Melasma can look like ordinary brown pigmentation, but it behaves differently from a sun spot. It is a chronic pigment condition influenced by ultraviolet light, visible light, hormones, inflammation, heat and individual susceptibility. That is why simply targeting every brown patch with more laser energy can backfire.
The clinic’s Melasma and Uneven Pigmentation guide describes melasma as something usually managed rather than permanently cleared. Laser and light treatments may have a role, but they are generally considered within a broader plan that includes light protection, skincare and realistic expectations.
Why Melasma Is Different From a Sun Spot
A solar lentigo, or sun spot, is usually a defined area of excess pigment related to accumulated ultraviolet exposure. Melasma tends to appear as broader brown or grey-brown patches, often symmetrically across the cheeks, forehead, upper lip or jawline.
Its biology is also more complex. Research has identified changes involving pigment-producing cells, blood vessels, inflammation, sun-damaged tissue and the skin barrier. Hormonal influences can contribute as well.
That complexity explains why a device that works well for a discrete sun spot may not behave the same way when used on melasma.
Why Lasers Can Sometimes Make Melasma Worse
Lasers and light devices create controlled energy within the skin. Depending on the technology, that energy may involve heat, pressure effects or controlled tissue injury.
Melasma-prone skin can respond to excessive inflammation by producing more pigment. This is particularly important in people who are already prone to post-inflammatory hyperpigmentation.
The clinic’s Pigmentation & Sun-Damage Treatment page specifically notes that heat and inflammation can drive melasma and that aggressive device treatment may leave pigmentation worse than before.
This is why “stronger” is not automatically better for melasma.
Lasers Can Still Have a Role
Caution does not mean laser treatment is never appropriate.
A 2024 systematic review and meta-analysis of ablative fractional laser treatment found that adding fractional laser to medication improved some clinician-rated melasma outcomes compared with medication alone. However, patient self-assessment did not show the same clear difference, and potential adverse effects remained an important consideration.
A newer systematic review examining randomized trials of laser therapy also found improvement across some laser approaches, while highlighting variability in recurrence, safety and treatment protocols.
The practical conclusion is that laser treatment can help selected patients, but it should not be treated as a predictable stand-alone cure.
Why Treatment Settings Matter
Two people receiving the same device can receive very different treatments.
Wavelength, fluence, pulse duration, number of passes, spot size and treatment interval all influence how much energy reaches the skin and where it is absorbed. Baseline skin tone and the depth of pigment matter too.
The aim in melasma is often to avoid provoking unnecessary inflammation while still achieving enough effect to justify treatment.
At Anti-Aging Vancouver, PicoWay may be considered for selected pigment concerns because picosecond pulses rely heavily on a photoacoustic effect and limit some thermal spread compared with longer pulses. Even then, the clinic’s melasma guidance treats laser as an adjunct rather than a stand-alone solution.
Skin Tone Changes the Risk Conversation
Melasma is more common in medium to deeper skin tones, the same skin types in which post-inflammatory hyperpigmentation can be more persistent.
That does not mean people with darker skin cannot have laser treatment. It means device choice and settings require greater attention because melanin in surrounding healthy skin can also interact with light energy.
The clinic’s pigmentation pathway specifically lists deeper skin tone, recent tanning and melasma as factors requiring more cautious device selection.
A history of becoming darker after irritation, acne or previous procedures is also useful information during assessment.
Sun and Visible Light Protection Come First
A laser procedure makes little sense if the main triggers remain uncontrolled.
Ultraviolet exposure is a major driver of melasma. Visible light can also contribute, particularly in more deeply pigmented skin. The clinic’s melasma guidance therefore places daily broad-spectrum sun protection at the centre of management and notes that tinted sunscreen containing iron oxides may be considered for visible-light protection.
This is not merely aftercare. It is part of treatment.
A person who receives a device procedure but continues substantial unprotected sun exposure may see pigment return regardless of how well the procedure itself was performed.
Topical Care Often Does More of the Ongoing Work
Melasma management commonly includes topical treatments that reduce pigment production, increase skin-cell turnover or address inflammation.
Which ingredients are appropriate depends on skin type, sensitivity, pregnancy status and previous reactions. Prescription hydroquinone is one established option in selected patients, while other pigment-directed ingredients may be used when appropriate.
Topical treatment is often used before or alongside procedures because stabilizing the pigment can make device treatment more controlled.
Selected Chemical Peels may also be considered, but the same caution applies. Excessive irritation from a peel can trigger further pigmentation, particularly in melasma-prone or deeper skin tones.
Recurrence Does Not Necessarily Mean Failure
Melasma is known for recurrence.
Pregnancy, hormonal medications, ultraviolet exposure, visible light and heat may reactivate pigment after it has improved. This means the goal is often long-term control rather than permanent removal.
Maintenance may involve ongoing light protection, skincare and occasional treatment adjustments. A recurrence months later does not necessarily mean the initial treatment did nothing. It may reflect the chronic biology of the condition.
This is another reason aggressive one-time treatment promises should be viewed carefully.
What a Melasma Consultation Should Review
A useful assessment may consider:
whether the pigmentation actually fits melasma
skin tone and previous pigment reactions
pregnancy or hormonal history
medications and contraception
sun and heat exposure
previous lasers, peels and topical treatments
whether pigment appears superficial, deeper or mixed
sensitivity and skin-barrier health
the likelihood that a device will add useful benefit
Any lesion that is new, changing, irregular, itchy or bleeding should be medically assessed before cosmetic pigment treatment. The clinic explicitly separates suspicious lesions from routine pigmentation because laser treatment can obscure rather than diagnose them.
Frequently Asked Questions
Can laser permanently remove melasma?
No treatment should promise permanent removal. Melasma is chronic and can recur when hormonal, light or heat-related triggers continue.
Is PicoWay safe for melasma?
It may be considered in selected patients, but suitability depends on skin tone, pigment pattern, settings and previous response. Any laser can potentially worsen melasma if treatment is too aggressive or poorly matched.
Is BBL appropriate for melasma?
BBL can treat many pigment concerns, but melasma requires greater caution than ordinary sun spots. The diagnosis should come before choosing a light platform.
Should skincare be tried before laser?
Often, yes. Light protection and topical care are central parts of melasma management and may be used before, alongside or instead of procedures depending on the individual.
Treat Melasma Conservatively
Melasma is not simply excess pigment waiting to be removed. It is a recurrent condition influenced by light, hormones, inflammation, vascular changes and skin biology.
Laser treatment may help selected patients, but it can also worsen pigmentation when the diagnosis, device, settings or aftercare are wrong. The safest approach is usually conservative and layered.
If facial pigmentation may be melasma, the clinic’s Contact page can be used to arrange an assessment before choosing a laser or light treatment.