Why Melasma Is Different from Other Pigmentation
Dr. Sarah Chen has been treating melasma in Sydney for over 12 years. In that time, she has seen the same pattern repeat: patients who have been through multiple laser treatments at other clinics, their melasma worse than when they started.
"Melasma is not just pigmentation," she explains. "It is a chronic condition with a hormonal component, a UV component, and a heat component. Treating it with laser alone — especially high-energy laser — is like trying to put out a fire with petrol."
The Three Drivers of Melasma
Dr. Chen identifies three primary drivers of melasma that must all be addressed for successful treatment:
- 1.UV exposure: Even minimal UV exposure can trigger melanocyte activity and worsen melasma. SPF 50+ applied every two hours is non-negotiable.
- 2.Hormonal factors: Oestrogen and progesterone stimulate melanocytes. Oral contraceptives, HRT, and pregnancy can all trigger or worsen melasma.
- 3.Heat: Heat from any source — including laser, IPL, and even hot showers — can stimulate melanocytes. This is why high-energy laser often makes melasma worse.
Key Takeaway: If you are on oral contraceptives and have melasma, discuss this with your practitioner. Switching to a non-hormonal contraceptive can significantly improve treatment outcomes.
Why Laser Alone Fails
"The biggest mistake I see is clinics using high-energy laser on melasma in Asian skin," Dr. Chen says. "The heat generated by high-energy laser stimulates melanocytes, causing post-inflammatory hyperpigmentation that is often worse than the original melasma."
Her protocol uses low-energy PicoLaser — specifically the 1064nm wavelength — at very low fluence, combined with a comprehensive topical programme. "The laser is just one component. Without the topicals and sun protection, the results will not last."
“I tell every melasma patient: this is a management condition, not a cure condition. We can achieve significant improvement, but maintenance is required for life.”
Dr. Chen's Melasma Protocol
Dr. Chen's protocol for melasma in Asian skin involves four phases:
- 1.Preparation (4 weeks): Topical tranexamic acid, azelaic acid, and vitamin C to suppress melanocyte activity before laser treatment.
- 2.Treatment (3–6 months): Low-energy PicoLaser every 4–6 weeks, combined with ongoing topical treatment.
- 3.Consolidation (3 months): Topical maintenance only, allowing the skin to stabilise.
- 4.Maintenance (ongoing): Annual low-energy laser sessions and daily topical treatment.
What Patients Should Know Before Seeking Treatment
- Melasma cannot be cured — only managed
- Treatment requires a minimum 6-month commitment
- Sun protection is the single most important factor in long-term outcomes
- Hormonal factors must be addressed alongside topical and laser treatment
- Avoid any clinic that promises complete clearance or uses high-energy laser on Asian skin
Editorial Disclaimer: This article is for informational purposes only and does not constitute medical advice. All treatments mentioned should be discussed with a qualified, AHPRA-registered practitioner. SKIN. Sydney does not accept advertising or affiliate payments. All editorial content is independently produced.
Written by
Dr. Sarah Chen
Dermatologist, AHPRA Registered
All medical content on SKIN. Sydney is reviewed by AHPRA-registered practitioners. Our editorial team maintains strict independence from commercial relationships.