This is an interesting case of an Asian patient who had a long history of melasma and multiple treatments for it in the past.
She had a history of 3 x Fraxel Repair and 1 X Fraxel Restore. Unfortunately, after the Fraxel treatments, she developed a worsening of pigmentation. It was at this time that she came to our clinic.
On examination she had melasma, which was quite severe on the forehead, but also on the cheeks. From her history, it was likely that she had developed Post-inflammatory hyper pigmentation after the previous laser treatments.
Melasma Treatment for this Case
- Our topical melasma treatment protocol: In this protocol, which is very intensive we use a combination of 3 separate skin lighteners, one of which is only available by prescription by a doctor. We introduce them as slowly as is required by the individual. We want to make a big difference to the melasma, without even touching a patient with a device. Also, the benefit of using topicals, is that it is great to pre-lighten a patient prior to laser, which will reduce the incidence of PIH.
- Q-switched laser: This is our first line laser for melasma, and is also safer than the 2nd and 3rd line lasers. PIH is less of a risk with this laser, but in a patient with a history of PIH from laser, it is only sensible to pre lighten them, which we did.
We haven’t finished treating this patient and the before and after photos above are only progress shots, but the patient is already delighted with her results. She has had so many compliments on her skin from family and friends. Her sister was so impressed that she also started coming to us so that we could work on her skin.
From her before and after results, I don’t think it will be necessary to use other lasers for the melasma treatment, although I will recommend twice yearly forever young BBLs and also regular maintenance Q-Switch laser facials.
For those who would like to know prices of those items discussed above, please see our pricing page for the following:
- Consultation with doctor or therapist
- Lightening creams, may need up to 3 types
- Q- switch laser multiple treatments
- Forever Young BBL
- Fractional non-ablative laser
- Fractional ablative laser
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