Q: Why Is Melasma so Hard to Treat?
Sharon Grasso, aesthetician and owner of Permanent Touch Cosmetics, clears up some misconceptions on this frustrating but common skin condition.
Sharon Grasso founded Permanent Touch Cosmetics over 25 years ago and has been a key opinion leader for multiple global laser device companies.
A: “Many people don’t understand melasma; they think it’s sun damage. It is a form of sun damage because ultraviolet light and heat trigger melanocytes in the skin, but hormones play a role, too. There are two different types of melasma: dermal melasma, which is located deep in the dermis [middle layer of skin] and is more challenging to treat, and epidermal melasma, which affects the top layer of skin. We see a lot of epidermal melasma, and it’s often combined with sun damage.
Because heat triggers melasma, treating it with lasers is tricky. Lasers emit heat. Even visible light sources such as Intense Pulsed Light (IPL) or Broadband Light (BBL)—the gold standards for treating superficial sun damage—can significantly exacerbate the condition. (Although, with a trained professional and the proper settings, BBL can be used in a melasma treatment protocol.) Often, melasma is mistaken for sun spots, so practitioners turn to the wrong treatments, and suddenly, the condition worsens horribly.
My go-to for treating melasma is the MOXI laser from Sciton. It’s a 1927 nanometer (nm) thulium laser that is attracted to water in your cells, not pigment, making it safe on all skin types all year long and should not trigger more melasma. It resurfaces your skin and stimulates collagen, fading existing brown patches. With any non-ablative laser [it doesn’t compromise the integrity of the dermis], the effects are cumulative, and it may take four to six treatments to see results and then maintenance treatments. And once your melasma is gone, it doesn’t mean it won’t come back because it’s coming from the inside out.
At-home topical treatments are essential, too. We may recommend a vitamin C serum or encourage clients to see their dermatologists, who may prescribe a topical bleaching cream. Sun protection is a must—and not just applying it once at 9:00 a.m. You have to reapply throughout the day. But remember that heat alone triggers it, so if your melasma is severe, you may want to rethink sitting on the beach all day. Even a hat traps heat from your head, and the sun reflects off the sand and water.
Melasma is systemic and comes from the inside out. As providers, we can’t control it all. So, I think the biggest challenge we face with melasma is treating it effectively, as well as client education and understanding that it will take multiple treatments and maintenance. And it won’t always work, which is the hardest thing for a provider to say to someone. But I’d turn someone away before giving them a bad result.
Melasma before and after images courtesy of Permanent Touch of Cosmetics.
At Permanent Touch Cosmetics in Woodbury, one MOXI treatment is approximately $800, and BBL is $600 for the face and neck, but there are often customized protocols and specials on buying packages. Inquire at (917) 734-7378.
About the expert: Sharon Grasso, LME, CLT, KOL, is a dually-licensed permanent makeup specialist, NYS licensed aesthetician, aesthetic consultant, and practitioner with over 30 years of experience, as well as a certified clinical application specialist.
