Hello Always Thank you for your question. Laser is a good method of treating prolonged redness and post inflammatory hyperpigmentation (PIH) from surgical scars. The redness and erythema can treated with a pulsed dye laser while the PIH can be treated with gentle laser toning. Laser treatment can be combined with topical agents such as triluma/ hydroquinone/ retinoid for the best result. Speak to a dermatologist/ aesthetic physician/ plastic surgeon to find out more. Hope this helps!

Melasma is a tricky condition to treat as there are many factors involved and the pigment can be situated superficially, deep in the skin or a combination of both superficial and deep. However, there are treatments available to treat this condition via different pathways. Personally, I use topical lightening creams, orals and different machine-driven therapies to target the pigment at different levels in the skin to get optimal results. Treatment of melasma is like a regime and requires patience as multiple sessions are required.

Hello Jol Thank you for your question. There are may ways to treat post inflammatory hyperpigmentation (PIH) marks as a result of acne. You can use topical creams, chemical peels or lasers. Depending on the severity of the PIH, usually a combination treatment will give you the best result. Depending on your skin type, I would generally use a milder peel such as Glycolic Acid peel 30% to 50% at the start. It is well tolerated, safe and has close to no downtime. Other peels such as Jessners/ TCA/ Salicylic Acid can be used as well.

There is significantly uneven skin tone. I would probably advise to do exfoliation. A mix of Chemical peels and topical products for gentle peels would help with the skin tone. Some lasers or light IPL will also help to reduce the discolouration. That should do the trick!

Q-switched Laser is the best treatment for acne scars that are Brown Spots called Post-Inflammatory Hyperpigmentation. Other types of Acne scars such as depressed scars (rolling scars is a type of depressed scar) and hypertrophic scars are better treated with subcision, fractional ablative/non-ablative lasers, fractional RF. Yes, Q-switched Laser can be combined with other treatments if you have multiple types of acne scars. In fact, Acne scar treatments should be specific and customised for each type of acne scar.

I'm so sorry to hear that. This must be troubling you quite a lot. Let me briefly discuss how to prevent and treat facial pigmentation. It's good that you are very meticulous with sun protection. This is one of the most important steps in preventing new pigmentation spots from appearing. You may read all about pigmentation and treatment here in my Ultimate Guide To Pigmentation Treatment In Singapore.

I totally agree with Dr Elias Tam that “There is no perfect laser for treatment of pigmentations”. The analogy is like having the fastest sports car alone does not guarantee to bring you the Formula One Championship trophy. In fact, to even have a shot at the trophy, the sports car must be driven by an equally matched professional experienced driver. In my own experience, pigmentation laser with the latest technology can certainly be very useful, but technology alone does not guarantee results.

I concur that melasma can be difficult to treat, so it’s necessary to tamper your expectations as to how much improvement you can expect. I’d generally be wary of anyone who promises that X or Y treatment will get rid of melasma completely. As both Dr Israr and Dr Rui Ming mentioned, it may require a combination of treatments before you see improvement. I’d suggest to have a doctor have a look at it and to ask him realistically what % improvement you can expect, and how many treatment sessions will be needed.

I fully agree with Dr David's advice to take a break from laser treatments for the time being. I also agree with his approach of emphasizing on the diagnosis and holistic approach to skin treatments. IPL is a valuable light treatment and the LASEMD and Dual Yellow are both wonderful lasers for treating solar lentigo and melasma. I highly doubt that adding a picosecond laser would have made a large difference in treating your pigmentation. In fact, there are some studies to show that the long pulse visible light lasers treat lentigenes and melasma better than the pico or nanosecond lasers.

You are most likely having post-inflammatory hyperpigmentation of the acne that has recovered. You also have active acne breakouts, therefore, for a treatment that targets both issues, I would highly recommend chemical peels. Salicyclic acid peels can calm down and stop acne, while Jessner’s peels can reduce hyperpigmentation. Subsequently you will need topical creams (e. g. Arbutin) for further pigment reduction, and acne products (e. g. salicyclic acid wash, retinA creams) for maintenance.

A genetic predisposition is one of the most important risk factors for the development of melasma (Melasma: A Clinical and Epidemiological Review; An Bras Dermatol. 2014). However, no definite clear pattern of inheritance has been identified so far. Most studies in various populations around the world in patients with melasma cite a positive family history and at least one relative with melasma, as high as 97% of first-degree relatives. However, there are other factors at play too, such as female gender, as you rightly pointed out, hormonal influence, pregnancy, and skin type/colour.

My experience is that I use 10-20mg daily for 1-2 months, then start to adjust or tail down after that. I warn patients of flares in the first 4-6 weeks, which is really common. I think that Benzoyl peroxide should be avoided. Also, you should consider moisturising more actively. I like Serums, including the Skinceuticals B5 hydrating serum which my patients on Isotretinoin seem to like. It's light and moisturising at the same time. Don't give up! The light is at the end of the tunnel. Been through that too!

Thank you for your question. Post inflammatory hyperpigmentation (PIH) occurs after an inflammatory event, leading to an increase in melanin production in the affected skin area. The more inflamed an acne breakout, the larger and darker the PIH. That would explain why even if you did not pop the pimple, PIH can still occur as acne is an inflammatory event, which may still eventually lead to PIH. Hope that answer your question and have a wonderful weekend. Do let me you if you have any further questions.

I agree with Dr Justin that there are several issues you have to combat and as such a combination of modalities needed. Q switch is not going to be the key answer. 1) You still have some acne which should be controlled with good mix of topical and oral medications. I always firmly believe that chasing after scars is pointless IF the outbreaks are not adequately dealt it. 2) You have post acne erythema which can be dealt with using Yellow lasers or in some clinics, even the use of IPL.

Melasma is relatively common skin problem where there are brown to grey-brown patches on the face. Treatment and response depends on the depth of the pigmentation. Treatment can be quite challenging. I personally prefer the PicoWay because it has the RESOLVE attachment which helps to further break up the pigmentation in question as well as stimulate rejuvenation. There is also very little social downtime since recovery is relatively fast.