Melasma is a chronic condition, not just dark patches
Melasma shows up as brown to grey-brown patches on the cheeks, forehead, and upper lip, and it behaves differently from sun spots or freckles. It is driven by hormones, UV, and heat, which is why it flares in the Singapore sun and after pregnancy or the contraceptive pill. Evidence-based reviews describe it as an acquired, chronic pigmentary disorder that tends to recur. The honest goal is long-term control, not a one-off removal.
Why the wrong melasma treatment can make it worse
This is the part most clinics skip. In Asian and darker skin, lasers are second-line to topical creams because of variable response and a real risk of complications. Aggressive, high-energy settings can sensitise the pigment cells and trigger rebound darkening, sometimes worse than where you started. Patients tell us they spent thousands on a course elsewhere and watched their melasma deepen. The research is clear that the answer is low fluence and restraint, not a stronger laser.
What melasma treatment should start with, per the evidence
Reviews consistently put topical treatment and strict sun protection ahead of any device. For melasma that keeps returning, oral tranexamic acid is a well-supported addition: a meta-analysis of randomised trials found it meaningfully reduces melasma severity with a strong safety record, and in Asian skin even low doses over eight to twelve weeks help. Dr Samantha builds this foundation before considering a laser.
When laser treatment is right for melasma, gentle beats aggressive
Used carefully, low-fluence picosecond laser has been shown to be effective with a low complication rate in Asian skin, but it responds better to a paced, maintained approach than to one aggressive course. At Nexus this is the gentle Pico Glow toning on our Pico laser, chosen by depth rather than by power.
How Dr Samantha approaches melasma treatment at Nexus
She maps your pigment under a Wood's lamp first, to read whether it is epidermal, dermal, or mixed, and calms an active flare before any laser. When a laser is appropriate she keeps it gentle, paced, and maintained. If a past treatment went wrong, bring photos. The fix is almost never a stronger laser, it is the right protocol at the right depth. When laser is the right call, she tackles it with Pico laser treatment, matched to your pigment depth.
