Melasma
Melasma is the pigmentation that returns. It is best understood as a condition to be managed over years rather than a set of spots to be removed, and the single biggest factor in how it behaves is how consistently you keep light off your face.
What causes melasma
Melasma is pigment produced in response to a set of triggers in skin that is predisposed to react. The predisposition is not something treatment removes, which is the whole reason the condition behaves as it does.
Ultraviolet light and visible light. Sun exposure is the dominant trigger, and visible light — including bright daylight through a window — contributes, which is why some people see no benefit from a sunscreen that covers UV alone.
Heat. Hot climates, saunas, cooking over heat and the warmth of aggressive treatments all provoke it. This is a distinct trigger from light and it is regularly overlooked.
Hormonal change. Pregnancy, hormonal medication and the years around menopause are common starting points. Where a hormonal driver is likely, a doctor decides whether anything needs reviewing.
Inflammation of the skin. Irritation from harsh products, over-exfoliation and too-strong treatments all feed pigment production in skin already inclined to it.
There is also a depth question. Some melasma sits mostly in the upper layers, some deeper, and most is mixed. Depth predicts how much treatment can achieve, and it is the reason two people with the same visible patches get very different results from the same course.
How to tell what you are dealing with
Melasma usually appears as symmetrical patches with soft, ill-defined borders — across the cheekbones, the forehead, above the lip, along the jaw. Discrete brown spots with sharp edges, scattered unevenly, are more likely to be sun-induced spots, which behave quite differently and clear far more readily.
A consultation examines the pattern and symmetry, looks at the skin under magnification and specialised light to estimate how deep the pigment sits, asks about pregnancies, medication, heat exposure and holidays, and reviews what has already been tried. That history matters: skin that has rebounded after a previous laser course is treated more cautiously still.
Nothing here tells you what you have. Symmetrical soft-edged patches on both cheeks are a reason to be assessed, not a diagnosis.
What addresses each part of it
| What is driving it | What the treatment category is |
|---|---|
| Continuing light exposure | Daily broad-spectrum sun protection, reapplied, plus hats and shade — the foundation the rest depends on |
| Pigment already present, upper layers | Cautious low-energy toning laser courses |
| Pigment sitting deeper | Slower, gentler work with modest expectations — depth limits what any device achieves |
| Overactive pigment production | Topical treatment, some of it prescribed and reviewed by a doctor |
| Barrier irritation feeding the pigment | Simplifying the routine, supported by gentle clinic programmes or skin boosters |
| Heat as a trigger | Changing the exposure — sauna, hot yoga, long cooking sessions, strong heat-based treatments |
| Hormonal contribution | A doctor’s assessment of whether anything needs to change |
What does not help
Strong, fast laser courses. The most common way melasma is made worse is by treating it hard. Heat and inflammation are triggers, so an aggressive device applied to melasma can produce a darker rebound weeks later.
Heat-based lifting treatments over affected areas. Radiofrequency and ultrasound lifting have their uses, but both deliver heat, and melasma across the cheekbones is a reason to discuss placement before booking.
Aggressive peels and scrubs. Irritation drives pigment. Anything that leaves the skin raw is working against the plan.
Treatment without sun protection. This is not a mild shortfall. It is the difference between a course that holds and a course that resets each summer.
A one-off session. Melasma does not respond to single treatments, and a single treatment strong enough to show an immediate change is the kind most likely to provoke it.
Realistic timeline and how many sessions
Expect a course of gentle sessions, typically two to four weeks apart and continuing over months, alongside daily topical treatment and protection. Meaningful lightening is usually assessed at three months, and holding it is an ongoing job rather than a finish line.
Plan for seasonal variation: most people are lighter in winter and darker after summer, even on a good plan. That pattern is normal and is not treatment failure.
What to ask at the consultation
- How deep does my pigment appear to sit, and what does that mean for what I can expect?
- What energy level are you starting at, and how will you decide whether to change it?
- What is the plan if it rebounds after a session?
- Which of my habits — heat, light, products — matters most in my case?
- What do I continue at home, and can I have it in writing?
FAQ
Can melasma be cured?
No. It can be lightened substantially and kept quiet for long periods, but the tendency remains and it returns with sun exposure, heat and hormonal change. Plans that promise clearance are describing something else.
Why would treatment make it worse?
Melasma reacts badly to heat and inflammation, and strong laser settings deliver both. Overtreated melasma can rebound darker than it started, which is why cautious, gradual courses are the norm in experienced clinics.
Is sunscreen really that important?
It is the centre of the plan, not an afterthought. Without daily, reapplied protection, in-clinic treatment is spent keeping pace with new pigment rather than reducing what is there.
Is it worth treating during a short trip to Korea?
A consultation, a conservative first session and a plan you can continue at home are worthwhile. A fast, intensive course compressed into one week is the pattern most likely to backfire.