What to Know Before Getting Melasma Laser Treatment

Melasma is a common skin condition that appears as dark, blotchy spots and patches. It occurs most often on the face and other areas of skin exposed to the sun. Women, particularly those with darker skin tones between ages 20 and 40, are more likely to be affected than men.

Melasma occurs when melanocytes (pigment-producing skin cells) become overactive and produce more melanin than usual. Though the exact cause of melasma is not fully understood, hormonal changes, sun exposure, medications, genetic predisposition, and certain health conditions are believed to play a role. 

Melasma isn’t harmful, but some may feel self-conscious about the discoloration it causes, wishing to seek treatment to restore a more even skin tone. Laser therapy is a popular melasma treatment. 

In this article, learn more about the pros and cons of laser treatment for melasma, the types of lasers used, what to expect, and more. 

Pros of Melasma Laser Treatment

Laser therapy is a promising melasma treatment, particularly for those with treatment-resistant melasma that does not improve with more conventional options, such as topical skin-lightening creams and chemical peels. Pros of melasma laser treatment include:

• Possible elimination of dark spots on the skin
• Quick sessions that do not require much recovery time
• Targets only the affected areas of the skin and not surrounding tissues
• Renews skin cells for a more even, smoother skin tone and complexion
• Improves self-esteem if affected by melasma

Cons of Melasma Laser Treatment

Though laser therapy may effectively reduce or eliminate melasma, it does have some potential risks and side effects, including:

• Skin redness, irritation, swelling, and peeling for three to 10 days after the procedure (similar to a sunburn)
• Hypopigmentation (lack of melanocytes) in treated areas
• Post-inflammatory hyperpigmentation (temporary hyperpigmentation of injured or irritated skin that occurs more often in people with darker skin tones)

Melasma Laser Treatment Effectiveness

Laser treatment may effectively reduce dark spots and patches, particularly for people with treatment-resistant melasma. Research shows that laser treatments are most effective when combined with other treatment methods, such as topical whitening creams and chemical peels.

Some studies show that melasma recurrence is common, even when laser treatments initially eliminate dark spots. Long-term topical creams are often recommended to reduce the risk of melasma recurrence and post-inflammatory hyperpigmentation. 

Types of Lasers Used

Several types of lasers are used to treat melasma.

Intense Pulsed Light (IPL) 

Intense pulsed light (IPL) laser uses a broad spectrum of light wavelengths to target hyperpigmented areas directly. The light pulses heat and destroys melanin to remove discoloration and restore a more even complexion. IPL is often recommended for people whose melasma is deep within the skin, as it targets the lower layers of skin (dermis) and does not affect the top layers (epidermis). 

IPL sessions last approximately 20 minutes, and treatment regimens may involve four to six sessions every three to six weeks to achieve desired results. Research shows that IPL achieves modest improvements, but recurrence is likely unless topical therapy is continued for up to a year after laser treatment is completed.

Q-Switched Lasers

Q-switched lasers deliver high-intensity light beams in very short pulses to break melanin into smaller pieces—which are then removed by the body—to reduce the appearance of dark patches and spots. Q-switched laser sessions last approximately 15 minutes and may need to be repeated six to 10 times, once every two weeks, until desired results are achieved. 

Research shows that Q-switched laser treatment produces better results when combined with other therapies, such as chemical peels and oral medications. However, the risk of post-inflammatory hyperpigmentation and melasma recurrence is high in people with dark skin tones. 

Picosecond Lasers

Picosecond (PicoSure) laser treatments deliver very short pulses of energy converted to pressure—rather than heat—to destroy pigment particles and eliminate hyperpigmented spots without damaging healthy surrounding tissue.

Studies show picosecond lasers are a safe and effective treatment for melasma in people with dark skin, with little risk of side effects, such as hypopigmentation or post-inflammatory hyperpigmentation.

Fractional Resurfacing Lasers

Non-ablative fractional resurfacing lasers create microscopic holes in the skin to release hyperpigmented cells and stimulate the growth of new, healthy skin cells. This treatment targets the epidermis and dermis and protects the surrounding healthy tissue. The procedure lasts less than 30 minutes; four to five treatment sessions are typically required. 

Research shows that fractionated resurfacing lasers help reduce melasma in most people. Still, one study reported that 33% of participants had a partial recurrence of melasma and 13% reported full recurrence within 10 months after treatment.

What to Expect

Laser treatment for melasma varies, depending on the type of laser used. Most treatment sessions last less than 30 minutes and create minimal pain that some liken to a rubber band snapping against the skin.

To minimize pain and discomfort, a topical numbing cream may be applied to the areas being treated before the procedure. Applying ice packs or cold compresses to the skin immediately after and in the days following the procedure can help reduce discomfort. 

You can expect to see some improvement in your complexion after the first session, but most laser treatments require multiple sessions spaced apart by a few weeks for the best results.

Your healthcare provider may prescribe topical lightening creams in combination with laser therapy to reduce the risk of melasma recurrence. Avoiding prolonged exposure to the sun and applying high-SPF sunscreen to sun-exposed areas of the skin is vital to protect the skin from damage and prevent melasma from recurring. 

Other Treatment Options

In addition to laser therapy, there are several treatment options for melasma, including:

Topical lightening creams: These are typically the first-line treatment for melasma. They are applied directly to hyperpigmented areas to reduce dark spots and patches. Most topical creams contain a combination of skin-lightening ingredients, such as hydroquinone, tretinoin, corticosteroids, and azelaic acid. 

Chemical skin peels: A chemical solution is applied to the skin to slough off the top layer of hyperpigmented skin, allowing new skin to grow in its place for a more even complexion. Chemical peels for melasma may need to be repeated every two to four weeks, depending on the concentration of the peels, until you achieve desired results.

Microneedling: Tiny needles gently puncture the skin to place topical melasma creams deeply and evenly into the epidermis and dermis to reduce hyperpigmented patches and spots.

Oral therapies: Oral medications, such as tranexamic acid, are taken daily for eight to 12 weeks to reduce melanin production. These may be used in combination with topical or laser treatments.

A combination of melasma treatments generally produces better results than one treatment alone. Talk with your dermatologist to determine which treatment options are best for you.

Who Might Consider This Kind of Treatment?

Laser therapy is considered a third-line approach to treating melasma. It is often recommended if first and second-line treatments (topical creams and chemical peels) are ineffective. 

People who have treatment-resistant melasma may consider laser therapy for treating hyperpigmentation. Those who developed melasma while pregnant and do not plan to become pregnant again are also good candidates for laser treatment.

Summary 

Melasma is a common skin condition that causes dark patches and spots on the skin. It is most common in women, particularly people age 20 to 40 with darker skin tones. Laser therapy is a good option when conventional treatments, such as topical creams and chemical peels, are ineffective. Several laser treatment options are available, including intense pulsed light, fractional resurfacing, Q-switched, and picosecond lasers.

Laser treatments are most successful when combined with sunscreen and topical lightening creams. Laser therapy for melasma has some risks, including worsened melasma or melasma recurrence months after treatment. Avoiding triggers, such as sun exposure, hormonal contraceptives, and skin irritation, may help prevent melasma from returning. 

A Word From Verywell

Melasma can be difficult to treat, and laser therapy offers hope to those who have not had success with other treatment options. It’s important to remember that laser therapy does not always work right away, and results are mixed. Talk with your dermatologist to discuss your options and determine if laser therapy is right for you.