Melasma Treatment

Melasma cannot be permanently cured. It is a chronic condition driven by hormones and UV exposure. It can be effectively managed and significantly improved with the right treatment protocol and consistent sun protection. Most patients see good ongoing control with maintenance treatment.

For melasma, the most suitable energy-based option is often not a traditional laser at all. It is Sylfirm X, a dual-wave RF microneedling platform used in pulsed-wave mode, which targets the vascular and melanin components at a controlled depth without the surface heat spike that can destabilise pigment cells. Aggressive ablative or Q-switched lasers can worsen melasma by triggering post-inflammatory hyperpigmentation, especially in Fitzpatrick III to VI skin. At VRA, Sylfirm X is the primary energy modality, and the Fotona laser is reserved for select cases at conservative low-fluence settings.

High-energy laser treatments can worsen melasma by triggering post-inflammatory hyperpigmentation, especially in darker skin types. Sylfirm X PW mode is designed to address melasma safely by targeting the vascular and melanin components without triggering this response.

Melasma treatment is a layered, long-term protocol. At VRA it combines three components: Sylfirm X RF microneedling in pulsed-wave mode as the primary energy device, medical-grade brightening chemical peels layered between sessions to accelerate surface fading, and prescription or medical-grade topicals (hydroquinone, tretinoin, cysteamine, tranexamic acid) to suppress melanin production between visits. A typical course is 3 to 6 sessions spaced 4 to 6 weeks apart over 3 to 6 months, built around your pigmentation depth, hormonal triggers, and skin type.

There is no single cream that resolves melasma on its own. The most effective topical regimens combine multiple actives that suppress melanin production through different pathways. Common prescription and medical-grade ingredients include hydroquinone (used in 4% prescription strength), tretinoin, azelaic acid, cysteamine, tranexamic acid, and kojic acid. Your practitioner assesses your pigmentation depth, sensitivity, and history to prescribe or recommend a specific stack. Topicals work best alongside in-clinic Sylfirm X RF microneedling sessions, medical-grade chemical peels, and daily SPF50+.

Yes, oestrogen-based contraceptives and HRT are common triggers for melasma. Stopping hormonal contraception or HRT can help treatment be more effective, though this is a personal medical decision. We discuss it sensitively at your consultation.

Yes, melasma is highly recurrent without ongoing sun protection and maintenance treatment. SPF50+ every day, rain or shine, is the single most important factor in preventing recurrence. We provide a maintenance protocol at every treatment session.

SPF50+ broad-spectrum (UVA and UVB) sunscreen, applied every morning and reapplied every 2 hours during sun exposure, is non-negotiable for melasma patients. Tinted SPF with iron oxides adds protection against visible light, which can also trigger melasma.