The Treatment That Promised Everything
I had melasma — the kind that appears on the cheeks and upper lip, triggered by years of sun exposure and hormonal changes. When a clinic in Sydney CBD offered me a "guaranteed" laser treatment for $3,500, I should have been suspicious. I was not.
The consultation lasted 20 minutes. The practitioner — a nurse, not a doctor — told me that their "advanced laser" would clear my melasma in three sessions. She did not ask about my Fitzpatrick skin type. She did not mention post-inflammatory hyperpigmentation. She did not discuss the hormonal component of melasma.
What Happened After Treatment
After my first session, my skin was red and sensitive for about a week — which I was told was normal. After two weeks, I noticed that the treated areas were darker than before. Not lighter. Darker.
I returned to the clinic. The nurse told me this was "temporary" and would resolve. It did not. After my second session, the hyperpigmentation was significantly worse. I had developed post-inflammatory hyperpigmentation (PIH) on top of my existing melasma.
Key Takeaway: Post-inflammatory hyperpigmentation (PIH) is a known risk of laser treatment in darker skin types (Fitzpatrick III–VI). Any practitioner treating melasma must assess your skin type and adjust treatment parameters accordingly.
The Science Behind What Went Wrong
Melasma in Asian skin (typically Fitzpatrick III–IV) requires a fundamentally different approach to melasma in lighter skin types. High-energy laser treatments can trigger melanocyte activity, causing PIH that is often worse than the original melasma.
The correct approach for melasma in Asian skin involves: low-energy, high-frequency laser protocols; combination with topical treatments (tranexamic acid, kojic acid, vitamin C); strict sun protection; and hormonal management if applicable.
- Low-energy PicoLaser (not high-energy ablative laser)
- Topical tranexamic acid before and after treatment
- SPF 50+ sunscreen applied every 2 hours
- Hormonal assessment if melasma is hormonally driven
- Minimum 4-week intervals between sessions
How I Recovered
Recovery took eight months. I found a dermatologist in Chatswood who specialised in Asian skin and melasma. She prescribed a combination of topical tranexamic acid, azelaic acid, and low-dose hydroquinone, combined with low-energy PicoLaser sessions every six weeks.
The PIH resolved after four months. The underlying melasma improved by approximately 60% over eight months. I now maintain with topical treatments and annual low-energy laser sessions.
“Melasma is one of the most complex skin conditions to treat. It requires a practitioner who understands your skin type, the hormonal component, and the risk of PIH.”
Questions to Ask Before Any Laser Treatment
- 1.What is my Fitzpatrick skin type and how does it affect treatment?
- 2.What is the risk of post-inflammatory hyperpigmentation for my skin type?
- 3.What energy settings will you use and why?
- 4.What topical treatments should I use before and after?
- 5.What is your protocol if PIH develops?
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
Anonymous Patient
Verified Reviewer
All medical content on SKIN. Sydney is reviewed by AHPRA-registered practitioners. Our editorial team maintains strict independence from commercial relationships.