Melasma is a common condition which can be stubborn and difficult to treat. It is caused by an internal imbalance of hormones that makes the skin very sensitive to the sun and leads to the formation of dark patches, or tanned areas, with very little sun exposure. Areas most commonly affected by melasma include the cheeks, forehead, and upper lip. Melasma is more common in women and often times occurs when hormone levels change such as during or after pregnancy, when taking birth control pills, and during menopause. The biggest challenge with melasma is that since the cause is internal, no matter what we do on the skin it usually comes back. Therfore melasma is a condition that we control, not cure; and after initial treatment maintenance treatments are required every three to six months. Melasma is more common in people of darker skin tones and in these people the sunlight causes the skin to make more pigment, which can be deposited in different layers of the skin. There are three types of melasma depending on exactly where the pigment is. In superficial melasma the pigment is close to the surface and often appears darker. In deep melasma, as it's name suggests, the pigment is deeper in the skin and often appears lighter or more faint. The third type, combination melasma, is perhaps the most common and is when there is pigment in both parts of the skin, deep and surface. Superficial melasma is easier to treat because the products and treatment used can reach the pigment easier. With deep melasma, the products and treatments have to penetrate deeper, making treatment more challenging. When the deep pigment is treated it is often exfoliated to the surface making it appear darker, or worse. Many people get frustrated when they see this because they think that their efforts and investments have made the problem worse. However, it is important to understand that the pigment is coming closer to the surface and a deep treatment will likely lead to improvement. Dr. Alex has specifically designed and tweaked the Ultimate Rejuvenation for deep and combination melasma. In one of the steps, tiny holes are made into the skin allowing the deep pigment to come out. Right after this step a brightneing ingredient is applied directly to the skin. Since there are tiny holes in the skin, the brightening ingredient can get to the deeper layers. In the photographs shown here, the before image is that of a patient with melasma after using the A E Skin Triple Antioxidant Serum and after having two Forever Young BBL IPL Photofacial treatments and two Soft and Smooth Rejuvenation treatments. The patches appear worse than when she started (not shown) because the pigment is coming closer to the surface. But six weeks after one Ultimate Rejuvenation treatment and the A E Skin Brightening Cream, Exfoliating Serum, Triple Antioxidant Serum, and Hydrating Serum the patches on her cheeks are significantly improved. As you caan see, melasma is often stubborn and treatment can be challenging and frustrating. But it is important to keep the course and understand what is going on and know what needs to be done for best results. Contact us for a free consultation with Dr. Alex.