Melasma, sun damage and pigmentation
Pigment responds to the right depth of treatment and to sun discipline afterwards. Melasma in particular can worsen with overly aggressive treatment.
Pigmentation problems can look similar on the surface and behave completely differently underneath, which is why one plan does not serve them all. Sun-induced pigmentation, or lentigines, is discrete, well-defined and sits relatively superficially. It responds predictably to treatment and, with proper sun protection, tends to stay away. Melasma is a different proposition: symmetrical, blotchy patches across the cheeks, forehead and upper lip, driven by a combination of hormonal influence, sun and heat. It is chronic and relapsing, the pigment often sits deeper, and it can be made worse by treatment that is too aggressive. Heat and inflammation are themselves triggers, so an approach that would clear sun damage in a session can rebound melasma into a worse state than it started in. Post-inflammatory hyperpigmentation is a third category, the mark left after any inflammatory insult, which fades with time and sun discipline. Any pigmented lesion that is changing, asymmetrical or new in an adult warrants dermatological assessment before cosmetic treatment.
How we treat it
Sun protection is not an adjunct here, it is the treatment: daily broad-spectrum SPF, reapplied, with visible-light protection where melasma is present. No in-clinic treatment holds against continued unprotected exposure, and that is stated plainly at consultation because it determines whether treatment is worth starting at all. For sun damage, medical- grade peels lift pigment predictably over a course. For melasma the approach is deliberately gentler and slower: superficial peels at conservative strength, spaced, alongside topical agents, aiming at gradual lightening rather than clearance. Microneedling is used cautiously in melasma and avoided where the skin is reactive, because inflammation drives the condition. Treatment is staged and reassessed rather than escalated on a schedule. Deeper skin tones require particular care throughout, as the risk of post-inflammatory hyperpigmentation from the treatment itself is higher, and creating new pigment while treating old is the most common way melasma management goes wrong.
Medically reviewed by Dr. Sherwin Hariri, MD, Medical Director & Chief Longevity Physician. Last reviewed August 2026.
This page is for information only and is not medical advice. Suitability for any treatment is determined at consultation.
Common questions
Can melasma be cured?
It can be controlled and substantially lightened, but it is a chronic, relapsing condition rather than one that is cured. Pigment commonly returns with sun exposure, heat or hormonal change. Management is ongoing: an initial course to lighten, then maintenance and rigorous photoprotection to hold it. Framing it as control rather than cure prevents a great deal of disappointment.
Why can aggressive treatment make melasma worse?
Because heat and inflammation are triggers for the condition itself. A treatment intense enough to clear sun spots can provoke a rebound that leaves the skin darker than before. This is why conservative, staged treatment produces better long-term results here than a single powerful session.
Do I really need sunscreen every day?
Yes, and it is the single most important part of the plan. Ultraviolet exposure drives both the original pigment and its recurrence, and visible light contributes in melasma, which is why a tinted mineral sunscreen is often recommended. Without daily protection, in-clinic treatment is being undone as fast as it works.
How long until I see a difference?
Sun damage often shows visible improvement after one or two peels. Melasma is slower by design: meaningful change is usually assessed over three to six months of staged, conservative treatment. Rapid clearance is not the goal, because the intensity required to achieve it tends to make the condition worse.
Other concerns
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