Pigmentation and melasma
Sun spots and melasma are treated differently. Sun spots usually clear in one or two laser or intense pulsed light sessions. Melasma is different: it always needs topical treatment and, when there is a deeper component, oral treatment, laser or tranexamic acid.
Diagnosis
Well-defined brown spots on the face, décolletage and hands. They respond very well to intense pulsed light, picosecond laser and thulium laser.
Slightly raised, rough lesions. They are removed with CO2 laser in the same session as other pigmented lesions.
The pigment is in the outermost layer of skin. Topical treatment is the foundation.
Some pigment lies deeper, beyond the reach of creams. This requires oral treatment, laser or tranexamic acid.
How I treat it
I mainly use intense pulsed light and picosecond laser, adding thulium laser when there are many small spots or extensive sun damage. If seborrhoeic keratoses are also present, I remove them with CO2 laser in the same session.
Topical treatment is always the foundation: everyone needs it. Many cases of melasma also have a dermal component that creams cannot reach. In these cases I add oral treatment, laser or tranexamic acid, either by intralesional injection or with microneedling.
Realistic expectations
It can lighten considerably, but sun, heat and hormonal changes can trigger it again. That is why topical treatment is continued over time.
Aggressive laser treatment can worsen some cases of melasma; in others, more intensive fractional picosecond treatment works very well. I adapt the technology and intensity to each person's skin.
Whatever the treatment, pigmentation returns if you do not protect your skin from the sun.
Real cases
Pending: real patient cases with signed consent for promotional use, including dates, number of sessions and techniques used.
Frequently asked questions
Usually one or two, using intense pulsed light, picosecond laser and, if needed, thulium laser.
Laser can help, particularly with the dermal component, but it is not the main treatment. Topical treatment is always the foundation, with oral treatment or tranexamic acid added in many cases.
It is a medicine that reduces pigment production in melasma. I administer it through small intralesional injections or with microneedling.
Yes. I remove them with CO2 laser in the same session as the pigmentation treatment.
It can return because sun, heat and hormones can reactivate it. That is why topical treatment and sun protection are continued over time.
It depends on the type of pigmentation and number of sessions. The initial consultation costs €150, and you leave with a treatment plan and a quote.
Content reviewed by Dr. Ignacio Torres Navarro, dermatologist (registration no. 46-24-287). Last reviewed: October 2026. This information does not replace a medical consultation; results vary from patient to patient.