Melasma: What Causes It, and How Can Lasers Help?
Melasma is not a spot that one laser session can simply erase. It is a pigment condition that needs lightening followed by care to keep it from darkening again. UV exposure and hormones interact with changes in vessels and the dermis, so addressing the different contributors helps stabilize results. Treatment begins by confirming that the pigment really is melasma.
Why does melasma develop?
Melasma typically appears as symmetrical light-brown patches on the cheekbones, forehead, upper lip, and chin, often in women in their 30s and 40s. Common factors include UV exposure, pregnancy or contraceptive-related hormonal changes, and family history.
A 2021 review of 76 papers identified five pathways: overactive melanocytes; melanin accumulation in the epidermis and dermis; increased mast cells and sun-induced dermal damage; damage to the basement membrane between epidermis and dermis; and increased blood vessels. The authors linked this complexity to treatment resistance and recurrence and concluded that addressing the separate pathways improves outcomes[1].
How does melasma differ from freckles and sun spots?
Not every brown facial mark is melasma. These three commonly confused conditions differ in appearance, distribution, and treatment.
| Category | Appearance | Typical age and location | Treatment focus |
|---|---|---|---|
| Melasma | Symmetrical light-brown patches with diffuse borders | Cheekbones, forehead, and mouth area in the 30s and 40s | Gentle treatment spread over several sessions |
| Freckles | Scattered tiny brown spots | Nose and cheeks, often from childhood | Lasers targeting epidermal pigment |
| Solar lentigines | Brown patches with clear borders | Chronically sun-exposed face and hands | Pigment laser removal of individual lesions |
Treating melasma like freckles can irritate and darken it. Where several pigment types overlap, distinguishing the edges of melasma from lentigines is particularly important; strong energy applied indiscriminately can worsen melasma. For more on other brown lesions, see our guide to sun spots and seborrheic keratoses.
Why can melasma darken again after treatment?
Lasers reduce pigment already present but do not remove every signal that tells cells to make more. UV, visible light, heat, hormones, and inflammation can reactivate pigment production. A systematic review found high recurrence across treatments and no single method that worked well for everyone. Combining two or three approaches produced better results than a single treatment[2]. We therefore plan a course of combined care from the start rather than expecting one laser session to clear melasma.
How are lasers used for melasma?
We generally use repeated, lower-irritation sessions to fade pigment gradually rather than trying to remove it all with strong energy at once. Epidermal pigment, deeper pigment, and vessels may need different approaches. An evidence-based review of 113 randomized trials involving 6,897 participants found inconsistent laser and light results. The strongest evidence favored hydroquinone-containing topical treatment; oral tranexamic acid was described as a promising option for moderate to severe or recurrent melasma[3]. We therefore include topical care and daily habits rather than relying entirely on a laser.
What care should accompany treatment?
Apply sunscreen daily, including on cloudy days and indoors, and reapply every 2–3 hours. Near windows or other sources of light, a product that also protects against visible light can help. Avoid harsh rubbing and frequent peels, which weaken the skin barrier and stimulate pigmentation. Keep up this care after melasma fades to slow its return. For sensitive skin at risk of post-laser pigmentation, we may recommend preparing the skin with HILO WAVE first.
How does Dong-An Joongsim Clinic treat melasma?
A doctor first distinguishes melasma, freckles, and lentigines, then selects devices for each. For melasma, we use HALO, which combines an epidermal resurfacing wavelength with one reaching the dermis. We may also combine BBL Forever, using filters to change wavelengths and address pigmentation and redness according to skin condition. This light treatment often suits a mixture of melasma, freckles, and other spots because filters can be changed for different pigments and redness. We generally start with three monthly sessions. The manufacturer also describes combining it with HALO.
We treat clearly defined lentigines and freckles separately with Reepot. Melasma is not this laser's main target, so overlapping pigment conditions need separate plans. After lentigines are removed, we usually wait around 1 month after the DuoDERM dressing comes off before toning or other pigment treatments. When patients have been disappointed by previous treatment, we start again by identifying the pigment types.
Dr. Chang-Hwan Cho has lectured on RF treatment for aging skin, melasma, and firmness at the Korean Aesthetic Surgery and Laser Society's spring meeting, and on effective topical ingredients for melasma in a webinar. At Dong-An Joongsim Clinic, your doctor personally conducts your consultation and treatment.
What should you know before melasma treatment?
Individual constitution, hormones, and environment affect response and recurrence, so results vary. We generally postpone lasers during pregnancy, after recent tanning, or while you are taking photosensitizing medication. We also do not recommend HALO or BBL if you have taken isotretinoin within the past 6–12 months or are taking anticoagulants, so we ask about medications at your consultation. If you have a photo shoot or event coming up, we may focus on BBL Forever because redness settles within hours and you can resume normal activities. Temporary redness or pigmentation can occur; careful sunscreen use and moisturizing are essential.
Melasma: common questions
What should I check when choosing melasma treatment in Apgujeong, Gangnam, Seoul?
Check whether the clinic distinguishes melasma, freckles, and lentigines and selects devices accordingly. At Dong-An Joongsim Clinic, a doctor personally diagnoses the pigment and plans treatment.
What causes melasma?
UV exposure, hormonal changes, and genetics are major factors. Within the skin, overactive melanocytes, melanin accumulation, dermal and basement-membrane damage, and increased vessels also contribute.
Will one laser session remove melasma?
Usually not. Several sessions lighten it gradually. Strong treatment in one visit can irritate and darken melasma, so we spread treatment over several visits and monitor the response.
How can I tell melasma from freckles?
Freckles are small scattered spots on the nose and cheeks, often present from childhood. Melasma forms broader patches with diffuse borders on the cheekbones, forehead, and around the mouth. Treatment differs too.
What determines the cost of melasma laser treatment?
Cost depends on pigment types, extent, device combinations, and session count. Your doctor explains the plan and cost after diagnosis.
References
- Artzi O et al., “The pathogenesis of melasma and implications for treatment”, Journal of Cosmetic Dermatology, 2021. https://doi.org/10.1111/jocd.14382
- Neagu N et al., “Melasma treatment: a systematic review”, Journal of Dermatological Treatment, 2022. https://doi.org/10.1080/09546634.2021.1914313
- McKesey J et al., “Melasma Treatment: An Evidence-Based Review”, American Journal of Clinical Dermatology, 2020. https://doi.org/10.1007/s40257-019-00488-w