Don't get Laser Toning treatment for melasma yet!

Dr. Ogana differentiates between various types of hyperpigmentation. Freckles are small, dark spots with clear borders appearing at a young age, typically on the nose, and are relatively easy to treat. Sunspots are larger, lighter spots with faded borders that appear with age due to UV exposure but are not melasma. Melasma, the focus of the video, is characterized by irregular shapes, appears on both sides of the face, predominantly affects women in their 30s-40s, and is difficult to treat due to its irregular, spreading nature.

Melasma is influenced by three main factors: genetics, UV exposure, and female hormones. Individuals with a family history of melasma are more prone to developing it, especially with sun exposure. Female hormones play a significant role, with melasma often worsening during periods of high hormonal activity (e.g., 20s-40s, after childbirth) and potentially improving after menopause.

Common treatment methods for melasma include lasers, topical medication, and oral medication. Dr. Ogana expresses a dislike for topical creams due to their subpar effectiveness and potential to cause irritation, leading to darker pigmentation. He strongly recommends oral medication, specifically tranexamic acid (Doransamin), which is effective in small doses for melasma and also used for hemostasis. However, he stresses the importance of consulting a medical professional to ensure an accurate diagnosis and suitability for oral treatment, especially since melasma often coexists with other pigmentations that may not respond to oral medication alone.

Dr. Ogana debunks the common belief that laser toning is effective for melasma, stating that from his experience, it often provides no benefit and can sometimes worsen the condition. He compares melasma to a weed that continuously produces pigment, emphasizing that simply 'cutting the top' (fading visible pigment with laser toning) is insufficient and can lead to a larger, more aggressive regrowth. Effective treatment requires 'replacing the soil,' meaning addressing the underlying collagen and elastin degradation in the dermis caused by genetics and UV exposure.

The key to treating melasma is not just to fade existing pigment but to prevent further formation by strengthening compromised skin tissues. Dr. Ogana's approach involves combining different laser treatments (e.g., X Laser and Y Laser, picolaser with XXX mode) and other therapies like soundwave treatments and extracorporeal shock wave therapy to rebuild and rejuvenate the deep skin layers. He concludes that for melasma, the goal is to gently reduce pigment formation and safely remove existing pigment without aggravating the condition, likening it to 'grooming a sleeping tiger without waking it up.'

Melasma treatment is typically a long-term process, and the exact number of sessions required cannot be precisely determined upfront due to individual skin variations. Dr. Ogana highlights that while his clinic offers guarantees for other conditions like redness and acne, melasma treatment requires a tailored plan considering the patient's financial situation and ability to commit. He encourages those with melasma not to give up, emphasizing that the present is the earliest time to start treatment and achieve improvement.