Lasers are useful adjunctive therapies for #melasma. The mainstay however, is medical management . . 🔬Skin Science: It is complex. Interplay between keratinocytes, vascular endothelial cells, fibroblasts, mast cells, basement membrane, & of course the melanocyte. Many cytokines, many modulators involved, more complex than just tyrosinase & melanin . . 🔫Lasers. The #fraxel 1550 was FDA approved in 2005. How it got approved for the treatment of melasma is beyond me. Nothing against Fraxel, but it simply is not great for the treatment of melasma- esp with the 1550-1540 NA wavelength. #Lutronic gained FDA approval in 2012 with their #spectra laser. This is a milestone in #melasmamanagement as the subcellular selective photothermolysis settings, published in 2010-2012 really did improve the majority of cases. Don’t destroy the melanocyte, don’t aggravate it, just shrink down the dendritic transfer of melanosomes- gently & slowly . . ⚡️🔫Picolasers : are effective. They offer faster clearance in my hands, but at a much higher incidence of PIH than nano lasers. Pico companies will quote differently based upon the old nano setting of 2.2-2.8 Joules 1064. Not cool as the ‘dermal toning’ settings are well researched. Regardless, nano or pico laser is NOT the solution for melasma. They are adjunctive treatments . . 👀👉Fraxel 1927- thulium - diode: My third line laser. V low settings. Very slow, under tyrosinase inhibition & VEGF/Plasminogen modulation . . 💡Copper Bromide + Vascular lasers: Occasionally I do use vascular lasers esp if teles & t.acid C/I. Can be useful . . 🧨🧱IPL - not great, fractional #IPL reported. I do not have one. Send one my way if any company is reading this. Oh, & I do need another #picolaser as well . 👌🏻Thanks for reading. Above all, don’t piss off the melanocyte. Like the tax man & your wife, you will NEVER WIN👍🏻 . 😎Dr Davin Lim Brisbane, Dermatologist .🇦🇺 #skinpigmentation #melasmatreatments #melasmacure (is impossible) #skinlightening #lasertoning #laserrejuvenation (at Brisbane, Queensland, Australia) https://www.instagram.com/p/CBRRqC3jha_/?igshid=1t1p11kfktl7p
