Melasma Peels

The most popular chemical peels for pigmentation include-

• Traditional superficial peels such as AHA, low concentration TCA & retinoic acid peels
• Accelerated treatment peels such as Dermamelan & Cosmelan peels

Dermamelan & Cosmelan peels are termed ‘commercial peeling;’ meaning they offer blanket solutions of all types of pigment, including melasma. The downside of these peels is that-

• Recovery ranges from 4 to 14 days
• The efficacy rate is around 60-65%
• Costs are significant, around $1250 to $1900 per peel

On this basis, dermatologists are very careful as to how we initiate these peels. Good candidates are patients who have more superficial melasma, & no contraindications to medical therapy. 

This is a crucial step in the management of melasma. Epidermal or superficial pigment has a much higher chance of responding to chemical peels, compared to dermal pathology. We can understand depth by-

• Physical examination, brown vs dusk pigmentation vs grey
• Wood lighting (epidermal lights up)
• Dermatoscopic examination

If you are unsure about the depth of pigmentation, book a consultation with our dermatologists. Our nurses also offer a FREE* consultation, redeemable upon treatments. *fee redeemable on product and treatment

Dermatologists follow a structured approach to melasma. We-

• Confirm the diagnosis, excluding other conditions that can resemble melasma
• Confirm the depth of pigment (Examination, Wood lighting, dermatoscopic exam)
• Exclude contraindications to medical therapy
• Prescribe medical management
• Adjunctively prescribe lasers (or peels in exceptional situations)

Unlike other forms of pigment, melasma is categorized as medical, meaning it responds best to a prescribed program, including- 

1. Pigment correctors known as tyrosinase inhibitors.
2. Fibrinogen modulators. These modify the input of blood vessels to the pigment cells. 
3. Laser pigment transfer inhibition by a process known as subcellular selective photothermolysis. 
4. Basement membrane stabilizers. This reduces pigment drop out into the deeper dermis. 

Use correctly, lasers are much safer than peels. They are also more cost effective and work better than peels. 

The settings we use are termed subcellular selective photothermolysis. It means we reduce pigment transfer and don’t blow up/shatter pigment. Lasers are matched according to the depth & resistance of pigment.

The 3 lasers we employ include – 

• QSL Nano lasers: account for 94% of our treatments
• Pico lasers: account for 5% of our melasma treatments
• Fractional lasers: make up the last 1% of treatments. Fraxel is great for sun induced pigment, but a disaster for melasma. 

We employ chemical peels in two situations-

1. Maintenance of melasma during the ‘off’ cycle. These peels are typically AHAs or mixed Jessner peels. We also use retinoic acid 1-7% peels.
2. Accelerated treatment with Dermamelan or Cosmelan peels. These peels are ideal for international or interstate patients.

Performed correctly, side effects are rare with conservative superficial peels. More things go wrong with medium depth peeling. These include-

• Rebound melasma (comes back very quickly)
• Worsening melasma
• Infection
• Demarcation lines
• Scars
• Acne

You can, but it’s not a good idea, especially if you are playing around with TCA or high strength AHA peels. Be sensible, stay safe. Don’t burn yourself or make your melasma worse.

Peels start from $98. T

These include lactic, glycolic & retinoic acid peels. 

Enquire with our nursing staff the price of Dermamelan or Cosmelan peels.

As a guide, lasers are more cost effective than Cosmelan/Dermamelan, starting from only $133 per laser session. 

Dermatologists are experts when it comes to sorting out stuff-ups. We know skin. 

Book an appointment to see us & we will formulate a treatment plan. Given permission, we can have a talk to the clinician who performed the peels & find out what went wrong. Regardless, effective treatments are possible. 

Melasma is a weird one. We know that-

• It can spontaneously improve in the 50s or
• It can occur in the late 40/50s, especially in Asian females
• Pigment will get worse in pregnancy 
• Some forms are resistant to treatment, no matter what