Melasma Treatment

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Melasma Treatment in Washington, DC

Before and After Gallery *

Melasma is a common skin condition distinguished by pigmented discoloration of the face. Typically, melasma is seen as irregular dark brown patches on the cheeks, forehead, chin, or bridge of the nose. Melasma has multiple factors and causes, including genetics, hormones, and external factors. Melasma is more common in men than in women. While melasma does not cause any noticeable symptoms, the irregular pigmentation is cosmetically bothersome to many patients. While anyone can get melasma, it is more commonly seen in women than in men. Sun exposure and hormone changes (either intrinsic or extrinsic) are common triggers for the development of melasma.

How is Melasma Treated?

In people prone to melasma the best treatment is non-stop sun protection in the form of sunscreen and proper protective clothing when outdoors. For people who suffer from melasma despite adequate sun protection there are cosmetic treatments which can be effective at reducing the visible effects of melasma.

The effective treatment of melasma typically involves a multifaceted approach. In addition to strict sun protection, we frequently utilize compounded topical lightening creams along with serial low intensity chemical peels as a first line treatment for  melasma. More recently both topical and oral transexamic acid, a potent pigment inhibitor, have been utilized with moderate to good success in treating melasma refractory to topical treatment alone. When starting treatment for melasma it is important to consider that melasma is typically a chronic condition, and treatment goals are a reduction in the visible manifestation of melasma through the most easily manageable and cost-effective treatment regimen possible.

Laser Treatment of Melasma

Contrary to the opinions of the minimally trained ‘providers’ at many med-spas, lasers are NOT considered first, second, or even third line treatments for melasma. Due to the nature of melasma as a light and heat sensitive condition, the use of lasers often provides temporary improvement followed by a rapid rebound of melasma, often worse and more widespread than prior to treatment. For this reason experts in the treatment of melasma rarely if ever recommend lasers to treat this condition, and only would do so in patients who are stable on yet not fully responding to a physician directed multi-faceted topical and/or oral medication regimen. While patients suffering from melasma often search for a ‘magic wand’ treatment for melasma, this unfortunately does not exist. In describing the treatment of melasma, a common parable is ‘the more quickly and aggressively melasma is treated, the more quickly and aggressively it will return’. We employ a stepwise approach to the treatment of melasma, with the goal of slow and steady improvement and long-term stability for this chronic condition.


At the Center for Laser Surgery we treat melasma as a cosmetic condition, and do not accept insurance reimbursement for melasma related visits or treatment. Initial melasma consultations are $250 and subsequent visits (required at least every 3-6 months for ongoing medication management) are $125 per visit. If you would like to schedule an appointment with Dr. Adrian to discuss melasma treatment please call our office at 202-966-8814 or click here to request a consultation via email.

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*Results may vary for each patient.