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Title says it all.

I am a fair skinned mixed race woman with melasma. Creams I have tried so far have been a complete waste of space and time. Needless to say, I am still unhappy with my melasma and am now hoping to learn a bit more about treatment options that do work. What about laser surgery? I have heard a little about this but also that it isn't always effective. 

Now I'd like to know just how high or low the success rate is for laser surgery for melasma and what the risks are?

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Laser surgery, either Intense Pulsed Laser or Fraxel, for melasma is a mixed bag... melasma in general is real hard to treat, you know? So you've got people who had severe melasma who totally got rid of it with laser treatment, and of course they're ecstatic... but by the same token you also got plenty patients who either only noticed minor improvements or nothing at all. Then there's even a few whose melasma actually got worse after laser treatment. If you book in for a consultation your surgeon will be honest about their clinic's success rates with either of these two laser treatments. Mind you even though laser treatment for melasma isn't guaranteed to offer success by any means I have to say that it's one of the more successful treatment out there for melasma so def something to consider...

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I have melasma as well, and from what I gather, treatment is not at all straightforward. Any laser treatment has to be approached with caution because people with melasma are more prone than average to severe reactions of inflammation that could make matters worse. The most important thing is to make the treatment low impact.

Low intensity laser, microdermabrasion, and in addition the topical treatments you are probably already familiar with seem to be the "holy trinity" of effective melasma treatment. I am planning to undergo this myself.
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Hey,

Since the surgical options for melasma are not all that effective, you may just want to experiment with home remedies first. I do not know whether they work from personal experience and you will have to google the exact ways to use them, but...

Turmeric paste, when applied to the skin and allowed to dry completely before washing it off, is said to help. Applying either apple cider vinegar or lemon juice may have some effect as well. Almond milk, oatmeal, and aloe vera are all supposed to work as well. Then you have almost juice, apricot oil, and guava. 

I am not sure they work but then again, laser treatment certainly does not work for everyone with melasma and these home remedies are much less invasive.

Rosie

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Be aware that although research shows that laser treatment for melasma can be highly effective in some cases, this is still very much more an art than a science with no guarantees as to the outcome whatsoever. Research indicates that topical bleaching creams are just as effective or more effective for melasma as laser treatment and that this is still the first treatment of choice. You can always go for a consultation, but if you do end up choosing laser surgery for your melasma, be aware that even if it does everything you had hoped for, melasma can still recur.

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One thing I wanted to bring to your attention is that the vitamin C and hyaluronic acid serums that have recently risen to enormous popularity and become a huge buzzword in general anti-aging skin care also have the power to remove sunspots. I do not know whether this means that they would be able to fade melasma as well at least to some extent, but what I do know is that these serums are much cheaper than laser surgery, and it doesn't sound like laser surgery is all that promising in this case anyway. Maybe you could try with vitamin C serum?
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I was just wondering whether you had tried with hydroquinone or kojic acid? These things both have skin lightening properties, one chemical and the other natural, and some people with melasma find that their condition gets a lot better after long-term use. There's also the possibility of having a chemical peel for melasma. There are different kind, such as TCA, lactic acid, glycolic acid, so talk to your medical spa about the best options for melasma. 

Laser treatment though? Not a good idea for melasma as some people actually see a drastic worsening of their melasma after undergoing these treatments. Not at all what you want!

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I have a friend who tried laser surgery for melasma and it didn't do anything at all. If anything, her melasma actually worsened slightly after a few sessions and she gave it up. She's now using hydroquinone (spelling?) and I heard that this is banned in some places because it's dangerous but it does work. I don't know how effective the more natural creams are though and I do understand that if you have this, you are willing to try almost anything to have normal pigment again.
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My cousin (also a close friend) had Fraxel done for her melasma a few years ago.

Well, after the first session, she looked remarkably better, with some of the dark spots faded noticeably. To improve the melasma even more, she was told she needed a few more sessions. That is where things went downhill. The second and third sessions, after she was done with those, her melasma got worse rather than better.

You can imagine how that left her feeling!!! I am just sharing this as a caution. Laser surgery for melasma seems to be very much experimental still and your melasma can also get worse.
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