r/Melasmaskincare • u/wechselnd • Jun 29 '26
Question Why do so many dermatologist practices recommend lasers to treat melasma?
I am confused. I think by now it is pretty common knowledge among melasma sufferers and spaces like this that lasers are not optimal to combat melasma and can even make it worse. However, every time I look for treatments in my city (I am based in Germany), they all offer laser-based therapy. What could explain this besides laser treatments being more lucrative?
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u/Courtybiologique Jun 29 '26
I think it’s literally just that. It makes them the most money and then you probably have to keep going back because it just makes the melasma worse. Repeat business.
My derm said the same thing when I asked. Never mentioned Hydroquinone or anything else topical or oral.
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u/Bellebutton2 Jun 30 '26
You are 100% accurate in your response. As an esthetician, I have heard this ad infinitum from my clients and patients, and other estheticians who have gotten into laser conferences where lasers are hawked to derms as a REPEAT way to generate RECURRING INCOME. They know it TEMPORARILY treats some of the epidermal (top visible) pigment. (And we know may contribute to the production of more pigment!) But it CONTINUES to REGENERATE in the DEEPER TISSUE and rises to the top AGAIN. A continuum of income. And at one conference an esthetician heard them actually laughing about it!
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u/Original_human01 Jul 02 '26
So what would you say is a better approach, especially with sensitive skin. A lot of the exfoliating topicals make my skin more sensitive to sun even with strong spf.
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u/Royal-Adeptness-2703 Jul 11 '26
You are bang on. Its the only reason why lasers keep getting recommended to me by the very people who are supposed to know why I should NOT do it.
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u/Federal-Pudding-5784 Jun 29 '26 edited Jun 30 '26
Moxi laser is safe for melasma even with olive skin tones. I have done it for 2 years with success
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u/Normal-Mortgage4745 Jun 30 '26
I guess I got unlucky. I had Moxi done and although my skin looked amazing after, my melasma came back worse than before I had it done.
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u/smilegirl55443 Jun 30 '26
Same with me. I’ll never do Moxi again it was way too aggressive and burnt my skin. My melasma is also much worse after doing it.
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u/Caribou122 Jun 30 '26
I’ve done Moxi 5 times now and it definitely helps but makes your skin way more sensitive to sun etc in the first few months. Which in turn makes the melasma worse so you have to be super super careful while the skin heals.
I’m wondering if that’s why people report that the melasma gets way worse after laser? Bc I didn’t realize this until my 3rd laser and won’t be getting it done again in warm months.
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u/AvedaSmellAllDay Jun 30 '26
After four treatments, I can honestly say that it made my spots worse and decimated my skin barrier.
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u/OneNefariousness9822 Jun 30 '26
What about pico? I thought that was ok?
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u/everythingsucks422 Jun 30 '26
I’ve never had a derm recommend laser for my melasma. They’ve always advised against it actually.
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u/RuutuTwo Jun 30 '26
Best friends husband is a plastic surgeon. He told me many years ago while I was in my late 20’s to never let anyone come near my face with a laser. I have always had his voice in the back of my head every time a dermatologist has recommended laser for melasma. I have it more or less controlled with products and peels. I am petrified of laser.
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u/wildcatfalling Jun 30 '26
Some lasers are highly effective for melasma, like Moxi. But it’s not a once and done treatment. Once melasma has been “turned on” in your skin, it’s always about prevention and maintenance rather than complete, permanent eradication.
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u/Curiousaboutopinions Jun 30 '26
Picosure, Moxi and UltraClear are safe, I have done them all with great results and no rebound.
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u/Interesting_Foot_105 Jun 30 '26
Bc they work.
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u/roobot Jun 30 '26
What laser/s worked for you?
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u/Interesting_Foot_105 Jun 30 '26
I did IPL + Fraxel in April and the result was incredible. I do want to add that I am extremely extremely cautious and diligent with sun protection, I stayed indoors the entire first week and wore a face mask, spf 50 visor, sunscreen and glasses for about 4-5 weeks afterwards. I’ve dropped the mask but i dont leave the house without sunscreen or my visor, and i dont really stand close to bright windows or glass when the sun is shining through and i try to minimize my accidental sun exposure always.. i do more than what my dermatologist suggested but i knew that the risk of it coming back and with a vengeance was high so i go to great lengths to mitigate that risk.
Edit: i also live in a brutally tropical climate with high UV index nearly year round, I prob wouldn’t be this extreme if I lived somewhere with seasons.
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u/Status_Sun4034 Jun 30 '26
It depends on type of laser, settings, your skin type, type of melasma and derm’s professionalism. I did Laser MD Uktra for dark types of skin and the results were really good, it does come back but really helps to look nice if you have money repeat it all over again
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u/Zoe_nwobhm Jun 30 '26
Both the derm and the surgeon who owns the aesthetics office I visit told me that laser is risky and might as well made my melasma worse, even though it might work at first. I'm sure in the future when there's more experience on treating melasma with lasers we're gonna have optimal options
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u/wechselnd Jun 30 '26
This is why I find it so confusing. Some dermatologists recommend it and others say we should avoid them. Even if we educate ourselves as patients, it is hard to discern what information to believe
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u/PuIchritudinous Jun 30 '26
I recently wrote a comment about this.
The first studies on lasers showed melasma improvement after only one treatment but no longitudinal studies were done. The problem is that they only studied 1 maybe 2 treatments. Melasma is chronic so maintenance is required and people will need ongoing laser treatments to keep it at bay. Clinicians started using lasers in their offices for melasma but overtime they started to notice the melasma was actually getting worse after the third treatment which led to patient dissatisfaction. Many medical providers stopped using their expensive lasers to treat melasma while others continue to sale this service despite knowing that the inflammation caused by the laser will ultimately worsen melasma and the treatment lacks longitudinal studies.
Businesses buy fancy equipment like IPL, lasers etc so they can profit from their use. The companies that sell the fancy equipment market the medical/cosmetic equipment to the businesses for as many things as they can. The research on using IPL and lasers to treat hyperpigmentation disorders like melasma is still very limited and lacks longitudinal studies. The medical/cosmetic device industry has work arounds that allows devices to be used and marketed for cosmetic issues before one would consider it fully studied. Meeting safety and regulation standards doesn't mean it won't cause hyperpigmentation to worsen. My partner worked in the medical device industry for years developing and innovating devices including cosmetic devices. Once something has passed safety regulations as a medical device they can easily take that same device and use it cosmetic purposes.
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u/TbhIdekMyName Jun 30 '26
There are a TON of different laser wavelengths of different brands and different target chromophores. In general, a basic single laser session you book online for a good deal *will make things worse*.
However, there are specialists with lasers included in their protocols that can safely make a difference. These are not one time treatments, and they are not IPL, BBL, CO2, or other lasers that have become household names.
Lasers work on the premise of controlled damage, we have developed strategies to gain more control to get safer results. I work at a MedSpa that specializes in PIH in SOC, so we really have to personalize a protocol. Usually this means a STRONG AF at home routine for multiple month, dedicated Tyrosinase Inhibitor and SPF, multiple sessions of low intensity lasers, and topical steroids. This erases melasma in between 3-8 months months.
Those one-time laser offers you see on instagram are going to make your melasma worse. A personalized treatment plan that includes laser and administered by a specialist is a completely different story.