nm)
Nonablative lasers used to treat melasma are:
Nonablative fractional laser (NAFL)
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erbium:yttrium-aluminum-garnet (Erb:YAG)
Treatments can cost $300- $500 per treatment. Usually 1-2 treatments are required.
The most common side effect is worsening of the melasma. Inflammation causes pigmentation so any skin injury-, such as a laser injury, can worsen melasma.
Intense Pulsed Light (IPL) used wavelength of light between 515 nm and 1200 nm. Although IPL has been shown to be effective at treating melasma- it also has a high risk of worsening the melasma.
All kinds of light make melasma worse. Green light therapy for melasma, red light therapy for melasma, blue light therapy for melasma, infrared light (heat), and sunlight (UV radiation)- they all make melasma worse.
Red light therapy is less bad for melasma than the other types of light, but I still do not recommend it.
The bottom line:
- Wear your SPF every day. Choose a tinted sunscreen of SPF 30+
- Use the correct skin care routine for your Baumann Skin Type®
- Make sure the products don’t cancel each other out
- Use the melasma skin care products consistently
- Avoid sun and heat when possible
- Change your lifestyle habits
- Consider these vitamins
- Ask your doctor about tranexamic acid
- Be patient and trust that it will work.
If you had a melasma laser and it made your melasma worse- please tell others or come tell me on Instagram @LeslieBaumannMD We need people to speak out to save others from having side effects from the melasma laser and ending up worse off than they started.
July 11, 2022
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