Hyperpigmentation and melasma are not the same condition, and they do not respond to the same treatments. Melasma in particular is one of the most clinically nuanced skin concerns we treat. It has internal drivers that topicals and lasers alone cannot address, and treating it aggressively without understanding those drivers can make it worse.
Getting the diagnosis right before selecting the treatment is the most important step. That is where we start.
Most patients who come to us for pigmentation have already tried something. Topicals, peels, laser treatments at other practices. The results were often partial or temporary. What they have not usually tried is understanding what is causing the pigmentation to form in the first place.
Post-inflammatory hyperpigmentation (PIH) is the dark mark left behind after a pimple, a wound, or a procedure. It is excess melanin deposited during the healing process. It responds well to targeted treatment and fades predictably with the right protocol.
Melasma is more complex. It is a chronic pigmentary condition driven by hormonal factors, UV exposure, and heat. It has a strong tendency to recur after treatment. Aggressive laser use on active melasma can worsen it significantly. Managing melasma requires a more nuanced approach: the right treatments in the right sequence, combined with an understanding of the hormonal environment driving it.
Estrogen and progesterone stimulate melanocyte activity. When these hormones are elevated or fluctuating significantly, as they are during pregnancy, while using certain oral contraceptives, and during perimenopause, melanocytes produce more pigment in response to UV exposure and heat. This is why melasma tends to flare in summer and fade slightly in winter, and why it often comes back after treatment if the hormonal driver is not addressed.
Understanding the hormonal context does not change every treatment decision, but it does change the conversation. Patients who know their melasma is hormonally driven can make more informed decisions about sun protection, about which treatments to pursue, and about whether addressing the underlying hormonal environment makes sense as part of their overall plan.
Your provider will assess your specific pigmentation type, skin tone, and history before recommending a protocol. For most patients, a combination of in-clinic treatment and a prescribed home care regimen produces the most complete and lasting result.
Fotona's Er:YAG and Nd:YAG wavelengths address pigmentation at multiple depths. For hyperpigmentation and post-inflammatory marks, the laser targets excess melanin directly. For melasma, the approach is more conservative, using gentler parameters to reduce pigmentation without triggering the post-inflammatory response that can worsen the condition. Your provider calibrates the treatment specifically for your pigmentation type and skin tone.
Your consultation includes a VeraFace skin analysis and a full assessment of your pigmentation type and history. A personalized treatment plan is presented at the appointment. No recommendations are made before your provider has seen your skin.
Pigmentation is one of the most nuanced concerns we treat. If you have tried treatments elsewhere that did not deliver the results you expected, a conversation about what drove that outcome is a good starting point. Call us or send a message.