Hyperpigmentation & Melasma Treatment in Danville, CA
Brown Patches and Melasma in Danville, CA
Hyperpigmentation means areas of skin have become darker because they contain more melanin. Melasma is a specific, often recurring form of facial or sun-exposed pigmentation influenced by light exposure, hormones, genetics and other factors. The first step is an accurate diagnosis, because treatment that helps one type of pigment can worsen another.
Hyperpigmentation simply means patches of skin that have gone darker, because they hold more of the pigment that colours your skin. Melasma is one particular kind: darker patches, usually on the face, that keep coming back, and that are affected by light, hormones and your genes. The first step is always working out which kind you have, because a treatment that clears one kind can make another kind worse.
Hyperpigmentation & Melasma: the essentials
The short version
Hyperpigmentation is an umbrella term for excess pigment; melasma is a distinct acquired pigment disorder.
Hyperpigmentation is the general term for skin that has gone darker. Melasma is one particular condition within that.
Sun/visible light, inflammation or injury, acne, hormonal influences, pregnancy, some medications and genetic tendency.
Sunlight and even ordinary visible light, inflammation or injury, acne, hormones, pregnancy, some medicines, and your genes.
Face is most common for melasma; post-inflammatory pigment can occur anywhere skin has been inflamed or injured.
Melasma is mostly on the face. Marks left by inflammation can appear anywhere the skin has been inflamed or injured.
Diagnosis-led combination care: photoprotection, topical therapy, selected peels/aesthetic care and carefully chosen laser or light treatment when appropriate.
By diagnosis, and usually with several things together: sun protection, creams, selected peels or facials, and carefully chosen laser or light treatment where it suits.
Depends on the treatment; topical care has little procedural downtime, while peels and lasers can cause temporary redness, peeling or darkening.
Depends what you have. Creams need no recovery. Peels and lasers cause redness, peeling, or temporary darkening.
Melasma is often chronic and recurrent; maintenance and strict sun/visible-light protection are commonly needed.
Melasma usually comes back. Most people need to keep something going, and to protect their skin from light very strictly.
What is the difference between hyperpigmentation and melasma?
What is the difference between the two?
Hyperpigmentation describes any excess darkening of the skin; melasma is a specific pattern of acquired pigmentation that most often affects the face and behaves as a chronic, relapse-prone condition.
Hyperpigmentation is the umbrella word for any skin that has gone darker. Melasma is one specific pattern of it, usually on the face, and it behaves as a long term condition that keeps relapsing.
Melasma is different from post-inflammatory hyperpigmentation. Post-inflammatory darkening can follow acne, eczema, burns, procedures or other irritation and may be especially persistent in darker skin tones.
Melasma is also different from the dark marks left behind after inflammation. Those can follow acne, eczema, a burn, a procedure, or anything that irritated the skin, and they can be particularly stubborn on darker skin.
Where does melasma appear on the body?
Where does melasma appear?
Melasma most often affects the face, but its distribution is wider than most people expect. It can appear on the cheeks, the cheekbones, the chin, the nose, the forehead, the eyebrows and the upper lip, and it can also affect the chest and the forearms. It is more common in patients with darker skin tones, and it can be more common in some families, so it is not unusual for a mother, a sister or an aunt to have the same pattern. Recognizing the full distribution matters clinically. Pigment on the chest or the forearms is frequently assumed to be ordinary sun damage, when in some patients it is the same condition, and it needs the same protection from light and the same cautious choice of treatment as the pigment on the face.
Melasma is usually on the face, but it turns up in more places than most people expect. It can appear on the cheeks, the cheekbones, the chin, the nose, the forehead, the eyebrows and the upper lip. It can also appear on the chest and the forearms. It is more common in people with darker skin, and it often runs in families, so a mother, a sister or an aunt may have the same pattern. This matters, because patches on the chest and arms usually get put down to sun damage. In some people they are the same condition, and they need the same protection from light, and the same careful choice of treatment, as the patches on the face.
What causes hyperpigmentation?
What causes it?
Hyperpigmentation develops when melanocytes, the pigment producing cells of the skin, begin to produce too much melanin. The usual causes are inflammation or trauma to the skin, some medications, and contact with certain cosmetics or plants.
The pigment cells in your skin, called melanocytes, start making too much pigment. The usual causes are inflammation or injury to the skin, some medicines, and contact with certain cosmetics or plants.
- Ultraviolet and visible light. Both deepen melasma and most other pigment disorders. Visible light matters as much as ultraviolet in melasma, which is why an ordinary clear sunscreen is often not enough on its own.
- Hormonal influence. Pregnancy, hormonal contraception and hormone therapy can bring melasma on, or make it worse, in susceptible patients.
- Inflammation and injury. Acne, rashes, burns, cuts and procedures can all leave pigment behind once the skin has settled.
- Medications. A number of prescription medicines can cause or contribute to abnormal pigmentation, which is one reason the medication list is reviewed at the consultation.
- Contact with cosmetics or plants. Fragrances and other cosmetic ingredients can leave a persistent pigmented contact dermatitis. Contact with the sap of certain plants and fruits, activated by sunlight, can leave streaky brown marks that last for months.
- Genetic tendency. Melasma in particular can be more common in some families.
- Sunlight and ordinary visible light. Both make melasma and most other pigment problems darker. With melasma, visible light matters as much as the ultraviolet, so a plain clear sunscreen is often not enough by itself.
- Hormones. Pregnancy, the contraceptive pill and hormone treatment can bring melasma on, or make it worse, in people who are prone to it.
- Inflammation and injury. Acne, rashes, burns, cuts and procedures all leave pigment behind once the skin has calmed down.
- Medicines. Several prescription medicines can cause abnormal pigment or make it worse. That is one reason we go through your medicines at the consultation.
- Contact with cosmetics or plants. Perfume and other ingredients in cosmetics can leave a long lasting pigmented rash. The sap of some plants and fruits, set off by sunlight, can leave streaky brown marks that take months to fade.
- Family tendency. Melasma in particular runs in some families.
Diagram comparing melasma patches with post-inflammatory hyperpigmentation
A diagram comparing melasma patches with the marks left behind by inflammation.
What is post-inflammatory hyperpigmentation?
What are the dark marks left after inflammation?
Pigmentation that follows trauma to the skin is known as post-inflammatory hyperpigmentation. The trauma may be obvious, such as a cut, a burn, an abrasion or a surgical incision. It may also be inflammation with no injury at all, such as the aftermath of a rash, of acne, or of severe skin dryness. The mark is not a scar. It is pigment left behind by skin that has been inflamed, and it sits in a different part of the skin depending on how deep the inflammation went, which is part of what determines how quickly it fades. It tends to be more persistent in darker skin tones. This is why controlling the original problem is part of treating the color: pigment cannot settle while the acne, the eczema or the dryness that keeps provoking it is still active.
Pigment that appears after the skin has been damaged is called post-inflammatory hyperpigmentation. The damage may be obvious, such as a cut, a burn, a graze or a surgical wound. It may also be inflammation with no injury at all, such as after a rash, after acne, or after the skin has been very dry. The mark is not a scar. It is pigment left behind by skin that has been inflamed. How deep the inflammation went affects how deep the pigment sits, and how fast it fades. On darker skin it tends to last longer. That is why we treat the original problem as well as the colour. The pigment will not settle while the acne, the eczema or the dryness that keeps setting it off is still going on.
Why is diagnosis important before treating pigmentation?
Why does the diagnosis matter so much?
Pigment disorders can look similar but respond differently, so a dermatologist should determine whether the problem is melasma, lentigines, post-inflammatory hyperpigmentation, another benign pigment disorder, or a lesion that needs medical evaluation.
Because different pigment problems look alike but respond quite differently. A skin doctor needs to establish whether this is melasma, ordinary sun spots, a mark left by inflammation, another harmless pigment condition, or something that needs medical attention.
A clinical examination is often enough, but dermoscopy or a Wood lamp may sometimes help estimate pigment pattern or depth. Any new, changing or suspicious pigmented lesion should be assessed before cosmetic laser treatment.
Usually just examining you is enough, though sometimes a magnifier or a special lamp helps work out the pattern and how deep the pigment sits. Any new, changing or suspicious dark spot must be assessed before anyone points a cosmetic laser at it.
Your consultation with Dr. Gallacher
Your consultation with Dr. Gallacher
During your consultation, Dr. Gallacher will diagnose the underlying cause and customize a treatment plan to fit your individual needs. With pigmentation I treat the diagnosis, not simply the color I can see. Melasma, sun spots and the marks left behind by inflammation all behave differently, and the safest plan usually combines excellent daily sun protection with carefully chosen topical treatment or procedures. Where a laser or light treatment is part of that plan, I perform it myself. Pigment work is not delegated at this practice, because the device, the wavelength, the energy and the endpoint have to be judged against the diagnosis and the skin tone in front of me, and adjusted while the treatment is happening.
At your consultation, Dr. Gallacher will work out what is actually causing the pigment, and build a treatment plan around you. In her words: with pigment, I treat the diagnosis, not just the colour I can see. Melasma, sun spots and the marks left by inflammation behave completely differently. The safest plan usually combines really good daily sun protection with carefully chosen creams or procedures. If a laser is part of that plan, she does it herself. Laser work for pigment is not handed to anyone else here, because the machine, the type of light, the energy and the point at which to stop all have to be judged against your diagnosis and your skin tone, and changed as the treatment goes along.
Who performs the laser treatment?
Who does the laser treatment?
Dr. Gallacher does. Every laser and light treatment at the Dermatology and Laser Centre is performed by Dr. Gallacher personally. She is a board certified dermatologist with fellowship training in laser and cosmetic dermatology, and the person who examines you, makes the diagnosis and sets the treatment parameters is the same person who holds the handpiece. In pigment work this matters more than in almost any other indication, because the correct endpoint is a visual judgment made during the treatment, and because the difference between a good result and post-inflammatory darkening can be a single setting.
Dr. Gallacher does. Every laser and light treatment here is carried out by her personally. She is a board certified skin doctor with a further year of specialist training in lasers and cosmetic work, and the person who examines you, makes the diagnosis and sets the machine is the same person who holds the handpiece. With pigment this matters more than almost anything else, because knowing when to stop is a judgment made by eye during the treatment, and because one wrong setting is the difference between a good result and skin that goes darker.
How the device is chosen for the diagnosis
How the machine is chosen for the diagnosis
There is no single laser for pigment. Different wavelengths are absorbed by pigment at different depths and to different degrees, and the wrong choice does not simply fail, it can inflame the skin and deepen the very problem being treated. The practice therefore keeps several distinct platforms rather than fitting every diagnosis to one device. What is selected depends on whether the pigment is epidermal or deeper, whether the diagnosis is melasma or a discrete sun induced lesion or a post-inflammatory mark, what the patient's skin tone is, and whether texture and sun damage need treating at the same time. Dr. Gallacher selects the platform, the wavelength and the settings at the consultation, and she performs the treatment herself.
There is no one laser for pigment. Different kinds of laser light are absorbed by pigment at different depths and to different degrees. Choosing the wrong one does not just fail to work, it can inflame the skin and make the problem darker. So the practice keeps several different machines, rather than forcing every diagnosis onto one. What gets used depends on how deep the pigment sits, whether this is melasma or a sun spot or a mark left by inflammation, what your skin tone is, and whether the texture and sun damage need treating at the same time. Dr. Gallacher chooses the machine, the type of light and the settings at your consultation, and she does the treatment herself.
What treatments may be used for hyperpigmentation and melasma?
What treatments are used?
Treatment is usually layered rather than based on one device: daily photoprotection and pigment-suppressing skin care form the foundation, with peels or laser procedures added selectively.
It is usually layered rather than a single device. Daily protection from light and creams that damp down pigment production are the foundation, with peels or laser added selectively on top.
| Option | Best role / limitation |
|---|---|
| Broad-spectrum photoprotection and protective clothing | Essential for prevention and maintenance. Tinted products containing iron oxides are useful for visible-light-sensitive melasma, and a wide brimmed hat and UPF clothing add protection that sunscreen alone cannot. |
| Prescription topical therapy | Prescription treatment to reduce pigment production or speed pigment turnover. The regimen depends on diagnosis, skin sensitivity and pregnancy status. |
| Medical-grade skin care products | Dispensed at the practice and matched to the diagnosis. Supports and maintains the result between active treatments. |
| Picosecond 1064 nm laser | Pigment-selective, minimal bulk heating. Preferred wavelength for pigment in medium and darker skin tones. Melasma still requires caution because heat or inflammation can trigger recurrence. |
| Fraxel FTX, 1927 nm setting, for pigmentation | Superficial wavelength for epidermal pigment and widespread photodamage. Settings individualized, especially in melasma and skin of color. |
| DiamondGlow | Exfoliation with simultaneous serum delivery. Supportive and maintenance care rather than a primary treatment for melasma. |
| Medical-grade chemical peels | Useful for selected superficial pigment. Depth and frequency kept conservative to avoid irritation and post-inflammatory darkening. |
| Erbium or CO2 resurfacing | More intensive resurfacing may be appropriate for combined texture and photodamage, but is not a routine first-line treatment for melasma because inflammation can worsen pigment. |
| Option | What it is for |
|---|---|
| Broad spectrum sun protection and covering up | Essential, both to prevent pigment and to keep your result. A tinted sunscreen with iron oxides also blocks visible light, which matters in melasma. A wide brimmed hat and UPF clothing add protection that sunscreen cannot. |
| Prescription creams | Reduce how much pigment your skin makes, or speed up how fast pigmented cells shed. Which ones depend on your diagnosis, how sensitive your skin is, and whether you are pregnant. |
| Medical grade skin care products | Supplied here and matched to your diagnosis. They keep the result going between treatments. |
| Picosecond 1064 laser | Targets pigment without much heat. This is the preferred type of light for pigment on medium and darker skin. Melasma still needs caution, because heat and inflammation can bring it back. |
| Fraxel FTX on the 1927 setting, for pigment | The shallower setting, for pigment near the surface and for widespread sun damage. Settings chosen individually, especially with melasma and darker skin. |
| DiamondGlow | Exfoliates and puts a serum in at the same time. Support and upkeep, not a main treatment for melasma. |
| Medical grade chemical peels | Good for pigment near the surface. Kept light and not too frequent, or the irritation makes the darkening worse. |
| Erbium or CO2 resurfacing | Stronger resurfacing may suit when texture and sun damage need treating together. Not a first choice for melasma, because the inflammation it causes can make the pigment worse. |
Lasers used for pigmentation
The lasers used for pigment
Picosecond laser. A picosecond laser delivers energy in extremely short pulses, which breaks up pigment largely by a photomechanical effect rather than by heating the surrounding skin. That matters in pigment work because heat is what provokes inflammation, and inflammation is what causes pigment to return. The practice uses a picosecond 1064 nm laser for pigment in medium and darker skin tones, because 1064 nm is comparatively poorly absorbed by the melanin in the upper skin and therefore passes the epidermis more safely than shorter wavelengths.
Fraxel FTX, 1927 nm setting, for pigmentation. The Fraxel FTX platform offers two wavelengths. The 1927 nm setting is the superficial one, and it is the setting used for pigment sitting in the upper layers and for widespread sun induced discoloration. The 1550 nm setting goes deeper and is used for texture and remodeling. Selecting between them is the point of the platform, and it is chosen for the indication rather than fixed in advance.
Erbium laser. Erbium is an ablative resurfacing laser. It removes a controlled depth of skin with relatively little heat spreading into the tissue underneath. It is used where pigment sits alongside texture, fine lines or sun damage that need treating together, rather than as a first choice for pigment alone.
CO2 laser. CO2 is the most powerful resurfacing option and is used where sun damage, texture and pigment all need addressing at once. It is not a routine first line treatment for melasma, because the inflammation it causes can make melasma worse. Where CO2 is appropriate, Dr. Gallacher performs it herself.
Picosecond laser. This laser fires in extremely short bursts, so it shatters the pigment mechanically rather than heating the skin around it. That matters, because heat causes inflammation, and inflammation is what brings the pigment back. The practice uses a picosecond 1064 nm laser for pigment on medium and darker skin, because that kind of light is absorbed less by the pigment in the top layer of skin, so it passes through it more safely than shorter wavelengths do.
Fraxel FTX, on the 1927 setting, for pigment. The Fraxel FTX machine has two settings. The 1927 one stays near the surface, and that is the one used for pigment in the upper layers and for widespread sun damage. The 1550 one goes deeper and is used for texture and firming. Being able to pick between them is the whole point of the machine, and the choice is made for your problem, not decided in advance.
Erbium laser. This one removes a controlled depth of skin, with very little heat spreading underneath. It is used when the pigment comes with rough texture, fine lines or sun damage that all need dealing with together, rather than as a first choice for pigment on its own.
CO2 laser. This is the strongest resurfacing option, used when sun damage, texture and pigment all need treating at once. It is not a first choice for melasma, because the inflammation it causes can make melasma worse. Where CO2 is the right treatment, Dr. Gallacher does it herself.
Aesthetic services, medical grade skin care and prescription treatment
Skin treatments, medical grade skin care and prescription medicines
DiamondGlow. A treatment that exfoliates the surface of the skin and delivers a serum into it in the same pass. It is not a treatment for melasma on its own, and it is not a substitute for diagnosis. It is used here as supportive and maintenance care alongside the main plan: keeping the surface clear, improving how well topical treatment is absorbed, and giving patients something gentle to continue with between or after more active treatment.
Medical grade chemical peels. Useful for pigment sitting near the surface. Depth and frequency are kept conservative, because irritation is itself a cause of darkening. In melasma, a light peel repeated sensibly does more good than a strong one.
Medical grade skin care products. Products dispensed at the practice, chosen for the diagnosis and for how sensitive the skin is. These support the plan every day, which is where most of the work in pigment is actually done.
Prescription medications. Separate from the products above. Prescription treatment can reduce pigment production or speed up the turnover of pigmented cells. The exact regimen depends on the diagnosis, on skin sensitivity, and on whether the patient is pregnant or breastfeeding, since several standard agents are not suitable in pregnancy.
DiamondGlow. A treatment that exfoliates the surface of the skin and puts a serum into it at the same time. It is not a treatment for melasma by itself, and it does not replace getting a diagnosis. It is used here to support the main plan and to keep things ticking over: clearing the surface, helping creams get in better, and giving you something gentle to carry on with between or after stronger treatment.
Medical grade chemical peels. Good for pigment near the surface. They are kept light, and not done too often, because irritation is itself a cause of darkening. With melasma, a light peel repeated sensibly does more than a strong one.
Medical grade skin care products. Products supplied at the practice, chosen for your diagnosis and for how sensitive your skin is. They do the daily work, which is where most of the progress in pigment actually comes from.
Prescription medicines. These are different from the products above. They can reduce how much pigment your skin makes, or speed up how fast the pigmented cells shed. Which ones you get depends on your diagnosis, how sensitive your skin is, and whether you are pregnant or breastfeeding, because several of the standard ones are not suitable then.
Prevention
Prevention
Prevention is not an afterthought in pigment care, it is part of the treatment. Pigment that is being provoked daily by light cannot be cleared by anything applied weekly or monthly.
Preventing pigment is not an extra, it is part of the treatment. Pigment that is being set off by light every day cannot be cleared by something you do once a week or once a month.
- Sunblock. Broad spectrum, applied every morning and reapplied through the day when outdoors. In melasma a tinted product containing iron oxides is preferred, because iron oxides block visible light as well as ultraviolet, and visible light alone is enough to keep melasma active.
- Protective clothing. A wide brimmed hat, long sleeves and clothing with a UPF rating do work that sunscreen cannot, because they do not wear off, are not applied too thinly, and do not need reapplying. This is the cheapest and most reliable part of the whole plan and it is consistently the part patients skip.
- Shade and timing. Avoiding direct sun in the middle of the day, and using shade deliberately rather than incidentally.
- Windows. Ordinary window glass filters some but not all ultraviolet, and it does not block visible light. Patients who drive a great deal often have asymmetric pigment for this reason, and window film is worth considering.
- Treating the source of inflammation. Where pigment follows acne, eczema or dryness, controlling that condition prevents the next round of pigment. This is prevention as much as treatment.
- Heat. Melasma may also be aggravated by heat, so significant heat exposure is worth discussing if melasma is proving unusually stubborn.
- Sunblock. Broad spectrum, on every morning, and put on again during the day if you are outside. With melasma, a tinted one containing iron oxides is better, because iron oxides block visible light as well as ultraviolet, and visible light on its own is enough to keep melasma going.
- Protective clothing. A wide brimmed hat, long sleeves and clothing with a UPF rating do something sunscreen cannot. They do not rub off, they are never put on too thinly, and they do not need reapplying. This is the cheapest and most reliable part of the whole plan, and it is the part people skip.
- Shade and timing. Stay out of direct sun in the middle of the day, and use shade on purpose rather than by accident.
- Windows. Ordinary glass stops some ultraviolet but not all of it, and it does not stop visible light at all. People who drive a lot often have more pigment on one side of the face because of this. Window film is worth thinking about.
- Treating whatever is inflaming the skin. If the pigment follows acne, eczema or dryness, getting that under control stops the next batch of pigment forming. That is prevention as much as it is treatment.
- Heat. Heat may make melasma worse too, so it is worth mentioning if your melasma is being unusually stubborn.
Do Erbium and CO2 resurfacing have a role in pigmentation?
Do Erbium and CO2 resurfacing have a role?
Yes, but for a different problem within the same face. Ablative resurfacing with erbium or CO2 is not aimed at melasma, and it is not a routine first line treatment for it, because the inflammation involved can make melasma worse. Where it earns its place is the combination that pigment patients very often have alongside the melasma: accumulated sun damage, uneven color, rough texture and fine lines, all in the same skin. In that situation resurfacing treats the substrate rather than the melasma, and the melasma itself continues to be managed with protection from light and with topical treatment. Which of the two is used depends on how much depth and how much thermal effect are wanted. In Dr. Gallacher's practice, CO2 resurfacing is performed by her personally, and it is planned so that the recovery is predictable rather than open ended.
Yes, but for a different problem in the same face. Erbium and CO2 resurfacing are not aimed at melasma, and neither is a first choice for it, because the inflammation they cause can make melasma worse. Where they earn their place is the combination that people with pigment very often have as well: built up sun damage, uneven colour, rough texture and fine lines, all in the same skin. In that case the resurfacing treats the skin underneath, while the melasma itself carries on being managed with protection from light and with creams. Which of the two is used depends on how deep the treatment needs to go and how much heat is wanted. At this practice, CO2 resurfacing is carried out by Dr. Gallacher herself, and it is planned so that you know in advance how long the recovery will take.
Who may be a good candidate, and who needs extra caution?
Who is it suitable for, and who needs extra care?
Good candidates have a clear diagnosis, realistic expectations and a treatment plan tailored to skin tone, trigger pattern and risk of post-inflammatory pigment change.
People with a clear diagnosis, realistic expectations, and a plan built around their skin tone, their triggers, and the chance of the skin darkening afterwards.
- Patients with active tanning, recent sunburn, open skin or uncontrolled inflammation usually need to postpone procedures.
- Darker skin tones can be treated, but device choice and energy settings require particular care because PIH risk is higher after inflammation.
- Pregnancy changes which topical medicines and procedures are appropriate.
- Anyone currently tanned, recently sunburnt, with broken skin, or with inflammation that is not under control, needs to wait.
- Darker skin can be treated, but the machine and the settings need particular care, because the risk of darkening after inflammation is higher.
- Pregnancy changes which creams and which procedures are suitable.
What are the benefits, risks and alternatives?
What are the benefits, risks and alternatives?
| Topic | Key points |
|---|---|
| Potential benefits | More even tone, lighter discrete spots or patches, improved confidence, and treatment of contributing photodamage when the diagnosis and modality match. |
| Common temporary effects | Dryness, irritation, redness, peeling or temporary darkening depending on the topical, peel or laser used. |
| Important risks | Post-inflammatory hyperpigmentation, hypopigmentation, burns, scarring or melasma flare can occur after procedures, particularly when skin is overtreated or sun-exposed. |
| Alternatives | Sun protection and topical therapy alone, camouflage makeup, observation of benign stable pigment, or treating the underlying inflammatory condition before cosmetic pigment treatment. |
What you can gain More even colour, lighter spots and patches, and the sun damage behind them treated at the same time, when the diagnosis and the treatment match.
What is normal afterwards Dryness, irritation, redness, peeling, or temporary darkening, depending on the cream, peel or laser.
The risks that matter The skin can end up darker or lighter than before, you can be burnt or scarred, and melasma can flare. That is most likely when the skin has been overtreated or exposed to sun afterwards.
Other options Sun protection and creams alone, camouflage make up, simply keeping an eye on harmless stable pigment, or treating whatever is inflaming the skin before touching the colour at all.
Visual guide to skincare, peels and laser options for different pigment concerns
A visual guide to skincare, peels and laser options for different pigment problems.
What is recovery like after pigmentation treatment?
What is the recovery like?
Recovery ranges from essentially none with daily skin care to several days or longer after peels or laser resurfacing; sun protection during healing is critical.
Anything from nothing at all with daily skincare, to several days or more after a peel or laser resurfacing. Keeping the sun off it while it heals is critical.
Possible warmth, redness, swelling or transient darkening after a procedure.
Warmth, redness, swelling, or the treated area briefly going darker.
Flaking or peeling can occur after chemical peels or resurfacing; stronger procedures take longer.
Flaking or peeling after a peel or resurfacing. The stronger the treatment, the longer it takes.
Pigment response is gradual; melasma commonly needs maintenance rather than a one-time cure.
The pigment responds gradually. Melasma usually needs keeping under control rather than curing once.
How long do results last?
How long will it last?
For hyperpigmentation, results are often long lasting, provided sun protection and the skin care regimen are maintained. Once the trigger is controlled, an individual sun induced spot or a post-inflammatory mark can stay clear for a long time. Melasma behaves differently. It is biologically prone to recurrence and is best managed as a chronic condition, and treatment may require ongoing care: maintenance peels, DiamondGlow or topical treatment may be recommended, alongside continued protection from ultraviolet and visible light. Individual results vary and no outcome is guaranteed.
With hyperpigmentation, the results often last a long time, as long as you keep up the sun protection and the skin care. Once whatever caused it is under control, a single sun spot or a mark left by inflammation can stay clear for a long time. Melasma is different. It is inclined to come back, and is best managed as a long term condition. It may need ongoing care: maintenance peels, DiamondGlow or creams may be recommended, along with carrying on protecting your skin from sunlight and ordinary visible light. Results are different for everyone, and nothing is guaranteed.
Some forms of hyperpigmentation may improve after a small number of procedures, while melasma often requires months of combination care and ongoing prevention. The number of treatments and durability of improvement vary and cannot be guaranteed.
Some kinds of darkening improve after just a few treatments. Melasma often needs months of combined care and continuing prevention. The number of sessions, and how long the improvement lasts, vary and cannot be guaranteed.
Treated by a fellowship-trained dermatologist
Treated by a fellowship-trained skin doctor
Pigmentation is diagnosed and treated here by Dr. Gergana Gallacher, a board certified dermatologist with fellowship training in laser and cosmetic dermatology. She completed her dermatology residency at UC Davis, postdoctoral fellowship work at UCSF, and has held faculty appointments at UC Davis and Stanford. Very few board certified dermatologists in the United States are both fellowship trained in lasers and have taught at that level. The practice keeps a range of technologies specifically so that the device can be chosen for the diagnosis, and Dr. Gallacher performs the laser treatments herself.
Pigment problems here are diagnosed and treated by Dr. Gergana Gallacher. She is a board certified skin doctor with a further year of specialist training in lasers and cosmetic work. She trained as a skin doctor at UC Davis, did research work at UCSF, and has taught at UC Davis and at Stanford. Very few board certified skin doctors in the United States have both the laser fellowship and that teaching background. The practice keeps several different machines on purpose, so the right one can be chosen for your diagnosis, and Dr. Gallacher does the laser treatments herself.
Illustrative result
What a result can look like
Illustration, not a patient photograph. Before and after treatment for melasma or facial hyperpigmentation. It shows the kind of change this treatment is intended to produce. Individual results vary, and no outcome is guaranteed. Photographs of real patients are published only with written consent.
This is a drawing, not a photo of a patient. It shows a before and after for treating melasma or facial pigment, to give you an idea of the kind of change it aims at. Results are different for everyone, and nothing is guaranteed. We only publish photos of real patients with their written permission.
Questions patients ask
Is melasma the same as hyperpigmentation?
Is melasma the same as hyperpigmentation?
No. Hyperpigmentation is a broad term for excess pigment. Melasma is one specific pigment disorder with a characteristic distribution and a tendency to recur.
No. Hyperpigmentation is the broad term for skin that has darkened. Melasma is one specific condition within that, with its own pattern and a tendency to come back.
How many treatment sessions will I need?
How many sessions will I need?
It depends on your skin type and on how severe the discoloration is. Discrete hyperpigmentation often clears in one to three laser sessions. Melasma is different: it usually needs a combination of therapies over several months for sustained improvement, and it is managed rather than cured. The schedule is set after the diagnosis is made and adjusted according to how your skin responds. The number of treatments and how long the improvement lasts vary between patients and cannot be guaranteed.
It depends on your skin type and how dark the discolouration is. Separate patches of hyperpigmentation often clear in one to three laser sessions. Melasma is different. It usually needs several treatments used together over several months to hold the improvement, and it is kept under control rather than cured. The plan is set once you have a diagnosis, and changed depending on how your skin responds. The number of sessions, and how long the result lasts, are different for everyone and cannot be guaranteed.
Are laser treatments safe for darker skin tones?
Are lasers safe on darker skin?
At the Dermatology and Laser Centre we treat all skin tones. We use advanced lasers such as the picosecond 1064 nm laser, together with customized regimens, to reduce the risk of post-inflammatory hyperpigmentation, which makes treatment workable for light, medium and darker complexions. The 1064 nm wavelength is chosen deliberately in skin of color because it is absorbed less strongly by melanin in the upper skin than shorter wavelengths are, so it reaches the target with less heating of the surface. That said, the margin for error is genuinely smaller in darker skin, because inflammation more readily leaves pigment behind. Device choice, wavelength, energy, cooling and aftercare are individualized in every case, test treatment may be used first, and Dr. Gallacher performs the treatment herself.
At the Dermatology and Laser Centre we treat all skin tones. We use advanced lasers such as the picosecond 1064 laser, along with plans built around the individual, to reduce the risk of the skin darkening afterwards. That makes treatment workable on light, medium and darker skin. The 1064 type of light is chosen on purpose for darker skin, because it is absorbed less by the pigment in the top layer than shorter wavelengths are, so it gets to the target while heating the surface less. Even so, there is genuinely less room for error on darker skin, because inflammation more easily leaves marks. The machine, the light, the energy, the cooling and the aftercare are chosen individually every time, a small test patch may be done first, and Dr. Gallacher does the treatment herself.
Can laser make melasma worse?
Can a laser make melasma worse?
Yes. Melasma can flare after heat, inflammation or sun exposure. Lasers and peels may help selected patients, but they should be used cautiously and usually as part of a broader maintenance plan.
Yes. Melasma can flare after heat, after inflammation, or after sun. Lasers and peels help some people, but they should be used cautiously, and usually as one part of a longer term plan.
Do I still need sunscreen after the pigment clears?
Do I still need sunscreen once it has cleared?
Yes. Ongoing photoprotection helps prevent recurrence and reduces new sun-related pigment.
Yes. Continuing to protect your skin is what stops it coming back, and stops new sun pigment forming.
What should be checked before cosmetic treatment of a dark spot?
What should be checked before treating a dark spot?
Any pigmented spot that is new, changing, uneven, bleeding or otherwise suspicious should be medically assessed before any cosmetic treatment.
Anything new, changing, uneven in shape, bleeding, or in any way suspicious should be medically assessed before it is treated cosmetically.
Where does DiamondGlow fit in?
Where does DiamondGlow fit in?
DiamondGlow exfoliates the surface of the skin and delivers a serum into it in the same pass. It is not a treatment for melasma in its own right, and it does not replace diagnosis, prescription treatment or protection from light. It is used at this practice in two places: as supportive care alongside an active plan, where clearing the surface helps topical treatment work as intended, and as maintenance once the pigment has improved, where it sits alongside maintenance peels and topical treatment as one of the options for keeping the result.
DiamondGlow exfoliates the surface of your skin and puts a serum into it at the same time. It is not a treatment for melasma by itself, and it does not replace getting a diagnosis, using prescription treatment, or protecting your skin from light. It is used here in two ways: to support an active plan, where clearing the surface helps the creams work properly, and for upkeep once the pigment has improved, alongside maintenance peels and creams, as one way of holding on to the result.
Talk it through with a physician first.
Every plan starts with an assessment of your skin, your anatomy and what you actually want to change.
This page is general health information, not medical advice. It cannot tell you whether a treatment is right for you. Approved uses, risks and results differ from person to person, and product labelling changes. Ask us at Dermatology and Laser Centre about your own situation, or make an appointment, and seek urgent care for any serious symptom.
