Melasma is the one pigment condition where the wrong laser doesn't just fail. It can leave you darker than when you started.
Picosecond laser is the safest laser for melasma, because it fragments pigment photoacoustically with almost no heat — and heat is what triggers melasma to rebound darker. Ablative CO2 and IPL carry real risk of worsening it. Melasma is chronic: treatment controls it rather than curing it, expect a longer series than ordinary sun spots, and photoprotection against visible light — not just UV — matters more than any single treatment.
A sun spot is a discrete deposit of pigment. Break it up, the body clears it, it's gone. Straightforward.
Melasma isn't a deposit. It's a chronic condition in which the pigment-producing cells themselves are hyperactive and primed to overreact. The brown or grey-brown patches on the cheeks, forehead, upper lip, and jawline are the visible output of melanocytes that have been sensitised — by hormones, by sun, by heat — and that remain sensitised after the pigment is cleared.
Which means two things follow. Treatment controls rather than cures. And anything that irritates or heats the skin risks provoking exactly the response you're trying to suppress.
Melasma is heat-sensitive. Thermal energy delivered into melasma-prone skin can trigger rebound hyperpigmentation — the pigment returning darker and more extensive than before treatment, sometimes months later.
This is not a rare complication. It is one of the most common ways melasma is mismanaged, and it happens most often when melasma is treated as though it were ordinary sun damage: with an ablative laser, at standard settings, by someone who didn't distinguish between the two.
The distinction matters enormously, and it is the reason melasma should be identified before anything is fired at it.
The pattern is consistent: the less heat a device deposits, the safer it is for melasma. That's the single most useful principle for evaluating any melasma treatment you're offered.
This is a genuinely difficult combination, and it's where a single-device practice tends to get patients into trouble — because the only available answer is the one device they own.
Melasma should generally be stabilised first with conservative Pico treatment and photoprotection before any thermal resurfacing is considered. Rushing to treat texture while melasma is active is how patients end up with better texture and worse pigmentation.
See Pico vs. CO2 for how the two compare, and combination resurfacing for when treating both is appropriate.
Patients frequently describe this as the treatment failing. It usually isn't — it's the condition doing what the condition does. Four drivers keep it active:
Treating melasma with laser alone is the most common reason results don't hold. The three components work together, and dropping any one of them undermines the others.
More than any treatment on this page. And specifically: a tinted mineral sunscreen containing iron oxides. Iron oxides block visible light; standard chemical sunscreens don't. Patients who switch from a clear chemical SPF to a tinted mineral one frequently see improvement before any treatment begins.
Pigment-suppressing topicals work continuously between sessions, addressing the melanocyte activity that laser doesn't. The specific regimen depends on your skin and history and is set at consultation — but topical therapy is generally not optional if you want the result to hold.
Pico laser for melasma is delivered at deliberately restrained settings across a longer series than ordinary pigment requires. Typically six or more sessions spaced about four weeks apart, then maintenance.
Conservative treatment across more sessions genuinely outperforms aggressive treatment in fewer. That's not caution for its own sake — with melasma, pushing harder produces rebound, not faster clearance.
Significant lightening. More even tone. Patches that are meaningfully less noticeable and easier to cover or ignore. Maintenance treatment to hold it.
Not: permanent clearance, complete resolution, or a face where melasma never returns. Any provider promising that is overstating what's achievable, and the patients who arrive expecting it are consistently the ones who feel let down by a course of treatment that worked exactly as it should have.
The patients who do best are the ones who understand from the outset that they're managing a chronic condition rather than fixing a spot.
The most common thing I see with melasma is a patient who was treated as though it were sun damage. Same device, same settings, and it came back worse. Identifying melasma before treatment isn't a formality — with this condition it's the whole decision, because the wrong choice doesn't just waste a session, it can set someone back years.
What is the best laser for melasma?
Picosecond laser is generally the safest and most appropriate laser for melasma. Because it works photoacoustically rather than thermally, it fragments pigment with minimal heat — and heat is the primary trigger for rebound pigmentation in melasma. Ablative lasers such as CO2 carry a meaningfully higher risk of worsening melasma and are generally not first-line for it.
Can laser make melasma worse?
Yes. Melasma is heat-sensitive, and thermal energy from ablative lasers and IPL can trigger rebound hyperpigmentation — the pigment returning darker than before treatment. This is one of the most common ways melasma is mismanaged, and it is why device choice and conservative settings matter more with melasma than with ordinary sun spots.
Is IPL safe for melasma?
IPL is generally not the preferred option for melasma. It delivers broad-spectrum light and heat, and because it targets melanin thermally it can cause rebound darkening in melasma-prone skin, particularly in deeper skin tones. IPL is better suited to diffuse redness and ordinary sun damage than to melasma.
Why does melasma keep coming back?
Melasma is a chronic condition, not a one-time pigment deposit. It is driven by hormonal influence, sun and visible light exposure, and heat, and the melanocytes involved remain primed to overproduce pigment. Treatment clears existing pigment but does not remove the underlying tendency, so recurrence without ongoing maintenance and photoprotection is expected rather than a treatment failure.
Can melasma be cured permanently?
No. Melasma can be significantly improved and controlled but not permanently cured. Realistic goals are substantial lightening, more even tone, and manageable maintenance. Any provider promising permanent clearance of melasma is overstating what is achievable.
How many laser sessions does melasma need?
Melasma typically requires a longer series than ordinary sun spots — commonly six or more sessions spaced about four weeks apart, followed by periodic maintenance. Progress is more gradual and less linear than with discrete pigmented lesions, and conservative settings across more sessions produce better outcomes than aggressive treatment in fewer.
Does sunscreen alone help melasma?
Photoprotection is the single most important factor in melasma control, but ordinary sunscreen is often insufficient. Melasma responds to visible light as well as UV, which standard chemical sunscreens do not block. Tinted mineral sunscreens containing iron oxides provide visible light protection and are meaningfully more effective for melasma.
Is heat a trigger for melasma?
Yes. Independent of UV exposure, heat can worsen melasma — including from hot yoga, saunas, cooking over heat, and even prolonged hot showers. This is also why thermal laser devices carry risk in melasma-prone skin, and why heat exposure is worth managing alongside sun protection.
Dr. Mortazavi will confirm whether what you have is melasma, sun damage, or post-inflammatory pigment — because they look similar and are treated very differently.
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