Why I Don't Do Lasers or Peels for Melasma
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I get asked about this constantly, so let me put my position on the record.
I don't offer lasers or peels for melasma.
Not because I think procedures are useless — they're not, and for several other pigmentation problems they can be genuinely helpful. And not because I'm against technology. It's because of what melasma actually is, and once you understand that, my reasoning is fairly hard to argue with.
I'd also rather you heard the argument than just took my word for it, because you're going to be offered these treatments elsewhere and you should be able to think it through yourself.
The mental model that causes the problem
Most people picture melasma as a stain.
There's pigment sitting in your skin. It shouldn't be there. So the obvious solution is to remove it — break it up, lift it off, resurface the layer it's sitting in. Job done.
That model makes intuitive sense, and it's why lasers feel like the logical answer. It's also the wrong model.
Melasma isn't a deposit. It's an active process. The pigment-producing cells in your skin have become overactive and they are currently, today, this afternoon responding to light and hormonal signals by producing more pigment than they should. That's why it took years to form and that's why it doesn't stay away.
Once you swap in the correct model, the problem with the removal approach becomes obvious. You can remove the pigment that's there. But you haven't touched the reason it was being made. So the cells continue doing exactly what they were doing before, and the pigment returns.
You've bought yourself a temporary result at some cost, and you're back where you started with the same overactive cells.
The bigger problem: melasma reacts badly to being provoked
This is the part I most want people to understand, because it's the difference between "the procedure won't help much" and "the procedure may leave you worse."
Melasma-prone skin responds to inflammation by producing pigment. That's essentially the underlying flaw — the pigment machinery is on a hair trigger. Anything that irritates or injures the skin risks provoking exactly the response you're trying to suppress.
And procedures work by injuring the skin in a controlled way. That's the mechanism. Heat, or a chemical, or physical disruption, followed by healing.
So with melasma you're doing something inflammatory to skin that responds to inflammation by making pigment. Sometimes you get away with it. Sometimes you don't, and the result is darker or patchier than the starting point — and that rebound pigmentation is often more difficult to treat than what the person originally came in with.
That risk is not hypothetical and it's not rare enough to ignore. For me, the risk-benefit doesn't hold up: a temporary result, against a meaningful chance of a harder problem.
This is also why I'm cautious about irritation generally in melasma patients — why the hydroquinone route is applied thinly rather than thickly, why tretinoin is introduced gradually, and why I don't encourage aggressive exfoliation. It's the same principle running through all of it. In melasma, irritation is not evidence that something is working. It's a risk factor.
What I do instead
My approach is sun protection plus topical treatment, aimed at reducing the pigmentation and then maintaining that.
Reduce it, then hold it. Rather than remove it and watch it come back.
That framing is the whole philosophy. I'm not trying to get your skin to a perfect endpoint in a dramatic way — I'm trying to bring the process down to a level you're happy with, and then keep it there for years. That means:
Sunscreen with SPF 50+, PA++++ and iron oxide, at least twice daily, indoors or not — because the visible light exposure that drives this is happening every single day.
Topical medication, on whichever of the two routes suits you.
Oral treatment where appropriate and after proper screening.
Review, adjustment, and then a maintenance phase you stay on.
It's less exciting than a machine. I'm aware of that. Nobody has ever been thrilled to hear that the answer is discipline. But it's what holds up over a period of years, which is the timescale that actually matters with this condition.
What procedures ARE useful for
I want to be fair, because I'd rather you understood the distinction than came away thinking all pigmentation procedures are a bad idea.
Procedures do improve pigmentation problems — for the right problem. Some kinds of pigmentation genuinely are deposits: a finite amount of pigment, sitting there, not being actively replenished. For those, removing it is a reasonable strategy, because there's no ongoing process making more.
Melasma is not one of those. That's the distinction, and it's why the diagnostic conversation matters so much. If what you have is largely something else, the calculus can be different.
Which brings up the complication I run into constantly: most facial pigmentation is a mixture. Melasma with post-inflammatory marks, or melasma alongside long-term sun damage. So the question is rarely a clean one — and if a meaningful melasma component is present, the risk of provoking it applies regardless of what else is in the mix.
If you're considering a procedure elsewhere
I'm not going to tell you what to do with your own face, and plenty of people will offer you these treatments. What I'd suggest is asking a few questions first:
Is my diagnosis actually melasma, or a mixture? If nobody has taken a proper history — when it started, what preceded it, pregnancies, hormonal medication, previous reactions — then the diagnosis behind the recommendation is thin.
What happens after the procedure? If the answer doesn't include a sun protection and topical maintenance plan, then nothing is addressing the process that made the pigment. You're getting removal without suppression.
What's the plan if it comes back darker? A straightforward question, and the answer tells you a lot about how carefully the risk has been thought through.
How many sessions, over what period, and what happens when I stop? Worth knowing before you begin rather than three sessions in.
If you get good answers to those, fair enough. My position is my position, and reasonable practitioners weigh this differently. But those questions are how you tell a considered recommendation from a reflex one.
The honest summary
Lasers and peels can remove pigment. Melasma is not a pigment removal problem — it's an overactive process that responds badly to being provoked. Remove the pigment and the process makes more; provoke the skin and you risk making the process worse.
So I treat it the boring way: block the light properly, suppress the process with topicals, review, and then maintain it. Reduce and control, rather than remove and recur.
If someone has told you a machine will clear your melasma permanently, I'd want to know what they've said about the years afterwards.
Come and talk it through if you'd like. Klinik Dr Tan (Skin & Acne), Lot 27, Ground Floor, Block D, Lintas Square, Kota Kinabalu. WhatsApp 017-234 7328. Appointments preferred.
I'm a GP with a strong interest in skin, not a dermatologist. Where a case genuinely needs specialist assessment, I'll say so and refer you on.
Book a consultation with Dr. Tan — Book Online or WhatsApp 017-234 7328.
简要说明
我是陈医生，亚庇 Lintas Square 的 Klinik Dr Tan（皮肤与暗疮）。我是对皮肤有专长的普通科医生，不是皮肤专科医生。
我不为黄褐斑做激光或化学换肤。 以下是我的理由。
多数人把黄褐斑想成一块「污渍」——色素在那里，把它清掉就好。这个想法很直觉，但是错的。
黄褐斑不是沉积物，而是一个持续活跃的过程。 你皮肤里的色素细胞现在、今天、此刻都在因应光线和荷尔蒙讯号而制造过多的色素。这就是它需要几年形成、也一直复发的原因。
所以：你可以清掉现有的色素，但你没有碰到它被制造出来的原因。 细胞继续做原本的事，色素就回来了。
更重要的问题是：黄褐斑受到刺激后反应很差。
黄褐斑体质的皮肤，一发炎就制造色素——这基本上就是它的核心缺陷。而所有疗程的原理都是以可控的方式让皮肤受伤（热、化学、物理性破坏，然后修复）。
等于是对「一发炎就produce色素」的皮肤做发炎的事。有时候没事，有时候结果比原本更深、更花，而且这种反弹性色素往往比原本的问题更难处理。
同样的原则贯穿我所有的做法：含对苯二酚的药膏要薄擦、A酸要慢慢加、不鼓励过度去角质。在黄褐斑，刺激不是有效的证明，刺激是风险因素。
我的做法：防晒（SPF 50+、PA++++、含氧化铁，每天至少两次，室内也一样）加外用药，必要时口服药（需先筛查），然后复诊、调整、长期维持。先减淡，再维持——而不是清除后复发。
疗程不是没有用——有些色素问题确实是「有限量、不再增生」的沉积，清除是合理策略。但黄褐斑不是。而且脸上的色素多数是混合型，只要含有黄褐斑成分，刺激的风险就存在。
如果你考虑在别处做疗程，建议先问几个问题：
我的诊断到底是黄褐斑，还是混合型？（有没有人详细问过病史？）
疗程之后的计划是什么？有没有防晒和外用药的维持方案？
如果反而变深了，接下来怎么处理？
需要做几次、多长时间、停下来之后会怎样？
Klinik Dr Tan (Skin & Acne)，Lot 27, Ground Floor, Block D, Lintas Square, Kota Kinabalu。WhatsApp：017-234 7328。建议预约。
预约陈医生 — 在线预约 或通过 WhatsApp 联系 017-234 7328
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