Published on: November 3, 2025
I still remember the first patient who came in tears about “dirty looking” patches on her cheeks. She’d stopped going out without makeup. If that’s you, take a breath. You’re not alone, and you’re not stuck with it.
As a physician and someone who has seen a lot of melasma up close, here’s the most helpful way to think about it: melasma is a chronic, trigger-prone pigment condition. You can get it dramatically better (often to the point where it’s barely noticeable), but it requires smart, gentle care and consistency.
In this post, I’ll break down what melasma is, how to tell it apart from look-alikes, why lasers so often make it worse, and the treatments I recommend at Glow to safely restore clarity.
Melasma is a form of hyperpigmentation most often appearing on the cheeks, nose, forehead, upper lip, and jawline. It usually looks map-like (think outlineable “islands”) and it tends to be symmetrical. While it’s most common on the face, it can show up on the chest and arms too.
Why it happens is multi-factorial:
Patients often ask, “Is this a sunspot or melasma?”
Why it matters: melasma behaves differently, and responds best to gentle, anti-inflammatory strategies.
Let’s address the elephant in the treatment room. I’m often begged to “just laser it off.” I get it, lasers can quickly clear visible pigment. But with melasma, that win is frequently short-lived.
Here’s the issue: many lasers and intense light devices deliver heat or explosive energy to break up pigment. Melasma is heat-sensitive and inflammation-prone. So while you might look clearer right after treatment, a rebound flare can appear weeks to months later, sometimes worse than where you started.
My rule of thumb: no lasers for melasma. The rare exception would be under a true laser specialist using ultra-gentle, ultra-short-pulse protocols after everything else has failed, and even then, with caution. Medicine’s first principle is “do no harm”; since we have safer, effective alternatives, we don’t have to gamble.
Melasma needs kindness, not aggression. Superficial peels help by lifting pigment sitting in the top layers and by reducing inflammation.
Key, melasma-friendly ingredients we use in tailored peel protocols:
What to expect: a series of 3–6 light peels, often every 2–4 weeks. Pigment can look a touch darker at first as it rises, then it lifts. After your series, we’ll set a maintenance cadence (often 1–2 touch-ups per year).
What I avoid: the old “triple cream” approach (hydroquinone + tretinoin + steroid) as a long-term plan. Chronic steroid use can thin skin and promote vascular changes; we can achieve excellent results without that trade-off.
In stubborn, recalcitrant melasma that hasn’t responded to the above, short courses of oral TXA can be effective. We reserve this for carefully screened patients because TXA may increase clotting risk in susceptible individuals.
We do not use oral TXA if you:
If appropriate, protocols are short and finite (often 8–12 weeks) with close follow-up and always paired with a robust topical routine and trigger control.
If you notice pigment with hairline recession or patchy scalp changes, ask a dermatologist to evaluate for lichen planus pigmentosus (and related scarring alopecia). That’s a different condition and requires a different, often more anti-inflammatory approach.
Melasma is chronic, but highly manageable. Our goal at Glow is to calm the biology, lift the pigment safely, protect the barrier, and help you avoid flares. Most patients can get to “barely noticeable” with less makeup and more confidence.
Think of it as a partnership between you, your skin, your lifestyle, and your care team.
If you’ve been battling stubborn discoloration, we’ll build a personalized, physician-led plan that respects your skin’s biology and your lifestyle.
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