Melasma
Melasma is a brown to grayish-brown pigmented patch that usually appears in a similar shape on both sides of the face. Myongji Best Plastic Surgery Clinic in Myeongji-dong, Busan explains its causes, how it differs from freckles and dark spots, treatment built on sun protection and topical medication, the role of lasers, and recurrence care.
At a glance
- Main symptoms
- Flat brown to grayish-brown patches on both sides of the face, such as the cheeks, forehead, chin and above the upper lip, without pain or itching
- Causes
- UV and visible light, hormonal changes such as pregnancy or birth control pills, and genetic predisposition stimulate the pigment cells (melanocytes)
- Related conditions
- Freckles, solar lentigines (dark spots that appear with age), post-inflammatory hyperpigmentation
- Treatment
- Sun protection and topical medication are the foundation; oral medication, peels or lasers are added when needed
- Course
- Results usually take 3-12 months, and melasma can darken again with sun exposure
- Department
- Plastic surgery
What is melasma?
Melasma is a darkish patch that appears mainly on the face, usually in a similar shape on both sides. Its color ranges from brown to grayish brown or bluish gray, it commonly appears on the cheeks, forehead, chin and above the upper lip, and less often on the arms or neck.
Melasma is not skin cancer and is not a sign of skin cancer. When the cause is clear, such as pregnancy or birth control pills, it may fade after delivery or stopping the pill, but it often lasts for years.
The American Academy of Dermatology explains that treatments such as creams can fade the color but cannot make melasma go away forever. So the goal of melasma treatment is not to erase it at once but to lighten the color and keep it from darkening again.
Why does melasma develop?
Melasma develops when the pigment cells that give skin its color (melanocytes) become more active, and UV light, hormones and genetic predisposition are the main causes. Why the same trigger causes melasma in some people but not others is not yet fully understood.
UV and visible light
Sunlight is the most important aggravating factor, which is why melasma darkens in summer and fades in winter. Visible light can also worsen melasma, especially in people with darker skin tones.
Pregnancy and birth control pills
The Asan Medical Center disease encyclopedia explains that melasma develops in 50-70% of pregnant women and in about 1 in 4 people taking birth control pills.
Genetic predisposition
In a study of 324 melasma patients worldwide, 48% reported having a blood relative with melasma.
Other factors
Some medications that make skin more sensitive to sunlight, indoor tanning devices and thyroid disease may be involved, and stress is mentioned as a factor, although this is controversial.
Who gets it more often
It is much more common in women aged 20 to 40 and appears more often in medium to dark skin tones, including people of Asian heritage.
What does melasma look like, and how is it told apart from freckles and dark spots?
Melasma is a flat patch spread widely on both sides of sun-exposed areas of the face such as the cheekbones and cheeks, with no pain or itching. It is told apart by shape and trigger from freckles, which are scattered small dots; solar lentigines, which appear on sun-exposed areas with age; and post-inflammatory hyperpigmentation, which remains after acne or wounds.
| Pigmentation | Shape and location | How to tell it apart |
|---|---|---|
| Melasma | Shape and locationBroad patches on both sides of the face, such as the cheeks, forehead, chin and above the upper lip | How to tell it apartFlat and similar on both sides; darkens in summer and tends to come back |
| Freckles | Shape and locationSmall dots 3 mm or less in diameter scattered on the nose, cheeks, backs of the hands and similar areas | How to tell it apartAppear after age 5, peak around puberty and darken in summer |
| Solar lentigines (dark spots) | Shape and locationBrown spots that appear on sun-exposed areas | How to tell it apartPigmented spots that appear with age and may be mixed with melasma |
| Post-inflammatory hyperpigmentation | Shape and locationDark marks where acne, a wound or irritation occurred | How to tell it apartOnce the cause is gone, a mark a few shades darker than the skin usually fades within 6-12 months |
How is melasma diagnosed?
Melasma is usually diagnosed by a close examination of the face and neck. A Wood's lamp or dermatoscope is used to see how deep the pigment reaches into the skin, and a biopsy may be done if it is hard to tell apart from another condition.
When and how it started
Check when the melasma appeared in relation to pregnancy, birth control pills or newly started medications.
Sun exposure and lifestyle
Check outdoor activity, sun protection habits and use of skincare products that sting or irritate.
Pigment depth and mixed pigmentation
Determine whether there is melasma alone or a mix with freckles, dark spots or post-inflammatory hyperpigmentation.
Previous treatment
Check the lightening creams, prescription medications and laser treatments tried and the color changes that followed.
How is melasma treated?
There is no single best treatment for melasma; combining sun protection with topical medication is the foundation, with a procedure added when needed. Laser or light treatment is a supplementary treatment that may improve results when added for people already using topical medication and sun protection.
| Treatment | Main role | Points to check |
|---|---|---|
| UV and visible light protection | Main roleFoundation treatment that keeps melasma from darkening or new patches from appearing | Points to checkBroad-spectrum SPF 30 or higher every day; tinted sunscreen containing iron oxide helps |
| Topical medication | Main roleReduces excess pigment with hydroquinone, triple-combination cream, azelaic acid and similar agents | Points to checkFollow the prescription and guidance on duration; redness, peeling and stinging can occur |
| Oral medication (tranexamic acid) | Main roleConsidered as an addition for melasma that does not respond well to other treatments | Points to checkBe sure to mention any history of blood clots |
| Chemical peels and microneedling | Main roleSupplement results on top of topical medication | Points to checkDepending on the peel depth, the skin may peel for several days |
| Laser and light treatment | Main roleSupplementary treatment added to sun protection and topical medication | Points to checkLimits such as recurrence and color change have been reported when used alone |
In a study that randomized 641 people with moderate or worse melasma, 26.1% of the group using a triple-combination cream (tretinoin, hydroquinone, fluocinolone) for 8 weeks cleared completely, more than the two-ingredient combination groups (4.6%). The most common side effects were redness, peeling and burning or stinging.
The evidence on lasers is mixed. A meta-analysis of 12 studies and 358 people found no difference in melasma score improvement between low-fluence Nd:YAG toning alone and drug treatment, and greater improvement when toning and drugs were combined. In contrast, a study using only a Q-switched ruby laser in 8 people with refractory melasma found no lasting improvement regardless of fluence, with some darkening, and a systematic review of toning studies reported mottled hypopigmentation and recurrence 3 months after treatment in some studies.
How does Myongji Best Plastic Surgery Clinic approach melasma treatment?
Myongji Best Plastic Surgery Clinic in Myeongji-dong, Gangseo-gu, Busan first checks the type, depth and distribution of pigmentation and the skin's condition, then chooses the suitable laser among Dual Toning, Ruby Laser and Lavieen BB, and reviews sun protection and any needed medication and lifestyle care together. Pigmentation with several overlapping causes, such as melasma, is approached with a wavelength and method distinguished from other pigmentation.
- STEP 01
Identifying the pigmentation
Check whether it is melasma or mixed with freckles, dark spots or age spots, along with pigment depth, density and skin type.
- STEP 02
Broad melasma and dull tone
Dual Toning, which uses two modes (Nd:YAG and Genesis), is done without anesthesia in about 20-30 minutes and recommended 5-10 times at 1-2 week intervals.
- STEP 03
When freckles or dark spots are also present
The approximately 694 nm Ruby Laser is planned separately for freckle, dark spot and age spot areas and applied cautiously to melasma areas.
- STEP 04
When managing tone, texture and pores together
Lavieen BB, a 1927 nm thulium fractional laser, is planned with a number of sessions and intervals suited to the skin's condition and goals.
- STEP 05
Checking progress
Sun protection, the care plan and the remaining sessions are adjusted while watching color changes and any recurrence.
What is the course after melasma treatment, and how should I care for my skin?
Even when the treatment plan is followed, results usually take 3-12 months to show, and longer if the melasma is long-standing. Even after treatment, outdoor activity without sun protection easily darkens it again, so self-care is part of the treatment.
Do
Apply SPF 30 or higher sunscreen 15 minutes before going out and reapply at least every 2 hours, and use a wide-brimmed hat and shade. UV rays get through on cloudy days too, so apply it every day.
Avoid
Avoid indoor tanning devices, skincare products that sting or burn when applied, and so-called secret melasma remedies sold without instructions.
Care after laser treatment
After Dual Toning, pause active skincare products for a while, and do not pick off scabs after Ruby Laser or flakes after Lavieen BB.
What symptoms mean I should contact the clinic right away?
Contact the clinic right away if blisters, severe pain or long-lasting color change appear after laser treatment. If a spot appears on only one side, feels raised, or changes in shape or color, it may not be melasma, so have it checked.
Non-prescription melasma products are best used for no longer than 3-6 months, and if you do not see the change you want by then, see a doctor.
Diagnosis, treatment combination and response for melasma vary with pigment depth and skin condition, so the medical team finalizes the plan after an examination.
How is the cost of melasma treatment determined?
Myongji Best Plastic Surgery Clinic's published non-covered fee information has no separate melasma treatment item; the related lasers are listed as toning KRW 77,000 per session and KRW 350,000 for 5 sessions, Ruby Laser KRW 220,000, and Lavieen BB KRW 220,000 per session (checked October 20, 2026). Whether dual mode is included, the number of repeat sessions and the total cost including any prescriptions are confirmed after an examination, and non-covered fees may change.
A note from Myongji Best Plastic Surgery Clinic
Melasma is closer to a skin condition kept light through sun protection and steady care than something erased at once. If you tell us when your melasma first appeared, the medications you take and your previous treatments, we will identify the pigmentation and decide the order of treatment together.
Frequently asked questions
Does melasma that appeared during pregnancy go away after giving birth?
Melasma that appears during pregnancy may fade or disappear after delivery, but it can remain after childbirth if sun protection is neglected. It is recommended to postpone treatment during pregnancy and start after giving birth.
How long should I try a melasma lightening cream before seeing a doctor?
The American Academy of Dermatology recommends using non-prescription melasma products for no longer than 3-6 months. If you do not see the change you want by then, see a doctor to check whether prescription medication or a procedure is needed.
Can melasma turn into skin cancer?
Melasma is not skin cancer and is not a sign of skin cancer. However, a spot that appears on only one side or is raised may not be melasma, so have it checked by a doctor.
Do I need sunscreen for melasma even on cloudy days?
Even on cloudy days, UV rays reach the skin at about 60% of the strength of a clear day and affect melasma. If you have melasma, apply SPF 30 or higher every day regardless of the weather, preferably a tinted sunscreen containing iron oxide.
About the clinic behind this article
Myongji Best Plastic Surgery Clinic is a board-certified plastic surgery clinic in Myeongji-dong, Gangseo-gu, Busan. Dr. Hyungseok Noh, board-certified plastic surgeon and medical director, provides care.
- Address
- Units 302–305, Building 1, 3 Myeongji-gukje 2-ro 28beon-gil, Gangseo-gu, Busan
- Main Line
- 051-711-7991
- Clinic Hours
- Weekdays AM 10:00 ~ PM 07:30Saturday AM 10:00 ~ PM 03:00Sundays & Public Holidays Closed
- Treatment guide
- View the Dual Toning page
- Booking
- Naver Booking
REFERENCES
References
This article uses the clinic’s published information together with authoritative medical sources.
- Myongji Best Plastic Surgery ClinicDual Toning guide
Supports: Roles of the two laser modes, use for melasma and dark spots, treatment time, anesthesia and recommended sessions, aftercare
A treatment that uses two different laser modes suited to the skin's condition to help improve pigmentation and support skin regeneration together.
- Myongji Best Plastic Surgery ClinicRuby Laser guide
Supports: The 694 nm wavelength and target pigmentation, approaching melasma separately from other pigmentation, scab care
Melasma involves several combined factors, so it is approached separately in a way suited to pigment depth and skin condition.
- Myongji Best Plastic Surgery ClinicLavieen BB guide
Supports: Principle of the 1927 nm thulium fractional laser, target concerns, session planning, care of flakes
A fractional laser that uses a 1927 nm thulium wavelength to deliver fine heat stimulation to the boundary between the epidermis and dermis.
- Myongji Best Plastic Surgery ClinicNon-covered fee information
Supports: Published fees for toning, Ruby Laser and Lavieen BB
Toning 1 session KRW 77,000, 5 sessions KRW 350,000; Ruby Laser KRW 220,000; Lavieen BB 1 session KRW 220,000
- American Academy of DermatologyMelasma: Overview
Supports: Appearance and location of melasma, difference from skin cancer, possibility of recurrence, how long to use non-prescription products
Treatments such as creams can help fade the discoloration, but treatments cannot make melasma go away forever.
- American Academy of DermatologyMelasma: Causes
Supports: Melanocyte activity, UV, hormone, medication, thyroid and stress factors, risk groups and family history
Researchers have discovered that when someone has melasma, the cells that give skin its color (melanocytes) tend to be more active.
- American Academy of DermatologyMelasma: Diagnosis and treatment
Supports: Diagnosis, roles of sun protection, topical and oral medication and procedures, the basis for adding lasers as a supplement, time to results
A few studies have found that adding a laser or light treatment can improve results for patients who are already applying medication to their skin and protecting their skin from the sun.
- American Academy of DermatologyMelasma: Self-care
Supports: How to use sunscreen, visible light and tinted sunscreen, avoiding tanning devices and irritating skincare
Visible light has been shown to worsen melasma, especially for people with darker skin tones.
- American Academy of DermatologyHow to fade dark spots in darker skin tones
Supports: Causes of post-inflammatory hyperpigmentation and how long it takes to fade
A spot that is a few shades darker than your natural skin color will usually fade within 6 to 12 months.
- Asan Medical Center disease encyclopediaMelasma
Supports: Definition of melasma, hormonal, sunlight and genetic causes and their frequency, sun protection on cloudy days, caution about secret remedies
Melasma develops in 50-70% of pregnant women, and many melasma patients remember first getting melasma while pregnant.
- Asan Medical Center disease encyclopediaFreckle (Ephelis)
Supports: Size, location, age of onset and seasonal change of freckles
Their size is usually 3 mm or less in diameter.
- MedlinePlusAging changes in skin
Supports: Solar lentigines that appear on sun-exposed areas with age
Pigmented spots including age spots or "liver spots" may appear in sun-exposed areas. The medical term for these areas is lentigos.
- PubMedEfficacy and safety of a new triple-combination agent for the treatment of facial melasma
Taylor SC, Torok H, Jones T, et al. Cutis. 2003;72(1):67-72. PMID: 12889718
Supports: Complete clearance and common side effects after 8 weeks of triple-combination cream in 641 people
The results of the combined clinical trials demonstrated that significantly more of the patients treated with RA+HQ+FA (26.1%) experienced complete clearing compared with the other treatment groups (4.6%) at the end of week 8 (P<.0001).
- PubMedEfficacy of low-fluence 1064 nm Q-switched Nd: YAG laser for the treatment of melasma: A meta-analysis and systematic review
Chen J, Yu N, Peng L, et al. J Cosmet Dermatol. 2022;21(7). doi:10.1111/jocd.15126. PMID: 35621242
Supports: Meta-analysis of 12 studies and 358 people comparing toning alone, drugs alone and combination
We found that combination therapy with LQSNY and drugs had a greater MASI improvement compared with LQSNY therapy alone (MD: 1.78, 95% CI 0.93-2.63, p < 0.0001)
- PubMedIneffective treatment of refractory melasma and postinflammatory hyperpigmentation by Q-switched ruby laser
Taylor CR, Anderson RR. J Dermatol Surg Oncol. 1994;20(9):592-597. doi:10.1111/j.1524-4725.1994.tb00152.x. PMID: 8089359
Supports: Limits of Q-switched ruby laser alone in 8 people with refractory melasma
Regardless of fluence, no permanent improvement and, in some cases, darkening was seen in each type of lesion.
- PubMedThe Low-Fluence Q-Switched Nd:YAG Laser Treatment for Melasma: A Systematic Review
Lee YS, Lee YJ, Lee JM, Han TY, Lee JH, Choi JE. Medicina (Kaunas). 2022;58(7):936. doi:10.3390/medicina58070936. PMID: 35888655
Supports: Hypopigmentation and recurrence 3 months after low-fluence Nd:YAG toning, and lack of long-term data
Although few studies have reported considerable recurrence rates three months after treatment, unfortunately, there is a lack of the long-term follow-up results of LFQSNY in melasma.
Published 2026.10.20Last updated 2026.10.28