Pigmentation
Sun damage and melasma behave differently. Identifying which you have comes before choosing any device.
What is actually happening
Sun damage sits in the upper layers and responds well to light and laser. Melasma is hormonally driven, sits deeper, and is aggravated by heat — including the heat from the devices that clear sun damage.
This is the single most common way pigmentation gets worse in a clinic. A patient with melasma is treated as though she has sun damage, the pigment darkens, and she is told she needs more sessions.
What we assess
Pattern, symmetry, borders, and history. Melasma is usually symmetrical and patchy; solar damage is scattered and irregular.
What we usually advise
Eight weeks of topical preparation before any device. It reduces the risk of rebound and improves the result of whatever follows.
When we say no
Active melasma in summer. We schedule these for autumn and start the topicals now.