Has anyone out there had Fraxel to treat melasma, and if so, how did your melasma react in the immediate weeks after your treatment? I
know it always leaves your face red for a few days, but did it make you dark spots fade immediately, or did they darken and then peel off, like with IPL?
I had the Palomar Fraxel 1540 for the first time over 2 weeks ago to treat melasma, and my face is more hyperpigmented than before. I stay out of the sun and have been using 4% hydroquonine. My skin color is not naturally dark or olive. The woman who treated me said to give it more time, that the Fraxel brings the pigment up and it sloughs off, but my face is not getting any better.
Yvonne
Submitted by Yvonne on August 19, 2007 - 7:35pm. Viewed 7862 times
9/16/07
I had 4 fraxel treatments for melasma spaced 1 month apart. It has been 7 weeks since my last fraxel treatment and I have been left with more pigment spreading around the original area and extensive hyperpigmentation around other areas. The person treating me says to wait afew more months and it should lighten. I do not see how this can possibly happen as the original pigment hasn't gotten better since my initial treatment over 5 months ago so how can he suggest that the hyperpigmentation will automatically go away on its own.
9/26/07
I am sorry to say that the Fraxel left me totally hyperpigmented and it has been a year now and it is still there. I don't think fraxel should be done on olive skin that suffers from Melasma. I don't think sufficient studies were done on melasma sufferers with type IV or V skin given all the horrible scenarios that I have heard of through other sites.
10/2/07
Melasma is hands down the trickiest skin condition to treat, because everyone reacts to treatments differently. I have very fair skin and have suffered from melasma for years. You cannot cure it, but you can control it. Here's my best advice: don't do things to aggravate your skin. That stress only causes more melanin production. Use both sunscreen and a meleanase inhibitor all the time, stay OUT of the sun, and wear a wide-brimmed hat when you are outdoors, and exfoliate regularly and gently without aggressive scrubs. Know that what works for one person may not work for another, who has the same skin tone and condition. If you are taking oral contraceptives, talk to your doctor about switching to very low dose or progesterone only pills, if that is safe and appropriate for you.
Fraxel and IPL work for pigment, but again, with melasma everyone reacts differently and there is no guaranteeing results.
From the comments above, I hope it was a doctor who recommended the treatment, albeit maybe a nurse or PA administering it.
3/10/08
Thanks for the info! I have had melasma for about two years and I feel that nothing is really working so far. Today I started to notice another spot cropping up on my upper lip! I hate it and feel that it is so obvious. I do not know of anyone else personally that has it. What is a meleanase inhibitor? After reading the reviews on the fraxel laser I am not that impressed! Thanks, jenilee
3/11/08
I have olive complexion and have mild break outs, which result in hyperpigmentation. I had an IPL treatment for my hyperpigmentation. It not only burned my skin, it left me with hypersensitive skin in the areas with the most hyperpigmentation, and worse hyperpigmentation than before the treatment. IPL is just another way for people to make money.
3/13/08
I have had 3 Fraxel laser treatment for melasma. I am 32 and hispanic/irish mix. I have a light olive skin tone. I am so dissapointed with the results. I actually have new brown patches I didn't have before treatment. Some of my old patches faded a tiny bit but they are all still there! Now I am super sensative to sunscreen and I breakout with an itchy/red/bumpy rash when I use it. I am so frustrated. I am going in tomorrow to talk to the derm about what is going on with my face. My entire face is darker than the rest of my body now and I still have all the brown patches! I also got some hard rock pimples that have left hyperpigmentaion spots. Fraxel didn't do what I was promised. It actually is making it worse. I do not reccomend it. I have spent over $3000 and have nothing but a dark face, new dark spots/patches and a sunscreen sensitivity to show for it. It's been 3 weeks since my 3rd treatment. I am suppossed to have a 4th on the 28th. I am thinking about canceling it and saving the $1000. I keep thinking maybe the next one will be the one to get rid of the spots. I think they count on that.
3/15/08
I have had three Fraxel treatments and am quite disappointed. My face is two shades darker (kind of an irritated redish looking color) and all of my freckles are still present. I was trying Fraxel for lines under my eyes and for freckles or hyperpigmentation, whatever you want to call it. I am very pale and always wear sunscreen. Now, and especially in photos, my face just looks irritated. I am scheduled for a fourth treatment, and I too, wonder if it will be the one miracle treatment that will finally show the results, or if it will be more of the same, a very red irritated looking face. I am very, very disappointed to date.
3/17/08
I have had melasma for years as well and like you, I feel frustrated and that it is very noticeable. I have been having IPL treatments which I suppose have made a very subtle change. It's hard to keep returning for treatments because they are $500, not covered by insurance and changes are so minimal. I was considering the fraxel as well but I don't know if it is worth it either because it seems that it can further aggrevate the melasma. Anyway, I am sorry you have the melasma, I completely understand how much you hate it and how frustrating it is trying to manage it. Good luck witn your treatments.
3/18/08
I have melasma brought on by scrubbing my face while using prescription retin a. Then as I have every summer for the last 15 years I hit the tanning beds and there it was, brown leather splotches. A plastic surgeon who did two great cosmetic surgeries on me suggested chemical peels. The 30 percent left me with brown lines above my upper lip, as well as doing nothing for the melasma. I am medium skin. I then discovered ipl and hydroquinone by skinerase 4percent. After one ipl treatment I had black brown scabs for one week, and then they sloughed off. You can still see where the blotches were because they are slightly red, and it didn't get rid of the chemical peel scar, but what a great result it was, goodbye leather. I also use a 30 percent block with titanium under my makeup. I get lasered 2-3 times a year and it seems to help somewhat with the pours and fine lines. My ipl only cost 300 for full face, I am in KY. I was thinking of fraxel but not after reading these posts! I wish I had read about retin a and chemical peels so I wouldn't be in this mess, but thank you all for saving me the money and heartache of fraxel.
I would be happy to recommend the lady who does my ipl. She has been telling me to forget about fraxel, and does a great job. She really cares - Janie at Dr.{EDITED} office (lexington, ky). He's a dermatologist. Still not sure what to do about the stupid discoloration above my lip!
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3/18/08
I had 6 IPL treatments for melasma and rosacea 4 months ago.I tried Retin-A and meleanase inhibitor with no results. I have fair complexion. Great results for melasma, it desappeared after the first tratment, not so satisfied for rosacea.
3/29/08
I have had three IPL treatments on my face and chest area for melasma and sun spots. I am thrilled with the results on my chest but my face is so much worse. I now have pigmentation problems where I never had them before. Now I don't know what to do.
3/30/08
In order to treat melasma with the Fraxel, you must be very careful and very skilled. We have had great success with melasma, but we have had to go through a learning curve. Hydroquinone and Retin A can irritate the skin and worsen the pigment problem (PIH). Treating too strongly with the Fraxel can also worsen the problem by causing Post Inflammatory Hyperpigmentation (PIH).
Patients must be premedicated with Retin A and Hydroquinone for 6 weeks prior to the first Fraxel. These meds must be started very carefully so they don't cause irritation (don't apply often (start every other day or less) and don't leave on for very long (don't leave on over night)).
The Fraxel must be set properly. The energy level must be set low at 6 - 10 j/cm2 (I prefer 6 j/cm2) so that it does not go too deep and so that it "carpets" the epidermis and upper dermis more completely. You also have to do treament levels of 3-5 (no more than 15% of the skin at a time). This is especially important in patients with darker skin types (asians, hispanics, african-americans).
If you have been hyperpigmented, it will go away eventually. The MedLiteC6 1064 Laser can help break up the pigment. We would treat hyperpigmentation with Hydroquinone, Retin A and a topical steroid.
Good luck.
3/31/08
I have had this problem for several years. It started after taking a "low dose" ocp. I had 1 photofacial thinking it would solve the problem but only brought out more pigment. I then found a medical aesthetician who recommended a series of IPL and vitalize peels. The IPL has still after 4 additional treatements brought up more pigment. I probably won't have another one but the vitalize peels did seems to help and aren't too expensive, only 95 bucks. Basicallly I've decided that I just have to live with the problem and use makeup to cover. Aveda makes a great tinted moisturizer that helps blend my "mask" into the rest of my face and then I use mineral powder over that. Thanks for the feedback on "fraxel" treatments. I thought IPL was going to be a "miracle" treatment for my melasma but after thousands of dollars and new pigmented areas I've resigned myself to just use sunscreen/hats and makeup as it's too expensive to experiment with procedures that just aren't what they promise to be. At least for my mixed skin (hispanic, german, native american, scottish)
4/2/08
Cari, in response to your IPL I would strongly advise you, based on my own experience, to not have any further IPL treatments.
I went through 5 IPL treatments myself, all the while believing I just had sun spots. By the 5th treatment my face was far worse than when I started out. I went to a new dermatologist for second opinion and she said I had melasma and IPL was NOT for melasma; it only aggravates it.
I've been investigating herbal remedies lately. I figure instead of treating the symptoms at the enormous expense they are, I should be focusing on the causes instead. I've gone off the birth control pill and just started a regimen of MSM, Vitamin C, Zinc & Vitamin B.
...we'll see how it goes.
4/9/08
To all of you who are thinking about having the fraxel laser done--don't do it!! In fact, really do your research prior to having any kind of laser. Think about it--any type of laser is burning of the skin in the deepest layers. So, you are always at risk of long term damage to the skin. I had a series of four fraxel treatments (10/06, 11/06, 12/06 and 1/07)for treatment of melasma and acne scars. Following my last treatment in January of last year, I developed post hyperpigmentation in in the middle of March 2007. It got worse and worse as the summer months approached. I was told that it would fade, but it hadn't faded. So, I turned to my dermatologist (my doctor didn't perform the laser; I had it done by a laser skin care center). She prescribed me Triluma. I began using the Triluma at the end of February. It worked after about 3 weeks. I could see a significant change in the darkening of my skin. It was lightening up quite a bit. However, after about four weeks of using Triluma, I developed tiny little blood vessels (telangiectasia) all over the affected areas. Now, in the last two weeks, my skin is getting darker (because of the weather changing and the sun coming out). I so regret doing anything to my skin--laser, steroid creams, etc. If you want my advice on skin care lines/treatment--I would recommend Skin Therapy by Dermaquest. It is a great line. I was using the C-lipoic antioxidant serum for awhile over the winter and it was fading my hyperpigmentation (naturally). I will never again have any type of laser done b/c now my skin is permanently damaged. Feel free to e-mail me with any questions. I would be happy to help!!
4/9/08
Dear Dr. Epstein,
I had a series of fraxel treatments done 10/06, 11/06, 12/06 and 1/07. I had the fraxel done because I wanted to smooth out my acne scars and I had a tiny patch of pregnancy mask above by left eyebrow that I wanted to eliminate. Well, on March 17, 2007 (about 13 months ago and 5 months after the treatment), I developed post hyperpigmentation. I went back into the skin care center and inquired about my patches. They didn't understand why I developed this. They said that they had never seen that before. They were no help at all. As the summer months came and went, my hyperpigmentation didn't get any better. Finally, I saw my doctor in January 2008 for an unrelated issue and she recommended Triluma. I began using the Triluma at the end of February 2008(I was very hesitant b/c of the side effects). After about three weeks of using this cream, my hyperpigmentation faded about 70%. It was amazing. However, I developed tiny littly blood vessels (aka telangiectasia). I was told to stop using the Triluma cream. My skin also became very dark in the last two weeks (when I stopped using it). Now, I'm so confused and don't know what to do. My skin looked so much better before I had the fraxel done. Now, I'm stuck with these red lines on my face and brown patches everywhere. I'm worse now than prior to having the fraxel done. So, Dr. Epstein, can you please answer the following questions?:
1. Will the post hyperpigmentation from the laser go away completely (per your e-mail--'it will fade eventually')? Not related to the cream.
2. Will the adverse side effect of dark skin patches from using the Triluma fade too or is that permanent damage from using the cream?
3. I'm pretty sure that the exposed blood vessels at the surface of my skin will not go away unless I have them removed via laser, which will never happen. I won't do that again. Any suggestions on those?
Thank you for your time Dr. Epstein!!!
4/9/08
I am a Latina and have olive skin. I had 5 fraxel treatments for melasma. I had light spots on my cheeks. Post fraxel 5 months later, I have full blown mylasma! This is awful! My skin has never been so discolored!
Thousands of dollars later, I wear sunscreen SPF 30, wear hats, stay out of the sun, but it's awful!
My husband always reminds me that sometimes the solution is worse than the problem. This definitely is one of those times.
I scheduled a follow-up visit with the doctor that performed the fraxel on Monday. I will keep you posted..
4/9/08
Heather,
The tiny blood vessels were probably caused by the steroid in the Triluma. Don’t use any more steroids on your face and see if the blood vessels resolve (hopefully they will – no guarantees). If they don’t go away, you may need laser treatments to resolve this issue. Make sure you see someone who is very experienced in cosmetic skin care and laser vein treatments.
Triluma contains Hydroquinone and RetinA (in addition to the steroid). Both can irritate the skin and cause more postinflammatory hyperpigmentation. A more gentle remedy for the hyperpigmentation is Vit C derivatives (5-10%). You may want to try something like this. Use the most gentle strength and don’t use it often or leave it on very long. Work you way up very slowly. Other possible remedies would be tranexamic acid and chemical peels. These are well known treatments for hyperpigmentation and melasma in Japan.
The postinflammatory hyerpigmentation usually fades. It usually fades sooner than 13 months. Maybe you have something other than postinflammatory hyperpigmention (ie. worsening of your melasma or something else???). . If you tell me what city you live near, I might be able to recommend a doctor near you who is an expert in cosmetic skin care. It is best to see someone, get a firm diagnosis of your problem and then get possible remedies. You would want to see a dermatologist who uses lasers and does cosmetic procedures. This type of dermatologist would know the most about hyperpigmentation problems following the Fraxel.
I hope this helps. Good luck.
4/18/08
I was the original poster to this thread and after watching it for a couple of months, forgot about it until someone from realself.com recently contacted me. It's been 8 months since that one fraxel treatment. The melasma or post inflamatory hyperpigmentation did eventually fade a little bit. The fraxel left me with the strangest pattern of pigmentation, like someone dripped candlewax on my face, leaving dots around my mouth and between my cheek and jaw bones. My skin is neither olive nor fair but tans easily and has responded very well to IPL in the past. In the last couple of years since beginning IPL and bleaching creams, I wear a hat not only TO the car but IN the car as well, so this was not post-treatment UVA damage. Also, I am menopausal and not on hormones, so birth control was not an issue. After the fraxel damage, the dermatologist recommended hydroquinone and other products; I can't remember them all. You name it, I've used it. I'll spare you the details and say that I recently figured out that I was "over-exfoliating" by always using a sponge, cloth or brush to wash my face, and even though I use a mild cleaner (important), these made the problem worse. All these products - hydroquinone, retinoids, and the like - gave me some kind of (can't remember the name) dermatitis around my nose and mouth,inflamed mmy face and pimentation, and the triluma, which doea work THE BEST for lightening my skin, did leave tiny red veins around my nose that need to be lasered off. My derma has been giving me free IPL to try and fix the spots, and the IPL has helped, I think. Her handpiece and her machine were old and she had them replaced, and I can tell it is stronger because it hurts more. The first couple of times, the IPL felt mild and didn't do anything. Now it hurts and gets brown spots that peel off. I use a good, grossly overpriced moisterizer called elixis(I think?) after washing and sometimes use the triluma. I'm trying not to stress my skin with all these "miracle" products I've invested in, but it's hard not to. I feel like a skincare junkie. While the damage may fade, I can still see the strange droplet pattern from the fraxel laser. Anyone who does this should get one of those skin xrays taken before they do it, like a picture that shows sun damage under a black light, so if you have a problem later, you'll have something to compare it to. I do think the fraxel improved the texture of my skin after I did it, but that lasted a very short time and was no bonus compared to the color damage it did to my complexion. Would love to hear if anyone else has found anything helpful on the road to fraxel recovery. - Yvonne
4/19/08
Dr. Epstein,
I had IPL around the first week of February. I had no burns or anything but I developed hyperpigmentation on my right cheek, which is tan but looks dark in certain lightings. I think it may be 3 shades darker than my skin tone. I am currently using cosmelan 2, which as kojic, phytic, and L-ascorbic. I only used it for 2 weeks and stopped, because I wasn't sure if it was working as I did not see any improvement after 2 weeks and I wanted it to fade on its on. Well, its been three months now, and it is still there - not darker or lighter. Will kojic, phytic and L ascorbic help it fade? I did not have a problem with it except for some exfoliation from the phytic, I believe. Also, I am currently using Obagi 35 sunblock with zinc oxide 9%. I am afraid of using HQ due to rebound darkening. If not, what would you recommend?
Also, you mentioned that PIH usually fades eventually? How is that possible without bleaching it?
4/20/08
My melasma which is pretty much a splat on my forehead causes me so much worry and frustration basically since it appeared 7 years ago. Mine was caused by getting sunburnt while on antibiotics (for a flu!). I have spent so much money on creams, peels and micro dermabrasion that it would make me sick to think how much. I looked into getting fraxel but won't waste anymore money after reading this link. I've yet to use a laser on my skin as I feel it is too drastic and until there is a proven safe way to eliminate melasma I am going to keeping looking after my skin and try to stop thinking of my splat as the worse thing in the world. No more burning, sanding, peeling as logically it dosen't make sense that these extreme methods should lead to beautiful healthy skin..........maybe it's just a way for people to make $$$ off other peoples problems.
4/26/08
Some great questions about hyperpigmentation and melasma.
First let me say that PIH (postinflammatory hyperpigmentation) and melasma are sometimes very difficult conditions to manage and treat. They can act unpredictably and can be resistant to treatment.
I want to make a few general comments which will answer most of the questions and then I will make specific comments about the specific questions. This is long and technical, but we are delving into a complex area where the science is not completely understood by even the most experienced experts.
1. The treatment for PIH can cause additional PIH if the products are not used correctly. Hydroquinone and RetinA can cause redness and irritation of the skin which makes PIH worse. When you use Hydroquinone and RetinA, if it irritates your skin, use it less often, leave it on for only a few hours rather than overnight and use a weaker strength. This is especially true for darker skin types. “Over-Exfoliating” can make matters worse.
2. Fraxel can sometimes make pigmentation and melasma worse. If it makes your skin worse, Fraxel may not be a good treatment for you. We are also finding that some individuals need very gentle treatment parameters. For example a treatment level of 4 or less and an energy level of 40 – 45 j/cm2 maximum. If Fraxel makes your condition worse you can try Hydroquinone, RetinA and Hydrocortisone to help the PIH. Other possible treatments include microdermabrasions (lightly without causing too much redness or irritation) and Interse Pulsed Light (make sure the wavelength in longer - 600 nm or greater – especially if you have a darker skin type).
3. In our experience, Cosmelan is an excellent treatment for melasma.
4. Hydroquinone can cause darkening if it irritates your skin. Anything that irritates the skin can cause PIH. This is expecially true in darker skin types.
5. Bleaching agents include: Hydroquinone, RetinA, Hydrocortisone, Kojic Acid 1%, Azelaic Acid 20%, Albutin and Licorice Extract. These agents effect the activity of melanocytes and melanin production. Some agents also have exfoliating components.
6. PIH fades over time. Bleaching agents help it fade more quickly. This happens because the production and degradation of melanocytes and melanin is a dynamic process. If the degradation is greater than the production, things fade. If the production is greater than the degradation, things get darker. The key is to effect this balance in a positive way. Sunlight effects the process in a negative way while bleaching agents effect the process in a positive way.
7. Pigment sometimes responds well to IPL and sometimes IPL makes the pigment worse. If you are Asian and you use an IPL with a cut off filter greater than 600 nm, your pigment will probably get better IF it is epidermal. If the pigment is dermal, it may not get better or it may get worse. This is why your provider has to be experienced and knowledgeable. Caucasians, Asians, African-Americans, Indians and Latins all act and react differently to different treatments and different light devices. This is a rapidly evolving area in cosmetic dermatology. It is also a very challenging area.
8. Steroids can cause telangectasias (small red veins on the face and nose) if the strength of the steroid is too strong or it is used for a long period of time. The telangectasias usually fade over time when the steroid is stopped.
9. We have found that the Q-Switched Laser (1064 nm) can help fade PIH when treatments are done gently (2-3 j/cm2) and frequently (every 2 weeks).
10. The tiny whiteheads after the Fraxel are either milia or acne pustules. These will go away within a week or two. If they are acne pustules, you may want to premedicate with an oral or topical antibiotics prior to your next treatment.
I know these answers are long and technical, but I think understanding your condition will make it less frustrating for you. Make sure you have an experienced provider who understands postinflammatory hyperpigmentation, melasma, the bleaching agents and also understands “skin of color” (African-American, Asian, Indian, Latin). Make sure you are not making matters worse by using too much bleaching cream, getting too much sun or by getting treatments that cause redness and irritation of your skin.
5/3/08
I've had IPL for melasma that I got from taking birth control pills for 10+ years. Needless to say I've stopped using all hormonal methods of birth control. I am fair skinned but have very dark hair and brown eyes. IPL worked great. They had to use the machine on the highest setting, my melasma did darken significantly for two weeks but over that time slowly flaked off and my skin looked really good. My bigger patches of pigmentation weren't gone but they were faded significantly. Then as time goes by they slowly come back and I'll go in for another IPL 2-3 times a year for touch ups. My doc was straight up and said melasma is difficult to treat and IPL wasn't a "cure". I use the fading creams in between treatments, sunscreens, hats and all that too.
I figure until fraxel is figured out, I'll settle with my results from occasional IPL, fading creams, and makeup.
5/4/08
So would you recommend Cosmelan 1? I have melasma on forehead and slightly on my cheek and I want to try it but will it come back worse or in a different area?
5/4/08
In my experience, Cosmelan is one of the best treatments for melasma. It should not come back worse or in different areas, but melasma is a chronic recurrent condition that could easily come back with sun exposure or any other precipitating event. The goal of melasma treatment is to reduce it to a minimal amount and then keep it minimal by sun avoidance and periodic maintenance treatments.
5/17/08
Dr. Epstein,
Is the cosmelan treatment effective in getting rid of PIH post IPL as well? Do you perform this in your office? What is your address and phone#?
I heard that the mask and the home treatment has to be done together or usually results are not consistent. Please advise. I am desperate to get rid of this. Or does it only work for melasma?
5/29/08
Thanks for all of the comments here.
I'm new to Melasma (received after stress in November last year)
I normally live in Thailand, (so some sun hasn't helped) and am on holiday in France for the last 6 months.
It has started to fade a bit, I am European with yellow based skin and dark hair.
But I though I would see a dermatologist here in france, he suggested that I have just had a light chemical peel just on my cheeks and upper lip.
Well I did and am still a bit pink after two weeks. I went to see my dermo again and he said relax it will be ok.
He has also given me cream with the following in;
hydroquinone pc = 1g
hydrocortisone base pc = 0,2g
acide retinoique pc = 0,005g
excipial hydroquin = 20g
I have applied it twice in the areas, but it makes my face itch.
I have stopped for now and am using Vitamin C, Zinc & MSM.
Can you advise, (if you can) I don't know if to continue to use the cream.
I go back to Thailand in a few days, I will wear sunscreen spf50.
5/30/08
I am 29 years old and have been suffering from Melasa for almost 5 yrs. This is the worst year so far. I have spots above my lip, under both eyes, on my forehead, and my temple. I have TRIED everything from Retina-A, hydroquinone , vitamin supplements that I have been told I might be deficient in Vitamin C and other vitamins. I had been on the pill but stopped taking it in January and my melasma continues to get worse. I cry all the time now and my boyfriend is so fed up with me. I won't go outside and I LOVE THE BEACH and the Sun. I just don't know what to do. I am olive skin and oily. I have been using Proactiv for a few years? Could that be a cause? I have been cosidering laser treatment but after reading these blogs I am scared. I hate the way I look and I hate wearing makeup. I feel so insecure and just don't know what else to do. Someone please help me.......
5/30/08
Hi MLH,
Find a good dermatologist in your area to help you. Melasma can be very difficult. The best treatments are Cosmelan (the old formulation) and Fraxel. Any treatment can make things worse so your provider must be very experienced. Sun avoidance, getting off birth control pills and using topical treatments can be very helpful. Chemical peels and IPL can sometimes help but only if the melasma is in the epidermis and not in the dermis. Melasma is a chronic recurrent condition so it will come back. You should try to minimize it and then keep it minimized for as long as possible. MLH, you really need to find a physician in your area who can help you with your melasma problem. Google Melasma and find out as much as you can about it to make sure you aren't doing anything to make it worse and then pick a treament that can help. Your situation is so severe that Cosmelan and Fraxel would be reasonable treatment to try.
6/4/08
To MLH,
Don't use Fraxel, IPL, or any type of laser for melasma. Results are so unpredictable. Your best bet is the old cosmelan mask and maintenance cream. Don't do the new formula,as it is useless. Go the the mesoestetic website and you get a listing of physicians in your area who carry the old formula. Some doctors still carry them. I found 3 in my area. Most don't because they are contracted with the distributor in the US. Some physicians still have contracts with Mesoestetic in Spain, so they can get a hold of the OLD formula. When you call the docs, ask if they have the original OLD formula or the current New one. Some of the docs. I called lies. Remember, he OLD formula will cause excessive peeling and redness for 2 weeks and is left on the face for 8 hours at least for olive skin. My friend had hers for 10 and she is hispanic. Her melasma was pretty bad. I am having mine done this Friday in LA.
Don't believe docs and medspas who states that the OLD formula is no longer being made. IT IS! Most of the clinics do not get them unless they are contracted with Mesoestetic in Spain.
Cosmelan works great. Cost is $850 and it comes with a maintenance cream (cosmelan 2) to maintain result. Although, some claims they have results with just the C2, it did not work for most. You have to do the mask.
Take care and good luck! Cosmelan is the BEST treatment for melasma.
6/5/08
Hi Doctor Epstein,
I had my first Fraxel treatment 6 days ago. I found the pain level to be pretty mild - only red for a day - no peeling at all. It seems as though my skin texture has slightly improved and the melasma has lightened just a tiny bit. I was wondering if it is bad that I never experienced any peeling? Could it be that the first treatment was not strong enough? I was told the melasma should be completely gone after 3 treatments - is that possible when i only see slight results at this point?
I'm scheduled to have the second treatment in 3 weeks (spaced 4 weeks apart). Will my skin continue to improve between now and then? Is it possible that the melasma will fade even more before the next treatment?
Your advice would be appreciated.
Al
6/7/08
Yes, I had Fraxel yesterday and did not experience the typical redness. My face hasdeveloped brown speckles throughout and feels like sandpaper. I am hoping that this will change in the near future as this is much worse than what I had before. My wrinkles, however, do seem decreased.
How did your treatment turn out after the 3 month waiting period?
6/9/08
i only had the first fraxel treatment a week and a half ago. the melasma seems to be a tad lighter but is still there. i was told it would take 3 treatments to completely fade. i never peeled - and the redness went away in a day or two. the texture of my skin seems to have improved slightly. i am schedule for the second treatment in about 3 weeks. i'll keep you posted.
6/12/08
Hi,
How did it go?
I've found a phisician online which has his practice in santa monica and charges $1000. I'm not sure he uses the old formula.
I've just visited the mesoestetic website but I can't find the list of phisicians. Can you give me your phisician contact details?
Many thanks
Francesca
6/13/08
Why would one spend $1000. when a $60. tube of retin-a used correctly can get better results. I don't understand why everyone is jumping on the lazer band wagon. It's a scam and a half!
6/22/08
I also had post inflammatory hyperpigmentation after Fraxel. It has been almost 2 years and my skin is still dark brown (and white around the eyes, where fraxel was not applied). It looks terrible. I do not recommend Fraxel at all!!!!!
6/27/08
Hi Dr. Epstein,
Thank you so much for your comments about the hyperpigmentation. I too have had 5 treatments of fraxel (about 5 weeks apart) at a level of, I think 17. I had the fraxel done on my face for acne scars and sunspots or hormonal spots. It helped the acne spots somewhat, but not really helped the little brown dots on my face (that I think is from sun or hormonal). I also had the fraxel done on spots on my back that were originally burned from Fotofacial that was done too close together when I was alittle tan. I also had a curling iron burn on my leg that I had treated with Fraxel. The fraxel has helped lighten the burns alot overall, but with this last treatment (about 3 weeks ago), I feel that I have more hyperpigmentation covering the whole burn and the surrounding area treated, so it looks bigger now! I have been using hydroquinone/kojic acid cream (10%/5%) and have worked up to this amount starting at 4%, then 6%, then 8% and now 10%. It helps alittle, but I am worried about it staying hyperpigmented like this, esp. the areas that were treated with Fraxel that weren't hyperpigmented before. Any suggestions? Also, if the Fraxel did not really help these little brown spots/dots on my face (mainly on my cheeks), is it sunspots or hormonal? Finally, I live in West Los Angeles, CA and would love to know of a very experienced dermatologist in my area to help me repair. My email is: {edited contact information} Thank you.
Banafshe
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7/3/08
Sera, do you honestly believe spending thousands on lasers is everone's first choice? Retin A, prescription strength, would never get to dermal melasma, and would only mildly at best help mixed epidermal/dermal melasma.
Retin A with sunscreen could never combat dermal melasma that is aggravated/brought on by stress, hormones, heat and sun.
There wouldn't be such a long thread of posts if $60.00, sunscreen, and a little time could make this condition tolerable enough to live with.
Going for fraxel on my mustache in the fall, am totally sick of having it for years, and yes I use Retin-a with 4% hydro and obagi sunblock.
side note - IPL's have done a great job on my epidermal melasma, I am fair with dark hair/eyes and I burn then tan easily. I tanned all my life until this cropped up. But IPL will not get to my dermis. I will post my results from the Fraxel, whether good, bad, or nothing, in hopes that it will help someone. Also, I have used kinerase/obagi hydro 4% and never had any rebound darkening or problems. I hated Jan Marini Kojic acid, it made me so red.
7/4/08
I had also three fraxel treatments for acne scars last winter. Now my skin is getting darker. Espesially above my eyes I have brown lines where the laser has gone. You said the C-lipoic antioxidant serum worked for you and it faded your hyperpigmentation. How long did you used it? Was you face as white as it was before the treatments? Do you use any sunscreens now in the summer? Are you still using C-lipoic antioxidant serum?
This is awful! I wonder if anyone have had this before us and could tell will the hyperpigmentation ever go away? Can we ever be able to be outside without sunscreen and been afraid? I wish we will some day have our beautiful faces again!
7/5/08
Dear. Anna33,
Hi, I think you got me mixed up with someone else, I have melasma not acne scars. I am freaked now though because I am scheduling Fraxel tomorrow!!!!!
I have been on the Obagi system for 1 month minus the Exofoderm (the acid stuff that makes you red and peel like crazy) and .25 retin a. I have been on 4% hydroquinone by kinerase before that for about a year w/no problems other than having to pay for it.
I use sunblock (OBagi or Skinceuticals) everyday regardless of the weather under my makeup. The trick is to get it where it is not greasy looking.
I do have a sample bottle of skinceuticals prevent which is vit.c and is supposed to help you while outside, but I haven't been using it so I don't know.
The Obagi is supposed to keep me from hyperpigmentation from the Fraxel, it darn well better.
I have two brown lines over my upper lip from a chemical peel done 2.5 years ago, and it is such a pain. It did go away, but then came back.
I have heard from two docs that vit.c is great, and unfortunately my lifestyle has changed from being outside all the time to being inside most of the time. I am always scared of being outside, and I sit in the shade, wear sunscreen, and a hat. Having Melasma is probably different than what happened with you, but I know you need to wear a good sunblock when outside with post inflammation hyperpigmentation, and try to avoid the summer sun from 10am to 4pm. And baseball hats are cute, even Louis Vuitton makes one.
Please wear sunblock, and I wish I could be of more help. Have you tried Obagi? (minus the Exfoderm, yuck!)
Can I ask you if you used anything to prep your skin before your fraxel? I am getting scared...
Did your entire face get darker after treatment 3, or was it right after one or two?
9/22/08
I had 6 fraxel treatments one month apart for melasma. Not only do I still have the dark spots, now I have small whitespots in the dark spots. After each treatment, for days I would had red spots which would sometimes scab, those left bright white spots. It looks worse than before I started. My treatment was supposed to be eight treatments long, but I did not go back for the last two treatments. I do not recommend this for melasma at all.
I was also told that the spots would completely go away and not come back before I started. I was very disappointed!