What is Melasma?
Melasma is a common skin condition. If you have melasma, you will see brown or bluish-gray patches or freckle-like spots on your skin. It is also often called "pregnancy mask." It is harmless and not contagious.
Most common locations: These spots usually appear in certain areas of the face (cheeks, forehead, nose, chin, upper lip), and less frequently on the neck, arms, or other areas. Melasma can develop on any area that is frequently exposed to sunlight, which is why symptoms often worsen in the summer.
Types of Melasma:
- Epidermal Melasma: As the name suggests, this refers to well-defined, dark brown patches located in the outer layer of the epidermis. This type of melasma typically has brown pigmentation, a relatively even distribution, and is easier to treat.
- Dermal Melasma: This affects the deeper layers of the skin (dermis), appearing as bluish-gray or light brown patches with indistinct borders. Because the pigmentation is located deep within the skin, this type of melasma is usually more stubborn and more difficult to treat, often requiring laser or microneedling.
- Mixed Melasma: This is the most common type of melasma, a combination of epidermal and dermal melasma, often presenting as brown or bluish-gray patches. Because mixed melasma exhibits characteristics of both the epidermis and dermis, treatment may require a comprehensive approach to target and improve symptoms.
How are Melasmas formed?
Melasma is primarily caused by three factors: sun exposure, hormonal changes, and genetics.
Sun Exposure:
Ultraviolet and infrared radiation from the sun are the biggest aggravating factors for melasma formation. In addition, even heat (infrared) light, LED screens, and mobile phones can cause melasma. The ultraviolet rays from tanning beds are just as damaging to the skin as those from sunlight; therefore, consistent sun protection is crucial for controlling melasma.
Hormonal Changes:
Estrogen and progesterone are believed to be related to the formation of melasma, which explains why it is more common in pregnant women. Furthermore, people taking oral contraceptives containing estrogen and progesterone may also develop melasma. Even some skincare products can cause hormonal fluctuations.
Genetic Factors:
A family history significantly increases the risk of developing melasma; many identical twins are affected.
Who is prone to melasma?
Melasma is a very common skin condition, primarily affecting women, especially those with medium to dark skin tones. Pregnant women are particularly susceptible compared to other groups. Many women experience the first appearance of dark patches or spots on their face during pregnancy or when starting birth control pills; hence, melasma is also known as "pregnancy mask." Taking oral contraceptives and hormonal medications can also increase the risk of developing melasma.
Three advanced laser cosmetic technologies effectively remove melasma
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Fractional CO2 Laser
This belongs to the category of ablative fractional lasers. The laser beam is divided into countless tiny beams, creating controllable micro-thermal damage zones on the skin. These columnar thermal damages reach the dermis, vaporizing and removing pigmented epidermal tissue while triggering a repair and healing response in the surrounding tissue, stimulating new collagen remodeling, and promoting epidermal renewal. For pigmentation, it primarily works by "directly ablating the pigmented epidermis" and "promoting subsequent new epidermal replacement."
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Q-switched Nd:YAG Laser
Nanosecond-level non-ablative Q-switched lasers are representative of traditional lasers for pigmentation removal. Their core principle is selective photothermolysis. The 1064nm or 532nm wavelength laser emitted is specifically and strongly absorbed by melanin. The energy is released in an extremely short time (nanoseconds), causing melanin granules to instantly explode into smaller fragments due to rapid heating. These fragments are then phagocytosed by macrophages and excreted from the body through natural metabolism. The entire treatment process does not damage surrounding normal skin tissue.
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Picosecond Laser
We can consider picosecond lasers as a higher level of Q-switched lasers, with their core being the photomechanical effect. It shortens the laser pulse width from nanoseconds (10⁻⁹ seconds) to picoseconds (10⁻¹² seconds). The ultra-short pulse width means energy is released at a higher peak power in a shorter time. This causes melanin granules to be "shattered" into extremely fine dust-like particles rather than "thermally exploded." This process generates very little heat, causing negligible thermal damage to surrounding tissues and resulting in higher pigment removal efficiency.
| Characteristic | Fractional CO2 laser | Q-switched Nd:YAG laser | Picosecond laser |
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| Main disadvantages |
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| Status | Not the first choice; extreme caution is advised. | Classic Choice | Cutting-edge selection |
Precautions before and after treatment
Pre-treatment Preparation:
- Professional Assessment and Communication:
Consult a professional dermatologist to determine the type of melasma (epidermal, dermal, or mixed), its stability, and the condition of the skin barrier. Thoroughly communicate with the doctor about expected results and potential risks.
- Strengthened Sun Protection:
Strictly employ physical sun protection (hats, umbrellas, masks) combined with broad-spectrum high-SPF sunscreen (SPF50+, PA++++) to minimize UV irritation.
- Skin Barrier Repair:
Discontinue the use of all irritating skincare products (such as glycolic acid, salicylic acid, and retinoic acid). Use repairing and moisturizing products containing ingredients such as ceramides and hyaluronic acid to strengthen the skin barrier.
Post-treatment Care:
- Immediate Soothing:
After treatment, the skin may experience a slight burning sensation and redness. Apply cold compresses or a cold spray immediately, and use medical-grade repair dressings to reduce inflammation.
- Strict Sun Protection:
This is absolutely crucial to prevent hyperpigmentation. In the initial post-treatment period, focus on physical sun protection and avoid direct sunlight. After the skin has healed, apply high-SPF sunscreen daily.
- Gentle Cleansing and Moisturizing:
For the first week after the procedure, gently wash your face with lukewarm water, avoiding friction. Use simple, medical-grade repair and moisturizing products to promote skin barrier recovery.
- Avoid Irritation:
Allow scabs to fall off naturally; do not pick or scratch. Avoid using functional cosmetics (such as whitening or anti-aging products), saunas, hot springs, and strenuous exercise for at least two weeks after the procedure.
- Combined Medication:
Continue using post-treatment repair products and/or oral medications as prescribed by your doctor to consolidate the treatment effect and prevent recurrence.
How to prevent melasma?
If melasma is caused by genetic factors, it cannot be prevented. Melasma caused by elevated estrogen and progesterone levels during pregnancy is also difficult to prevent in advance. However, you can try to avoid factors that worsen melasma. Besides these two factors, you can take preventative measures against other possible causes.
Pay attention to sun protection:
Apply broad-spectrum sunscreen with SPF 30 or higher daily, even indoors or on cloudy days. If outdoors, reapply every few hours and wear a hat, mask, and protective clothing for physical sun protection. You can use products containing vitamin C or vitamin E to help combat sun damage.
Gentle skincare:
Use fragrance-free, hypoallergenic skincare products. Avoid using harsh scrubs, strong chemical peels, and irritating ingredients.
Moisturize well: Keep your skin well-hydrated to strengthen its protective barrier.
Avoid high temperatures and sweating:
Avoid saunas, hot showers, and prolonged exposure to high temperatures outdoors.
