I’ve devoted over a decade of my medical career towards treating melasma. Many patients approach this particular skin pigmentation completely wrong. I know how this skin condition, while seemingly superficial or “not a big deal”, can take a huge toll on the patient’s self-esteem or self-confidence at times.
One of the reasons I started this blog is to help those suffering from melasma and other pigmentary conditions to dispel their misconceptions, to get accurate information, and to seek the right medical opinion and treatments.
Melasma is an inherently tough skin pigmentation condition, often wrongly believed to be untreatable and unavoidable.
While melasma is a benign condition(1), I know from experience that it can cause emotional distress by adversely affecting the self-esteem and quality of life(1) for some patients. The story often builds up in the same disappointing manner. Many of my patients often tell me they’ve exhausted a myriad of costly and ineffective treatments before coming to see me.
I sincerely hope that by sharing the following stories of 3 patients suffering from tough melasma that it closes the gap between existing melasma patients and their knowledge of effective medical treatments.
Madam MR, 59 years old Malay lady, educator
|Patient had tried:
This patient’s 10-years CLASSIC struggle with melasma is one of the main reasons why I started this blog. By the time we met, she had already tried all sorts of non-medical treatments (as mentioned above) at over-the-counters and beauty salons, but to no avail. One of the treatments she had undergone was IPL, which she mistakenly thought was identical to the lasers used by aesthetic doctors!
Can you just imagine the resultant financial and emotional toll on her? She was obviously very dejected and told me her story whilst holding back tears. Mostly she was very mad at herself, and also very upset by the money she felt she had “wasted”.
Needless to say, she had used the wrong methods to treat her melasma! At first, she was understandably very sceptical about any treatment I had suggested. To reassure her, I started her on basic topical lighteners (e.g. hydroquinone), gentle laser treatments and encouraged her to apply sunscreen and practice sun protection, while reassuring her that she should see good results in 5-7 weeks’ time(2).
Sooner than I expected, in just a few weeks, she was already texting me excitedly that she had seen significant improvement. That newfound confidence, like renewed faith, was a catalyst that boosted her journey towards getting rid of her melasma.
Key Takeaways from This Case
1. Be careful NOT to confuse over-the-counter (OTC) products or oral supplements with medical creams for pigmentation.
Many OTC products, while useful for pigmentation prevention (e.g. sunscreen), are often not very effective when it comes to treating pigmentations. Whereas, medical-grade creams (e.g. hydroquinone(1)(2)) are proven scientific formulations with studies to back their effectiveness in dealing with pigmentation issues.
2. Understand the HUGE difference between “spa-grade lasers” and “medical-grade lasers”.
Under Singapore’s regulations, only certified doctors are qualified to operate medical-grade lasers. What some claims to be “laser treatments” can be just spa-grade Intense Pulsed Light (IPL), which are NOT the same lasers used by doctors in terms of their functionality and thus do not yield the same results for pigmentation treatments.
Madam CJ, 49 years old Chinese lady, office administrator
|Patient had tried:
Various laser treatments over a span of more than 1 year, which instead of helping, seemed to exacerbate her condition, causing her to develop skin redness and sensitivity (3).
She was also prescribed many bottles of skincare products which she had a hard time following through.
This patient’s condition was rather severe, so I was very keen to investigate her treatment history first. I learned that the patient was very (perhaps overly) enthusiastic in seeking out “new treatments” and very diligent in undergoing lasers that showcased the “newest technology”. In total, she had gone for 18 laser sessions, with her previous clinic. Each time, 2-3 different types of the “newest” lasers were used, including “picosecond lasers”, which were relatively new back then.
She had also endured these 18 laser sessions patiently over more than 1 year, and always hoping for some form of reasonable improvement that would be worth her wait, but it didn’t really happen unfortunately.
Having spent a lot of money on these high-tech treatments, coupled with the fact that the repeated exposure to unnecessary “strong lasers” had caused disconcerting skin sensitivity on top of her dark brown melasma patches, the patient was understandably very upset when we first met.
She was sure her condition was “beyond hope” and she even shared her heart-breaking experiences… “People had asked me why my face looks so ‘barbecued’” she said, a seemingly innocuous statement, but one that had visibly chipped away at her confidence tremendously. Again, it’s seeing such cases that really ignite a fire in me to tell their story.
My first thought was that her treatment regimen was overcomplicated, so I prescribed her a simple regimen of lightening creams and a basic sunscreen routine that was easier for her to abide to.
I studied her condition and concluded that just using conventional laser treatments with a long-standing history in the medical realm (e.g. Q-switched Nd:yag laser(1)(4)) would be enough to see some positive results. I also adjusted the laser settings without affecting the results, so that it wasn’t too harsh on the skin and didn’t have any downtime at all (eg redness, swelling, peeling).
Turns out, the patient had a way easier time with the topical regimen upkeep. She was also very thankful for the fact that she did not need to deal with pain or post laser redness or sensitivity, allowing her to continue all social activities of the day.
It took around 3 months, and her melasma has cleared up almost completely!
Key Takeaways from This Case
1. Just because a laser device is marketed as the “latest” or “newest”, it is DEFINITELY NOT an indication that it GUARANTEES results.
Please don’t get me wrong. Of course, I’m open to and excited with new technologies and believe that constant technological advancement is extremely important in the evolution of medical aesthetics treatments.
However, I still believe treatment fundamentals are ULTIMATELY essential to the outcome, for instance:
Only a doctor with the relevant clinical experience in treating melasma, and who has mastered that laser device (which may take years!) can fully address all these fundamentals and get optimal results.
Madam DC, 40 years old Filipino lady, healthcare worker.
|Patient had tried:
Repeated intensive lasers at close intervals (2 sessions per week).
After speaking to this patient, I then understood that her treatment history included repeated intensive lasers at close intervals. Just in the last 4 weeks alone, she had gone for lasers 2x per week; that’s 8 sessions in a month!
This patient had already undergone a series of intensive laser treatments at a clinic in Singapore, before seeing me. However, not only did her melasma worsen, what left an impression on me when I first met her, was the disturbing mosaic-like appearance of unsightly contrasting dark and white spots on her face. Upon closer examination of her face, she actually had darker patches of melasma associated with scattered confetti white spots (hypopigmentations) on her cheeks and forehead.
She noted very clearly that these strange white spots had developed only after she had done the series of intensive lasers. She had felt so embarrassed whenever she looked into the mirror while hoping they would just somehow disappear miraculously. Afraid that other people may mistake these white spots to be some contagious skin infections, she had to spend time camouflaging them with thick concealer and makeup every day.
I could totally empathise with what this patient was going through. I made her STOP ALL laser treatments immediately, then prescribed her a gentle lightening cream (with hydroquinone) to improve her melasma, and asked her to follow a basic skincare routine to heal her skin first.
In less than 2 months, her condition improved significantly! Today, the mosaic-look caused by the contrasting dark and white spots has reduced substantially and her skin has become clear and attractive once more.
She felt so liberated and thankful that she now can go out and face the world brimming with confidence, with just application of light makeup!
Key Takeaways from This Case
1. Avoid doing laser toning treatments too frequently (e.g. weekly sessions)(1)(5). Personally, I don’t ask my patients to undergo ‘strong’ laser or toning sessions on a weekly basis.
While medical lasers are recognized treatments for pigmentations, I would advise a certain degree of caution. Lasers can be a double-edged sword.
With the wrong power settings or scheduling laser intervals too closely, there is the very real possibility of causing complications such as post-inflammatory hyperpigmentation (PIH) or confetti hypopigmentations(1)(5) (which can last for years), like in this case.
Till now, doctors and scientists still have not decisively figured out all the factors that lead to melasma.
We do know that a complex interplay of factors can lead up to it, including age, female gender, genetic predisposition, vascular, hormonal changes and ultraviolet (UV) exposure from sun.
Thus, melasma is inherently a tough-to-handle skin pigmentary condition that can often be tenacious and may fluctuate and recur(1), especially so if you do not practice sun protection measures.
Furthermore from my experience, melasma treatment results can also be affected or even worsened due to other factors like:
You should not have to spend tens of thousands of dollars (SGD) like some of the melasma patients I have encountered.
In fact, these are some of the estimated treatment costs.
Generally from my experience, patients can expect to see results between 3 to 6 laser sessions averagely, and of course, the really severe cases may require more eg. 8 sessions(6).
Facial pigmentations like melasma are also considered skin diseases. So, the right way to deal with them is to seek medical treatment, from skincare medical professionals trained in this field.
For a condition that can have such a harsh effect on one’s social life and self-esteem, I see a personal duty as a skincare doctor to raise awareness on the availability of its treatments. I know that skin problem can greatly reduce someone’s quality of life. Any condition that affects a patient’s mental and emotional wellbeing should not be taken lightly.
No matter which treatment stage or severity you are in, if you have melasma and are FRUSTRATED in not getting the desired results, please DO NOT lose hope!
|1. Sun protection measures e.g. regular use of sunscreen(2) with (SPF 50, PA+++), avoid prolonged sun exposure.
2. Pick the RIGHT DOCTOR with the relevant clinical experience in treating melasma,
Singapore has great doctors for treating pigmentations like melasma but ensure you do your due diligence before committing to one.
Experienced doctors will be able to provide you with the right information, insights and bring you REAL results, so going to the RIGHT doctor can help you to save time and money, and to avoid disappointment when seeking melasma treatment in Singapore.
Dr. David Ng C H, in his 15 years of treating skin and other aesthetic conditions, has done over 30,000 aesthetic laser treatments for his patients.
He has a firm belief that a holistic approach towards treatments helps to achieve the best results for his patients. Apart from a deep interest in aesthetic medicine, Dr. David is a self-proclaimed foodie who travels the island with his family to satisfy his appetite with the delicious foods Singapore has to offer.
If you have any questions or need advice on melasma treatments, please feel free to contact me over WhatsApp @ +65 9822 2989, or call in @ +65 6222 2262, as I enjoy sharing my knowledge on skincare and medical aesthetics in general.
You can also email me at: email@example.com
Dr. David Ng C H
02. Krupa Shankar et al
Evidence-Based Treatment for Melasma: Expert Opinion and a Review
Dermatol Ther (Heidelb) December 2014, Volume 4, Issue 2, pp 165–186
03. Laser resurfacing
Mayo Foundation for Medical Education and Research.
Last accessed 9th April 2020.
06. Gokalp H, Akkaya AD, Oram Y
Long-term results in low-fluence 1064-nmQ-Switched Nd:YAG laser for melasma: is it effective?
J Cosmet Dermatol. 2016 Dec; 15(4): 420–426.
A Note to Readers: Dr. David Ng C. H. is proud to be the original author of this article, which was first published on 12th May 2018. Content is distilled from more than 15 years of his clinical experience in pigmentation treatments in Singapore. This current article is an updated version by Dr David Ng […]Read More
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