Melasma and Dark Spots: How to Treat Them and What Actually Works
Patches of discoloration on the cheeks, forehead, upper lip, or chin are one of the most common reasons clients come in for treatments. Melasma and hyperpigmentation get lumped together a lot, but they aren't quite the same thing, and treating them correctly starts with knowing which one you're dealing with.
Melasma vs. Dark Spots
Melasma is a chronic condition. It shows up as brown or gray-brown patches, usually symmetrical, and it's driven mostly by hormones (pregnancy, birth control, hormone therapy) combined with sun and heat exposure. Melasma tends to be persistent. Even after it fades, it can come back with the right (or wrong) trigger, so it's something you manage over time rather than fix once and move on from.
Dark spots, sometimes called post-inflammatory hyperpigmentation or sunspots, are usually smaller and more defined. They come from sun damage, acne marks, or skin injury, and they tend to respond more predictably to treatment.
Both come down to the same basic process: the pigment cells in your skin (melanocytes) produce too much melanin in certain spots.
What Causes It
UV exposure. This is the biggest trigger for both conditions, by far.
Hormonal changes, including pregnancy, birth control, and thyroid issues
Heat and visible light. Even screen light and infrared heat can aggravate melasma.
Inflammation or injury, such as acne, cuts, waxing, or aggressive extractions
Certain medications that increase sun sensitivity
Genetics. A family history of melasma raises your own risk.
Treatment Options
No single treatment fixes pigmentation on its own. Most effective plans combine a few of these.
Medical-grade topicals. Hydroquinone is still the gold standard for lightening pigment, usually used short-term under supervision. Tretinoin speeds up cell turnover and helps fade pigment gradually. Azelaic acid brightens while calming inflammation and works well on sensitive skin. Vitamin C and tranexamic acid are often layered in as antioxidant and pigment-blocking support.
Chemical peels. Glycolic, lactic, salicylic, or mandelic acid peels exfoliate the surface and help even out tone. For melasma we lean toward gentler, more gradual peels. Aggressive peeling can actually make melasma worse instead of better.
Microneedling. Fine needles create controlled micro-injuries that stimulate collagen and let brightening serums penetrate more effectively. We often pair it with tranexamic acid for better results.
Laser and light treatments. Options like low-fluence Q-switched lasers, Fraxel, or IPL can target pigment directly, but they require an experienced hand. The wrong settings can trigger more melasma, especially in deeper skin tones, so a proper skin assessment before treatment matters.
LED light therapy. Lower intensity and non-invasive, LED works well as a supportive treatment to calm inflammation between more active procedures.
Sun Protection Isn't Optional
None of the above holds up without daily sun protection. That means a broad-spectrum SPF 30 or higher (mineral formulas with zinc oxide work best for melasma-prone skin), reapplied every two hours outdoors, plus a wide-brimmed hat for extra coverage. Tinted sunscreen is worth the switch too, since it blocks visible light, which regular SPF doesn't fully cover and which is a known melasma trigger.
Sunscreen is what protects the progress you make from every other treatment.
What to Expect
Pigmentation doesn't clear overnight. Most clients start seeing improvement around 6 to 8 weeks into consistent treatment, with more noticeable changes by the 3 to 6 month mark. Melasma especially is something you manage long-term. Flares can return with sun exposure, heat, or hormonal shifts, so keeping up a maintenance routine matters even once your skin looks clear.
Getting a Plan That Fits Your Skin
Melasma and dark spots can look similar but need different approaches. Treating melasma too aggressively, or with the wrong laser, can make it worse. Dark spots from sun damage or acne, on the other hand, often respond well to more assertive treatment.
That's why we start every pigmentation consult with a skin history or visual exam to identify the type and depth of pigmentation, and a treatment plan that combines in-office procedures with an at-home routine and a sun protection strategy built around your daily life.
Book a Consultation
If you're dealing with melasma or dark spots, we can take a look and build a plan around your specific skin. Reach out to schedule a consultation.
This article is for general educational purposes and isn't a substitute for a one-on-one skin consultation. Results vary based on skin type, severity, and how closely you follow your treatment and sun protection plan.