Clinical FAQs

Can I use my own skincare products?

Yes, if you know what you are doing, however it is best to check with your treating clinician. 

Here is a rough guide & our treating philosophy. 

Only use ingredients that serve a purpose. If you are targeting pigmentation, only apply pigment correctors. 

1. Start an ingredient slowly, eg. apply every second or third night. Use common sense, if you have any redness, stinging, flaking, burning or irritation, reduce application.
2. Interactions are most commonly seen with hydroquinone, retinol or retinoids, & ascorbic acid. Whilst this rule is not for everyone (designed to keep the lowest common denominator from having side effects), you can be guided by your clinician. 

*A sensible guide to adding your own skin care goes something like this- application of prescription skin care in the evening. After week 4 to 6, you can add azelaic acid or even vitamin C (ascorbic acid 10-20%) in the morning, before sunscreen application. 

What conditions do we treat?

The Melasma Clinic treats all forms of pigmentation, including-

• Melasma
• Post inflammatory hyperpigmentation
• Age spots, sun spots, freckles
• Hori, Ota & CALM birthmarks
• Rare causes of pigmentation
• Dark underarms
• Perioral pigmentation

What is the fastest way to treat or remove melasma pigmentation?

The Cosmelan Series is the fastest way to treat melasma. Results can be seen within 1-2 weeks, & it only requires one in office appointment. The downside is the variable recovery time of 7-14+ days. 

Cosmelan treats approximately 60% of melasma cases. In contrast, The Melasma Pico series treats up to 80-85% of cases, however it does require 4 sessions of pico laser. 

What is the cheapest way to treat melasma pigmentation?

Go to Coles, buy the cheapest sunscreen on sale. Apply 1 teaspoon three times a day regardless of sun exposure. The whiter you are, the better the application. 

Go to the Chemist Warehouse, buy the cheapest vitamin C on sale, apply in the morning. Persist for 3 months & you will get some result, albeit modestly. 

Failing that, ask your GP to refer you to the nearest dermatology department in a public hospital. Consultations are free of charge. 

Occasionally we run clinical trials for new lasers or skin care, subscribe to our Instagram account for updates. 

What is the best chemical peel for melasma pigmentation?

The most popular peel for melasma is the Cosmelan mask or peel. This effectively & progressively removes melasma pigmentation over a period of a few weeks, however it has a recovery period of 7 to 14 plus days. Cosmelan is effective in approximately 60% of melasma cases.

We also employ the Vi Precision Peel for melasma. This is more cost effective & has a much shorter downtime compared to Cosmelan. 1-3 sessions are recommended. Delayed peeling is expected at day 3, with complete recovery 3-5 days later. 

Other good peels include the Dermamelan peel. Chemical peels such as glycolic & lactic acid are less effective, working in approximately 20% of cases. 

Can Cosmelan be used at home?

Only Cosmelan 2 can be used at home. The Cosmelan Peel Series has to be performed in a clinic. The peel itself takes 15 minutes to put on, however it can be washed off 8-12 hours later at home. 

From there we will transition you to Cosmelan 2, which is a home routine for the next 3 months. 

How many sessions of Cosmelan will I need?

Only one in-office peel, followed by home care for 3 months. The Cosmelan Peel Series has an efficacy rate of approximately 60%.

What is the difference between Dermamelan & Cosmelan?

There has been a recent change in the application of Dermamelan & Cosmelan as of 2023. Dermamelan has always been more powerful compared to Cosmelan, however changes in formulations are somewhat confusing.

We will keep you updated for 2024, for now, goto the Dermamelan website for more information. 

What better Vi peel or Cosmelan peels?

At the Melasma Clinic we use both Vi & the Cosmelan peeling systems. The clinical outcomes are comparable, however the Vi Precision Peel has several key advantages-

• Less downtime (only 3 actual days of mild peeling), Cosmelan peeling can last beyond 14 days. 
• Much less skin irritation as compared to Cosmelan
• Less cost compared to Cosmelan peels (typically half the price) 

*Chemical peels are only useful for superficial melasma pigmentation. Deep dermal melasma or mixed melasma responds poorly to peels. Understanding the depth of pigmentation is essential for best results. 

What is skin recovery like following Vi peel?

The Vi Precision peel has what we term ‘delayed peeling.’ It starts at day 3 & typically lasts 3-5 days. Peeling is mild, however make up may not sit well during this time. 

As compared with Cosmelan & Dermamelan, the Vi peel has less irritation & overall recovery. 

How to chemical peel at home / DIY chemical peel?

Before performing a glycolic acid peel at home, there are several important considerations to keep in mind. 

1. This is more risky than having an expert perform it. If you screw it up, your pigment will be worse. 
2. Recommendations are only for low concentration TCA or glycolic acid (as outlined below).
3. Not all pigment will fade as the ideal treatment depends on your skin type, pigment type & depth. 

Here is how to execute an AHA peel (glycolic) with relative safety.

1. Patch Test: Perform a patch test on a small area of skin to assess sensitivity and ensure you don’t have an adverse reaction to the peel. This is not mandatory as allergic reactions are exceedingly rare with glycolic acid. 

2. Choose the Right Strength: Select a glycolic acid peel with an appropriate strength for your skin type and concerns. Beginners should start with a lower concentration (e.g.10%). You do need to source your own as we only use 20% or higher in our clinics.

3. Sun Protection: Glycolic acid increases skin sensitivity to sunlight, so it’s crucial to apply a broad-spectrum sunscreen with SPF 50 or higher daily, even on cloudy days.

4. Avoid Active Ingredients: Discontinue the use of exfoliants, and other active skincare ingredients for several days before and after the peel to prevent excessive irritation, this includes AHAs, salicylic acid, retinol, retinoids, & other potential irritants. 

 

Performing the Glycolic Acid Peel: advice is given based upon the lowest common denominator reading this ‘how to’ guide.

Step 1: Clean the skin. 

Start by cleansing your face with a gentle, non-abrasive cleanser to remove dirt, oil, and makeup. Pat the skin dry with a clean towel. Cetaphil wash is a simple cleanser. 

Step 2: Prep the Skin

Apply a pre-peel solution or toner (eg. acetone) to degrease the skin and remove any remaining impurities. Cover delicate areas with Vaseline (corners of mouth under eye area, side of nose). 

Step 3: Apply the Glycolic Acid Peel

Using a cotton pad or fan brush, apply an even layer of the glycolic acid peel solution to the skin, avoiding the eye area, lips, & around the corners or sides of the nose. 

Step 4: Monitor the Skin

Keep a close eye on your skin during the peel application. You may experience a tingling or stinging sensation, which is normal. However, if you experience severe burning, itching, or discomfort, immediately neutralize the peel and rinse the skin with cool water. 

Step 5: Neutralize the Peel

After the desired peel time (typically 1 to 5 minutes), neutralize the peel by applying a neutralizing solution or rinsing the skin with cool water. This helps stop the exfoliating process and soothe the skin. Sodium bicarbonate in water is a good neutralizing agent.

Step 6: Rinse and Moisturize

Gently rinse the skin with lukewarm water to remove any remaining peel solution. Pat the skin dry and apply a soothing, hydrating moisturizer to replenish moisture and minimize post-peel dryness.

Step 7: Post-Peel Care

In the days following the peel, avoid direct sun exposure, exfoliants, and harsh skincare products. Use a gentle cleanser, moisturizer, and sunscreen to protect and nourish the skin as it heals. Do not use any skincare products for 1-7 days (depends on your skin sensitivity) post peel. 

Safety Precautions and Tips

• Start with a lower concentration and gradually increase as tolerated. Max out at 25% for DIY peels. 
• Limit the frequency of glycolic acid peels to once every 10 to 14 days to prevent over-exfoliation.
• Avoid contact with mucous membranes, eyes, and lips during the peel application.
• Discontinue use if you experience prolonged irritation, redness, or other adverse reactions.

Which is better for melasma; chemical peels or lasers?

The Cosmelan Peel (& Dermamelan) remains as the fastest way to clear up melasma, requiring only one clinic visit. The downside is the long recovery time- upwards of 10 to 14 days. 

The Pico Melasma Series provides effective pigment reduction with no recovery/downtime. 

Cosmelan is effective in 60% of melasma cases, whilst pico has an efficacy of over 80%. 

As a guide, most patients will choose the Melasma Pico Series over the Cosmelan Series, due to the downtime & lower efficacy of the Cosmelan peel. 

What is the best skin care or cream for melasma?

It depends on the depth of pigmentation. A simplified skin care regimen is; 

• AM: SPF, Vitamin C, E, ferulic acid
• PM: Pigment corrector. Over the counter includes azelaic acid, arbutin, kojic acid, bearberry extract & botanicals, followed by glycolic & lactic acid. 

Clinical skincare will provide the best outcomes, especially when combined with pico lasers. 

What is the best laser for melasma?

Pico lasers are by far the most effective way to treat melasma. We use both Picosure Pro & Picoway, however in most cases we prefer the former. Pico lasers have many advantages over other laser systems, namely-

1. No downtime
2. Superfast results
3. No flare ups
4. Cost effective
5. Addresses the cause of melasma

As always, settings matter. 

What pico lasers do we use?

We use both the Picoway & Picosure Pro lasers. Our clinicians have had 10 years of pico experience, starting with the Picosure in 2015. 

Picoway & Picosure Pro in Brisbane, latest Picosure Pro in Sydney. Depending on the depth of your pigment, we select the best wavelength & device. 

Which is better, Picoway or Picosure?

Both are good, however here’s the truth (we have both); 

• Picoway is better for deep pigment such as Ota & Hori.
• Picosure is better for Ethnic – Asian rejuvenation & melasma.

Apart from the brand of laser, setting matter. Think of lasers as a pair of Japanese grade scissors- this helps cut hair, but it is HOW you use it that counts. 

Do we remove moles?

No. The Melasma Clinic is very specific on the conditions we treat, we do not offer laser mole removal for several reasons including- 

1. High rate of recurrence following laser mole removal. 
2. Incomplete removal of the mole with lasers.
3. Changing the microscopic nature of moles with lasers.
4. High risk of scarring secondary to laser mole removal. 

If you would like to have your mole removed, consult a skin cancer doctor, dermatologist or a plastic surgeon. 

What is the best treatment / way for removing moles?

Tough question as the answer ranges from excision to do nothing. If your mole is changing, you should see a dermatologist to exclude anything sinister. 

If you are considering removal on cosmetic grounds, the best/most predictable treatment is excision. You should book an appointment with a plastic surgeon. 

We do not laser moles in our clinic (Google ‘pseudomelanoma’ & you will understand why). If you are considering laser mole removal, there are many cosmetic clinics that will do this for you. Our ethos is not to remove moles on cosmetic grounds (exceptions apply- namely if the outcome will yield better results than the complications with a confidence level of >95% Discuss this with your dermatologist). 

How to treat / get rid of a scar from mole removal?

The best person to speak to is the person responsible for causing the scar. It is universally accepted that whoever does the procedure is also responsible for treating any complications such as scarring. 

If they can not fix the scar, you may be seen by a dermatologist for further scar management. Fill out the expression of interest form as the first step. 

Do we treat birthmarks?

We treat birthmarks that are amenable to lasers, including Ota & CALM or Cafe Au Lait Macules. Treatments are performed by Dr Davin Lim. The average cost ranges from $740 to $990 out of pocket, Medicare does cover approximately $130 per session. 

Dr Davin Lim does not laser moles including congenital melanocytic naevi. Google your birthmark to identify what it is. This can determine the best course of treatment. 

Birthmarks NOT amenable to laser: Congenital moles, moles, Becker nevus, Naevus spilus.

How old do I have to be to get a birthmark removed/ do we treat children?

As a guide we can treat children at 12 to 16 years of age. Lasers require eye protection & in some cases anesthetic. Most children under the age of 12 will not allow this to happen. We do not have general anesthetic facilities in our Sydney clinic. 

For Brisbane patients, book an appointment with our pediatric dermatologist, Dr Heba Jibreal. She has a clinic at the Children’s Hospital and may elect to laser birthmarks there (under sedation). 

*Pediatric patients in Sydney are best seen at The Skin Hospital, Darlinghurst. 

How to treat Becker naevus / naevi / birthmark?

Becker nevus are brown birthmarks that typically increase in size & intensity around puberty. They are notoriously difficult to remove because the birthmark is more than just pigment (consists of sebaceous glands, hair follicles, & even muscle). Try this BEFORE seeing us-

1. See a general dermatologist for a diagnosis (other things to consider include CALM birthmarks; usually flat but responds to lasers). 
2. Get some laser hair removal done. Hair removal is not offered in our Sydney clinic, but is available in our Brisbane clinic. 
3. Laser treatment results are highly variable. Your chances of significantly improving Becker naevi is less than 5%, recurrence is seen in over 90% of cases, even if you do respond. 
4. Test patches are required. They are not covered by Medicare & cost $990. 

All forms of Becker are seen by our dermatologists. In summary, we encourage patients not to pursue treatments.

Can I get melasma treatments if I am pregnant or breastfeeding?

If you are pregnant, here is what to do-

1. Sunprotect (duh!)
2. Start azelaic acid at night (10 to 20%)
3. Start vitamin C in the morning

We do not treat melasma in pregnancy with prescription medications, so you are limited with more ‘fluffy’ treatments such as glycolic or lactic acid peels & novel pigment correctors. 

If you are breastfeeding we can treat you with pigment correction creams, lasers & peels. 

Some cases of melasma settle postpartum, but it could take a year or more. We can speed up resolution in most cases. 

Do we treat iron staining?

Yes, but you do need to see a dermatologist for an initial consultation. Iron staining is notoriously difficult to treat, as some cases are unresponsive to even the best lasers. It is because staining lies in the deeper layers of skin, away from the effects of lasers. Cases that do respond are superficial. As a guide-

• 6-12 months of pico laser
• 30-40% respond
• 6 to 8 sessions of pico required
• $790 to $890 per session

Do we treat – remove eyebrow tattoos?

Our Brisbane clinic removes eyebrow tattoos, however as of 2024 we do not offer this service in Sydney. A few pointers if you are considering eyebrow tattoo removal-

• Your pigment may oxidize (get darker). 
• You will require 3-6 sessions for best results.
• If the tattoo is in your eyebrow itself, you may get temporary reduction on eyebrow hair. 
• A dermatologist is NOT involved in your treatment. It is performed by our nurses & dermal clinicians. 

Do we microneedle eyebrow tattoos for removals?

No, we do not. This should be performed by the tattoo artist themselves. We do offer laser treatment in some cases (good candidates). Laser tattoo removal is offered in Brisbane, not the Sydney clinic. Points you should consider before considering laser include- 

• Your pigment may oxidize or turn darker before improving.  
• You will require 3-6 sessions for best outcomes. 
• Some pigment may be resistant to lasers. 
• If the tattoo is in your eyebrow itself, you may get temporary reduction on eyebrow hair. 
• In some cases it may be better to wait for the pigment to resolve. 

Do we treat lip liner tattoos?

We do offer this service in Brisbane, but not Sydney (if you are a good candidate). Here are some facts regarding lip liner tattoos- 

• Your pigment may oxidize or turn darker before improving.  
• You will require 3-6 sessions for best outcomes. 
• Sessions are spaced 7-12 weeks apart
• Some pigment may be resistant to lasers. 

Do we treat tattoos?

The Brisbane clinic does offer tattoo removal (both cosmetic tattoos & normal tattoos), however we do not offer this service in Sydney. 

For a tattoo removal consultation, book an appointment with our nurses or dermal therapists at Cutis Dermatology. 

Do we treat radiation tattoos?

We do treat radiation tattoos in Brisbane. You do not need to see a dermatologist for this procedure, book in with a nurse or dermal therapist. Unlike traditional tattoos, radiation tattoos require only 2-4 sessions to completely remove them. 

Do we treat tattoo scarring?

We do treat tattoo scarring in Brisbane, however you will require a dermatologist to review your case. Dr Davin Lim may be involved in your treatment if it is complex. 

Sydney patients must go through an application process as we only open up a few slots for scar patients every month. A referral from your treating doctor may expedite the process. 

*Treatments for tattoo scarring include steroids, 5 FU chemotherapy, lasers, silicone sheeting, & steroid impregnated tape. 

What laser do we use / what laser is best for tattoo removal?

The Melasma Clinic in Brisbane & Sydney employs the very best tattoo removal lasers. We choose the laser & desired wavelength based upon your skin’s color as well as the tattoo ink color. 

We run the Picoway, Picosure, Picosure Pro, Spectra, QRas, Hollywood & Pastelle tattoo removal lasers. 

How much does it cost for laser tattoo removal?

Price varies depending on the size, complexity & location of the tattoo. Book an appointment with our nurses in Brisbane. We do not offer tattoo removal services in our Sydney clinic. 

Do we treat morphea or scleroderma?

If you have morphea or scleroderma, the best person to see is a medical dermatologist. They can discuss treatment options with you, including pulse CS, vitamin D, narrowband phototherapy or UVA 1. They will also discuss the use of methotrexate chemotherapy for extensive cases. 

Pigment lasers do not work well for morphea, hence we advise against ‘giving lasers a go.’ The Sydney clinic is a cosmetic only clinic, if you would like medical treatment in Brisbane, see one of our medical dermatologists at Cutis. 

Do we treat self harm or cutting scars?

We treat cutting or self harm scars in our Brisbane clinic, not in Sydney. This condition can be seen by our senior nurses at Cutis Dermatology. You do not need to see a dermatologist to embark on treatments. 

For more on self harm scars, visit drdavinlim.com search ‘cutting scars.’

Do we treat lichen amyloid / lichen amyloidosis?

We treat amyloidosis in Brisbane, but not Sydney. Sydney is a cosmetic pigment clinic, whilst Brisbane is a medical dermatology clinic. Lichen amyloidosis is treated by a team of medical & procedural dermatologists. 

The most cost effective treatment is with narrowband UVB, keratolytics & pulsed corticosteroids. Book a real time consultation with a dermatologist at Cutis Dermatology, Brisbane. 

Do we treat acne scarring?

We treat flat pigmented acne scars, also known as grade 1 scars or post inflammatory hyperpigmentation. These are discolored scars that do not have contour changes. These scars can be effectively treated with skin care products, & pico lasers. 

Of utmost importance is to have acne in remission during treatment as this ensures successful outcomes. If you have active acne, we will refer you to a medical dermatologist. Note: Dr Davin Lim is a procedural dermatologist, namely he does not prescribe medications for active acne. 

Do we treat pigmentation lines or pigmentation demarcation lines?

PDL or pigmentation demarcation lines are often refractory to treatment, meaning they do not respond well to lasers or creams. The chances of success is less than 5%. PDL test spots can be performed in Brisbane (as Sydney is a cosmetic clinic). Consider these facts-

• Though laser (in particular alex 755 Q switch) has been reported to remove PDLs, results are unpredictable. 
• Test spots are required over 3-6 months, cost for each session is $990 plus dermatology review.
• If you do respond (less than 5%), further treatment may be possible.
• Further treatment cost $1690 per session, it is not covered under Medicare.
• Cure is unknown.
• If you have pigmentation demarcation lines, consult a medical dermatologist who specializes in pigment. 

Our advice? Buy a nice pair of shoes instead. If you really want to ‘have a go’, you can get a test patch performed by Dr Davin Lim. FYI; we have published on the failure of even pico lasers in treating pigmentary demarcation lines. Consider these as latent birthmarks with an abnormality in the DNA. 

Do we treat pigmentation due to drugs?

Our Brisbane Clinic offers treatments, however this needs to be cleared by a medical dermatologist at Cutis Dermatology. We do treat some forms of drug induced hyperpigmentation in Sydney at the discretion of our dermatologist. 

*Some types of drug induced pigmentation are easier to treat than others. Minocycline pigment is relatively straightforward, as is argyria. PIH due to fixed drug eruptions are harder to treat. Rarer forms of drug induced pigmentation such as chemo induced pigment (bleomycin/ flagellate hyperpigmentation) can also be resistant to treatment. A dermatologist needs to be involved in these cases. 

Do we treat pigmented purpuric dermatosis or lichen aureus?

We do in Brisbane, but not in Sydney. PPD including lichen aureus is a medical condition treated by medical dermatologists. Treatments include phototherapy, pulsed CS topically as well as grade 1 compression stockings. In some cases a biopsy is required. 

Lasers are not first line treatment, but can be considered in recalcitrant cases under the supervision of a medical dermatologist. Test spots are required. This can be done in our Brisbane clinic, we do not offer this service in Sydney as Dr Davin Lim is a procedural dermatologist. 

Do we treat morphea or scleroderma?

Morphea or scleroderma can cause hyperpigmentation of the skin. These conditions are commonly seen by medical dermatologists. The mainstay of treatment is not with lasers but with medical therapy such as pulse CS, vitamin D, methotrexate chemo & UVB- UVA1. 

Lasers are not very effective. We do not treat morphea in our Sydney clinic, however you can make an appointment with our dermatologists at Cutis Dermatology in Brisbane. 

Do we treat lichen planus?

Lichen planus including lichen planus pigmentosus, Ashy variant, & others are usually resistant to lasers. They should be managed medically & hence treated by our medical dermatologist in Brisbane. We do not see/treat lichen planus in our Sydney clinic. 

Do we treat dark underarms / armpits?

Yes, however you will need to understand that lasers are only effective in some cases of dark underarms, namely secondary to post inflammatory hyperpigmentation. Other types of dark armpits are not treatable with lasers. 

At The Melasma Clinic we treat pigmented underarm patches via- 

Skin care at home: this is for mild cases of pigmentation in the absence of inflammation. Read the section on Dark Underarms to understand more. 

Prescriptive skin care by a medical dermatologist: is best if there is inflammation. 

Laser treatment by procedural dermatologist for some cases of underarm pigment. 

Combination treatment provides the best results. 

What is the best treatment / remedy for dark underarm patches?

This is complex. Dark underarm patches can be genetic, secondary to post inflammatory hyperpigmentation or a condition called acanthosis nigricans. Here are the treatments available-

1. Genetic; hard to treat. Pico laser & lightening creams. 4 sessions over 4 months. Chances of success is less than 25%.
2. Post inflammatory hyperpigmentation; usually secondary to excessive sweating & deodorants or antiperspirants. Sweat stopping injections can markedly reduce sweating (under Medicare). Use QV brand antiperspirants, followed by a series of pico laser treatments & bleaching creams. Treatment is over a period of 4-8 months with a success rate of over 70%. 
3. Acanthosis nigricans present as dark patches under the arms & the back of the neck. This is best managed by a medical dermatologist or endocrinologist. Lasers are rarely helpful as they work in less than 20% of cases. 

What home remedies/ DIY treatments are there for dark underarms / armpits?

Read the section on Dark Underarms for more information about DIY or home remedies. In summary-

1. Use a glycolic acid 7% toner in the shower. 
2. Use Azelaic acid 20% in the evening. 
3. Add niacinamide 10-20% as tolerated. 

Home remedies are not as effective as pico lasers & prescriptive skin care. 

 

Miscellaneous FAQs

What is our cancellation policy?

We have long waiting lists for appointments & treatments.  As a courtesy to other patients & our clinicians we request that you provide at least 24 hours notice for cancellation or change of appointment. This  ensures that we may offer your appointment to other patients on our wait list.

A $140 cancellation fee applies  for not notifying reception of inability to attend within 24 hours of the scheduled appointment. 

Do we have a clinic in Melbourne?

No, the clinic is only in Brisbane & Sydney. If you have melasma or pigmentation in Melbourne, see Laser Dermatology in Box Hill. 

Professor Bekhor treats more complex pigmentation, whilst simpler cases are managed by his experienced nursing team & dermatologists. 

Our clinicians will most frequently prescribe you a bespoke formula based on the above factors. 

Do we have a clinic in Adelaide or Perth?

No, the clinic is only in Brisbane & Sydney. The rate limiting aspect of The Melasma Clinic is the diagnosis & training. It is not a cookie cutter clinic (like Laser Clinics or Australian Skin Clinics), it takes many years to train our physicians & dermal therapists. 

Do we have an overseas branch?

No, the clinics are only in Brisbane & Sydney. It takes many years to train the staff at these two locations. We can not replicate the standard of care elsewhere. 

Do we guarantee our results?

The Melasma Clinic is based upon science & not marketing. We are not a spa or beauty salon but a specialist center. We treat patients & not clients. Though we have one of the highest hit rates for melasma, at over 80% however we do not guarantee results. Here is why-

1. We can not modify genes. One of the causes of melasma is a genetic drive to produce pigment at a certain age. Genes means your genetic profile not your families. 
2. We can not supervise your degree & extent of sun protection. This includes sunscreen compliance & other methods to reduce background radiation (this includes sun, heat & sources of HEV or visible light).
3. Melasma & other causes of pigmentation are managed at our clinic in a medical problem, much like high blood pressure or diabetes. These are chronic medical conditions that usually respond to medical therapy, however treatment failures are known to occur.

Why is my melasma not responding to treatment?

It is hard to say without more information (real time not, AI generated) & an in-clinic examination. Briefly the most common causes of melasma not responding to treatments include-

1. In-adequate photoprotection. By far the most common cause & overlooked by 90% of melasma sufferers. You need the correct photoprotection with correct application technique, frequency & amount. 2 finger lengths of SPF 50+, at least twice a day, augmented with visible light protection. Read this website for more information. 
2. Dermal melasma. This can be in-situ or secondary to previous procedures like microneedling
3. Wrong combination of pigment correctors. 
4. Wrong selection & settings of lasers. 
5. Wrong combination of treatments
6. Post inflammatory pigmentation due to products, chemical peels, or lasers. 
7. Resistant melasma (reality of treating a medical condition). 
8. Sources of IR heat; sauna, heat via cooking. 
9. Wrong diagnosis- PIH, pigment demarcation lines, secondary causes of pigmentation. 

For resistant melasma, you should, ideally, be seen by a dermatologist. Our biggest tip? Read point number one & eight & get this correct before moving onto other reasons. 

What is the best cream for pigmentation?

It depends on the intensity of pigmentation. For home use; try the following-

• Ascorbic acid or vitamin C (10-20%)
• Azelaic acid (15-20%)
• Arbutin (0.5 to 2%)
• Licorice root 
• AHA such as glycolic or lactic acid
• Retinol & retinoids
• Niacinamide
• Kojic acid
• Green tea
• Cysteamine 

Our clinic uses more powerful pigment correctors known as tyrosinase inhibitors. Examples include hydroquinone, cysteamine, & high strength arbutin as well as prescription retinoids. The exact formulation is made up according to your type of pigmentation. 

What is the recovery following pico laser treatment?

Pico laser recovery depends on the settings we use. As a guide-

• Melasma pico laser; skin recovers within 30 minutes
• Normal rejuvenation pico laser; up to 16 hours
• Pico for birthmarks, up to 4-6 days

Our clinicians will always inform you of the expected recovery time prior to the laser. 

Do pico lasers have side effects?

Side effects are exceedingly rare with pico lasers such as Picosure or Picoway, however settings matter– a lot. 

If incorrect settings are used (or in paradoxical situations), post laser skin darkening can occur in up to 5% of cases.  Your clinician will mitigate these risks depending on the application of pico laser. We may take steps that include prescription of appropriate skin care prior to, or just after laser. 

Can melasma be cured?

Unfortunately there is no cure for melasma, however with appropriate skin care, lasers & peels, 85% of melasma can be treated. In most cases we can get remission periods of 4 to 18+ months. 

To date, pico lasers give the longest remission period. Cosmelan peels can also help, especially when combined with at home skin care. 

What causes dark patches on the neck?

You mean acanthosis nigricans? Google this. You are best treated by a medical dermatologist with metformin & tretinoin cream. Salicylic acid washes may help. 

This condition is notoriously difficult to treat with lasers. The success rate is around 10%, with an out-of-pocket cost of over $2,800 for a cycle of pico lasers. 

Do we do skin lightening?

Yes, however you must be a good candidate for this procedure. In most cases we can get one to two shades lighter. This requires –

1. Sunscreen use (alot).
2. Topical pigment correctors for both face & body.
3. Laser treatments.
4. Supplements. 

Most patients get several months of benefit from skin lightening, especially leading up to winter, however we can not permanently change your DNA that programs your skin’s color. 

Do we lighten lips?

No, with the exception of freckles on the lips (laser). This is done by our dermatologist. 

We do not use chemical peels or lasers to treat dark lips as-

1. Side effects are higher.
2. Results are temporary, especially for genetically dark lips (seen in ethnic or darker skin patients). 

Can we lighten skin on the body?

In most cases we can get your skin one to two shades lighter. Skin color is ingrained in your DNA, however we can suppress pigmentation production with a series of laser sessions. 

Do we treat dark circles?

Yes. But only certain forms of dark circles. Review the page on dark circles on this website to understand more, but here is a quick summary-

• The causes include genetics, volume loss – tear trough, vascular, pigment induced or mixed. 
• Mixed causes are the most common.
• Constitutional or genetic causes respond poorly to treatment.
• Pico lasers can be effective in some cases.
• Vascular lasers can be added.
• Dermal fillers provide the best results for hollowness.

Dark circles is a complex type of pigmentation to treat, as there are multiple factors at play. A dermatologist is often required for diagnosis & management. 

For medical causes of dark circles (endocrine, maturational hyperpigmentation, irritant contact, allergic contact), you will be managed in our Brisbane clinic under a dermatologist. The Sydney clinic will only manage dark circles due to volume loss – tear trough deformity, as we treat this with dermal fillers. 

Do we have Dermamelan Intimate?

We will be getting this treatment in mid 2024. This is a depigmentation method for the intimate area. Intimate hyperpigmentation is an increasing concern, and is one of the dermo-aesthetic treatments that generates the most interest. This is because darkening skin in the intimate area can have a negative impact on the quality of life, affecting self-esteem and one’s sex life.

Do we use IV glutathione?

No we don’t, primarily because the effects are temporary & unpredictable. 

Major side effects such as renal failure or blood poisoning may develop if a patient is given a dosage that is far higher than recommended. Apart from that, some other side effects that may occur if the dose supplied is greater than 5 grams include: Nausea. Rashes, hives, or allergic responses on the skin.

Possible side effects may include:

• abdominal cramps.
• bloating.
• trouble breathing due to bronchial constriction.
• allergic reactions, such as rash.

If you would like to consider glutathione, take a tablet instead. The dose is 500 mg daily, with a max of 1500 mg.  

Can I get a single spot treated?

Yes, however the cost is the same as per Series treatment. The Pico Rejuvenation Series consists of 4 Pico sessions. This treats the pigment spot/s PLUS the full face. 

Alternatively you can book an appointment with Dr Davin Lim. Each session of laser starts from $1490, regardless of the number of spots. Factor in 1-3 sessions, depending on the diagnosis. 

If you have one or two spots, it may be more cost effective if you see a laser technician at a mainstream commercial skin clinic.

Is this Chat GPT or an AI generated chat bot?

Congratulations. You think you have figured it out, yeah? Guess again. If you are reading this, you are the one in 2,567 who asked this question, so that’s awesome. 

Firstly, no, you are not talking to a Bot. Dr Davin Lim programmed this. Why all the effort? 95% of questions can be answered with 20-30 FAQs. Imagine explaining the same shit for the rest of your professional career. Seriously. It is much easier to program this over a glass or two of wine than to spend a lifetime telling people how to use sunscreen or how to treat pigmentation. It’s called efficiency & time management. Please ask more questions…but seriously, congratulations for asking that question. 

Do we treat Ashy dermatosis?

Yes, but we are no different than your treating dermatologist. All cases of Ashy will need to go through Dr Davin Lim, Dermatologist. Here is a summary of how he manages Ashy; 

1. I work in conjunction with your medical dermatologist. My work is non-prescriptive, only laser. Your dermatologist may start you on hydroxychloroquine, retinoids, or clofazimine. Topically they may add tacrolimus. 
2. If inflammation is controlled, we may start you on pico lasers. You will need 4-8 sessions over the course of 3 to 7 months. Your chances of successful pigment removal is less than 25% after this time period. 
3. In summary, Ashy is very hard to treat with lasers, medical management is the gold standard. You may require a biopsy by a medical dermatologist prior to commencing laser therapy. 

Do we treat lichen planus?

This is a medical condition & the inflammation should be under control before embarking on a course of lasers. You will need clearance from our dermatologist prior to treatment. If you have any active lichen planus, Dr Davin Lim will coordinate treatments with a medical dermatologist first, prior to treatment. 

*We do not get involved in medical (prescriptive) dermatology. For conditions like lichen planus & lupus, the treatment is medical. Lasers only address post-inflammatory hyperpigmentation. 

Do we treat lichen amyloidosis?

All cases of lichen amyloidosis will need to go through Dr Davin Lim, Dermatologist. Here is a summary of the algorithm for lichen amyloid- 

I work in conjunction with your medical dermatologist. My work is non-prescriptive, only laser. Your dermatologist may start you on retinoids, creams & or narrowband light.

Pico lasers can be effective in less than 35% of cases. You will require 4-6 sessions over 6-8 months. The high failure rate means you should carefully think of treatments before commiting to a course of laser. 

Do we treat lichen planus pigmentosus?

All cases of Ashy will need to go through Dr Davin Lim, Dermatologist. Here is a summary of how he manages LPP or lichen planus pigmentosus; 

1. Medical management via your dermatologist ( I do not prescribe medications or follow up LPP, this is done via a medical dermatologist). Your LPP must be non-inflammatory before any laser treatment. 
2. Pigment correctors during laser treatment.
3. Pico laser over a period of 6-8 months. 4 sessions, spaced 4-8 weeks apart. 

*The chances of LPP responding to a laser is less than 40%, even with the most technologically advanced pico lasers available. 

Do we perform genital skin lightening?

At this stage, no, we do not lighten-bleach-genitalia. You can perform a Google search as to who performs this procedure. There are products available, see below for suggestions. 

• Dermamelan Intimate is a depigmenting treatment for the genital area. It requires an in office visit, followed by an at home routine. 
• Welltimize™ White It Up is a skin whitening gel that claims to be effective in treating dark spots, uneven skin tone, excessive pigmentation, and skin discoloration for intimate areas. Customers have reported seeing positive results in both the short-term and long-term periods, making it a reliable and effective option for those looking to lighten their intimate areas.
• Famirosa intimate area whitening cream is considered to be acceptable. However, as with any skin product, users with sensitive skin should take caution and perform a patch test before applying the cream to the entire intimate area. 

Do we treat DPN or dermatosis papulosa nigra?

Dermatosis papulosa nigra presents as spots of small, dark bumps that usually appear on the face & neck. DPNs are asymptomatic, however can cause skin irritation & itch if clothing or jewelry causes friction. They are also unsightly. 

Treatments are available via our dermatologist, however given how simple treatments are we suggest you see your normal dermatologist for management of DPN. 

As a guide, Dr Lim combines lasers & surgery to treat. Each session cost $2490, factor in 2 sessions if they are extensive. Healing time is approximately 5-6 days. The treated areas are often white for 1-2 weeks, normalizing in color over the next 3 months.  

For cases of DPN in Brisbane, book an appointment with our senior nurses of dermatologists for treatment options. 

Do we treat pigmented purpuric dermatosis?

No. PPD or pigmented purpuric dermatosis is managed by a medical dermatologist not a procedural dermatologist. Dr Davin Lim is a procedural/laser dermatologist. 

PPD is managed via a biopsy to exclude MF (in suspicious cases), followed by compression stocking, pulse cs ointments, & in some cases narrowband UV. Though lasers have been reported to treat pigmentation (hemosiderin staining secondary to leaky vessels), the results are unpredictable. 3-6 sessions are required with multiple test patches & costs over $5500. The chances of success is less than 10%. Additionally lasers do not guarantee that PPD will not return. Again, a medical dermatologist can guide you as to the best treatment options. 

Do we treat dark knuckles or fingers?

This type of pigmentation is difficult to treat. A medical dermatologist is the first port of call as conditions such as dermatomyositis, lupus etc. will need to be excluded from constitutional or genetic causes of pigmentation. Occasionally, your medical dermatologist may request cortisol & thyroid function tests. The Sydney clinic will not treat this condition as Dr Davin Lim is a procedural dermatologist, not a medical one!

Providing medical conditions are excluded, we can initiate patients on a course of lasers & topical creams. The success rate is around 10% at best. Factor in 5 sessions at $890 per laser treatment. 

Do we treat pigment or dark spots on the hands?

Age spots are common on the hands. We use pico & Q switch lasers to treat these spots. Factor in 2-4 sessions, depending on the depth & extent of pigmentation, as well as your expectations. 

Do we treat age warts or seborrheic keratosis?

We do not treat warts. You are best seen by your dermatologist or a skin cancer clinic for removal of benign warts. The main reason is that laser treatment of warts generates plume, & our smoke evacuators in the clinic can not handle high loads of vapor plume. 

Do we treat DPN or dermatosis papulosa nigra?

We can treat DPN, however this is performed by a dermatologist, primarily because dermatosis papulosa nigra occurs in darker skin types & hence treatments can be tricky to perform. 

For Sydney patients, the procedure is performed by Dr Davin Lim. Each session cost $2490, factor in 2 sessions. We use lasers, cautery & curettage. Brisbane patients are treated by our experienced nurses at Cutis Dermatology. Once treated, most patients will have remission for several years. 

*DPN can be treated by experienced dermal clinicians who deal with darker skin types. 

Do you / we treat skin tags?

Skin tags are not treated in our Sydney clinic, however you can book an appointment with our nurses at Cutis Dermatology in Brisbane. Alternatively a dermal therapist can provide you with skin tag removal. 

Our dermatologists do not treat skin tags. 

Do you / we treat acne scars?

Dark acne scars are treated at The Melasma Clinic using pico lasers. Important factors to consider are-

1. Your acne should be in remission or at the very least show a downward trend in activity. This prevents you getting more breakouts, leading to continual post inflammatory hyperpigmented acne scars. A medical dermatologist can assist. 
2. Scars, ideally acne scars should be FLAT & not raised – depressed. For other types of scarring, the algorithm is complex. Go to drdavinlim.com for more information. 

Read point number one again, then read it again. This factor is overlooked by over 80% of acne scar sufferers. If you have active acne together with pigmented acne scars, our clinicians will refer you to a medical dermatologist for specialist management of your acne. Dr Davin Lim is strictly procedural & does not prescribe medications for acne. 

What treatments are there for dark scars / burns?

Dark scars can be treated with pico lasers. You will require a series of sessions over 4-8 months, depending on the extent of your scarring. 

Here is a quick summary of the rather complex algorithm of scar treatments.

Scars that do well: dark flat acne marks with acne in complete remission. Chicken pox scars, post inflammatory pigment from insect bites, & laser accidents

Scars that don’t do well: raised scars including keloid scarring. These scars are managed by our dermatologist, Dr Davin Lim. The aim of scar revision is to flatten down these scars. Pigment fading may take 24 months or longer. 

Acne scars & post inflammatory hyperpigmentation: Providing the patient has insight as to their acne activity level, pigmented scars are relatively easy to treat, especially with pico lasers. If the patient has little insight (common), they will chase their tail with pigmentation. 

How to treat acanthosis nigricans?

AN or acanthosis nigricans is a common skin condition that affects the armpit areas leading to dark patches. It can also affect the neck, groin & in some cases the face. We discourage treatment at the Melasma Clinic as you will have better results by seeing your GP, endocrinologist, dietician or medical dermatologist.  

This is what other practitoiners will do- 

1. Diet & lifestyle changes. This is the most effective method. Your GP, dietician & endocrinologist will guide you through weight loss & insulin management, including the potential use of metformin at 500 to 1500 mg daily. Once your weight drops, your dark patches will more than likely resolve. 
2. Skin directed treatments with prescription medications by a medical dermatologist. Creams include retinol serums, vitamin D creams & exfoliants such as glycolic acid 7% toner washes. 
3. Laser & peels. Acanthosis nigricans do not respond well to lasers & chemical peels. The chances of resolution following laser therapy is less than 20% after a series of 3-6 sessions. We discourage you from trying lasers. Whilst chemical peels such as Dermamelan Intimate may be effective in some patients, they require close follow up as the recovery time is significant. 

Is BBL better than pico laser?

Pico laser is better than BBL or IPL in 95% of cases. 

BBL is better than pico for –

1. Poikiloderma of Civatte (neck pigmentation).
2. Overlap of red & brown cases (rosacea & pigmentation)

Pico has less side effects & less recovery compared to BBL. Additionally, pico improves melasma, BBL flares or worsens melasma. 

Will treatments guarantee that melasma is treated or removed?

There is no guarantee that treatments are 100% effective, especially when dealing with melasma. The Melasma Clinic approaches your pigmentation in a medical not a retail manner. This means we will give you a percentage probability of your treatment working. As a guide-

• For medical & pico management of melasma, we are successful in over 80% of cases.
• Cosmelan peel? 60% effective. 

We will discuss the effectiveness of treatment & consent prior to treatment to ensure your expectations are met with realistic outcomes. 

Your percentage probability of effective treatment drops significantly if you have dermal melasma, or resistant melasma secondary to microneedling. 

How to treat dermal melasma?

Dermal melasma is difficult to treat. Response rate is low & if successful, it takes many treatments. Pigment is in the deeper layers of skin, out of reach of many lasers. The algorithm goes like this- 

• Tyrosinase inhibitors can work in less than 5% of cases. Vitamin C, L-ascorbic acid, 20% in the AM, followed by HQ (rotational to avoid ochronosis which is a differential diagnosis of dermal melasma). Consider vascular modulators orally. 
• Lasers; can be effective in rare cases. You have a greater chance of failure than success. Realistically the chances of responding to lasers is less than 5%. Pico lasers can be trialed. You will require at least 4 sessions spaced 8 weeks apart. For non-responders we can attempt erbium laser in fractional drill mode. This requires 4-6 sessions over a course of one year. Post laser hyperpigmentation is not uncommon.
• Microneedling can be effective in less than 5 % of cases, but you need to go deep- beyond 1.5 mm. This requires a needle then squeeze technique for the melanin shuttle to work. Count on 10 sessions over 12 months.

We encourage you to carefully consider the costs of these treatments (often close to $10,000 USD) vs that of the success rate prior to your journey. Until we find a way to remove dermal pigment, dermal melasma is still one of the most challenging types of pigment to treat. 

How to treat upper lip pigmentation or melasma?

The upper lip is commonly affected by melasma pigmentation. This area is more resistant to treatment compared to the cheeks & forehead, especially if some ‘expert’ has used microneedling in this area (a frequent mistake). 

At the Melasma Clinic we use a combination of pigment correctors, special picosecond lasers & in some cases, novel chemical peels to remove unwanted pigment. Upper lip pigmentation can be markedly improved in 70% of cases (as compared to 85% in other melasma areas). Dermal pigment, especially secondary to microneedling or lasers/IPL has a poorer prognosis.  

*Another frequent instigator (not a cause but a catalyst, know the difference) is waxing or laser hair removal, especially with IPL. Whilst pigment rebound looks dramatic, it is easier to remove as compared to microneedling pigment. 

How to treat ochronosis?

Ochronosis is difficult to treat. Response rate is low & if successful, it takes many years & a multitude of treatments. Here is the algorithm-

• Get a diagnosis. See a medical dermatologist for a biopsy. Though we can provisionally diagnose ochronosis via dermatoscopy, a sample of skin should, ideally be taken. Do this via a normal-regular dermatologist BEFORE seeing Dr Davin Lim. If the biopsy shows ochronosis, you can get a referral to see Dr Lim via your dermatologist. 
• Try some fuzzy skin care. It can work in less than 5% of cases. Vitamin C, L-ascorbic acid, 20% in the AM, retinoid in the PM. Oral vitamin C has been reported to work in exceptionally rare cases. Do this for 6 months. Obviously if ochronosis is secondary to hydroquinone use, stop it. 
• Lasers; can be effective in rare cases. You have a greater chance of failure than success. Realistically the chances of responding to lasers is less than 10%. We try pico lasers first- 3-5 sessions spaced 8 weeks apart. If you respond, good. If not we use non-ablative lasers, followed by erbium laser in fractional drill mode. This requires 4-6 sessions over a course of one year. 
• Microneedling can be effective in less than 10% of cases, but you need to go deep- beyond 1.8 mm (or as deep as the histology, hence refer to point number one). This requires a needle then squeeze technique for the melanin shuttle to work. Count on 10 sessions over 12 months.

We encourage you to carefully consider the costs of these treatments (often close to $10,000 USD) vs that of the success rate prior to your journey. Until we find a way to remove dermal pigment, ochronosis is still one of the most challenging types of pigment to treat. 

Do we treat other skin conditions?

We do treat a range of skin conditions via our skin clinic or via Dr Davin Lim. For more on what conditions we treat, goto drdavinlim.com 

Please note, we are a procedural dermatology clinic, namely we focus on injectables, lasers, deep peels & skin surgery. We do not treat rashes & our modus operandi is non-prescriptive dermatology.  

Does Dr Van Park do treatments?

Van does injectables only, her partner Davin does injectables & lasers. If you would like to see Van for injectables, you can be placed on a waiting list. Alternatively, you can book to see Dr Kate at DVP. 

Do we treat hypopigmentation?

Dr Davin Lim treats hypopigmentation. The most frequent causes of hypopigmentation (lighter skin patches) include acne scars due to picking, ice scars (due to gouging), chicken pox/shingles, burns, & trauma due to skin picking. Here is what to do PRIOR to seeing Dr Lim-

1. See a normal dermatologist for the usual microneedling + prostaglandin analogues & or calcineurin inhibitors. Persist for 6 months. 
2. If you have active lesions (eg. if you pick your skin), consult a medical dermatologist to place your condition in remission. This is essential. Note; Dr Lim does not treat this condition as his work is entirely procedural. 
3. Providing the above criteria is fulfilled, you may be a candidate for pigment transfer. This is a highly complex procedure that requires skin surgery in an operating theater, often under sedation. It works well in over 80% of cases, but it can take up to & beyond one year for best results. Go to drdavinlim.com to find out more on how to manage hypopigmentation. 

Do we or can we treat darkening around the mouth area?

Pigment around the mouth area can be due to 2 things. 

1. Irritant or allergic reactions. Easier to treat, required medical intervention. 
2. Genetic causes. Hard to treat. 

Here is the treatment algorithm –

• Exclude irritant or allergic dermatitis. A medical dermatologist is the first port of call. They can differentiate conditions such as lick-lip dermatitis, irritants (secondary to saliva or skin care) versus allergies. Patch testing may be required. This clinic has a procedural dermatologist, we do not get involved in medical conditions. 
• If above excluded, option for pico lasers & pigment correctors. If the cause is secondary, treatments are more successful. 80% of cases respond within one year.
• If there is a genetic component (darker skin – ethnic patients), the chances of pigment fading drops dramatically to 20-30% response rate. 
• We prefer pico lasers over chemical peels as the latter has downtime. Cosmelan or Dermamelan peels can be effective in some, but not all patients. 
• Perioral pigment is challenging to treat, understanding the cause & potential success or failures of treatment is important. 

Do we treat neck or chest pigment?

Yes, but treatments can be complex, depending on the type & extent of pigment. The aim of treatment is to blend the area, and not provide areas of demarcation. A series of 4-8 sessions may be required. We employ-

• Pico & fractional lasers for brown areas
• Vascular lasers for red areas

In some cases both lasers are indicated. This project often takes 4 to 10 months. 

What is better tablet or cream tranexamic acid?

In order of merit, tablets, followed by injections, followed by topical creams & serums.

TA orally has the potential of side effects, hence it is prescribed by a specialist. The most important contraindication of tranexamic acid orally is to exclude a personal or family history of blood clots. 

If you would like to try a 5% tranexamic acid serum for your melasma, you can order this online. Any brand is fine, just Google. 

What is the best tranexamic acid brand?

There are no studies comparing different tranexamic acid brands, however the consensus is to use a concentration ranging from 2-5%. A simple, cost effective brand is the Inkey List tranexamic acid. 

For more effective solutions, a prescription of tranexamic acid is required. You will need to be reviewed by a physician prior to scripting. 

What are the side effects of tranexamic acid?

Creams: skin irritation. 

Tablets: blood clots, irregular bleeding, gastrointestinal upset, tummy cramps. 

Our clinicians will take into account your personal & family history prior to prescribing t.acid. This ensures that we pick up any contraindications to therapy. 

Can melasma be treated without tranexamic acid?

Yes, but your odds go down. When we formulate a treatment plan, it is based upon –

• Your clinical findings
• Your past treatments
• Your expectations
• Your medical history

An ideal plan is formulated based upon the above, however if you would like to add/subtract/view your treatment like a Maccas menu, then the odds of pigment resolution diminishes. 

Can Rejuran treat melasma?

Though there are some anecdotal reports of polynucleotides such as Rejuran improving post inflammation & melasma, we do not traditionally employ this method of treatment for pigment. 

Rejuran is best for improving skin quality, anti-aging & enlarged pores. It is best combined with pico lasers. 1-3 sessions are best for optimal results. 

How do I know if I am allergic to Cosmelan or Dermamelan peels?

The provider of your treatments should know the difference between an irritant contact dermatitis (very common with Cosmelan & Dermamelan peels) & allergic contact dermatitis. 

They will alleviate your skin irritation with pulse CS topically & or a short sharp tapering dose of prednisone. Once your skin has settled they can do a ROAT test (Repeat open application test) or a test patch. If an allergic reaction is suspected, your clinician can escalate this to a medical dermatologist for patch testing in the clinic. 

Our Brisbane clinic has medical dermatologists who have an interest in patch testing, our Sydney clinic has a dermatologist who has extensive knowledge in patch testing but zero interest. For Sydney patients, your clinician can escalate your case to the Skin Hospital at Darlinghurst for management & investigations. 

Why did melasma worsen with a laser?

Lasers are merely instruments & not a means to the end. Much like a pair of scissors for a haircut, the results depend on the person/s performing it. 

• Settings matter – a lot! Lasers are merely tools, the settings are critical for results. This includes power, spot size, shot count, wavelength, pulse duration, pass speed, & technique. At The Melasma Clinic we use our own settings, honed over the past 20 years. 
• Pigment corrector selection; is also important. The ideal topical depends on the phase of melasma treatment & your innate skin sensitivities. We then formulate a concentration of the best ingredients based on the above factors. 
• Radiation protection is critical, everything from UVB, UVA, high energy visible to IR. Your clinician will provide you a comprehensive guide based on the above. 
• Misc. factors include; application technique, depth of melasma, tachyphylaxis, ochronosis & more. 

If you have complex cases of pigmentation, you may be required to be reviewed & treated by our dermatologists over nurses & therapists. 

Do we do microneedling PRP for melasma?

At the Melasma Clinic we practice evidence based clinical dermatology, meaning we offer better treatment options for patients. As a guide- 

• Pico lasers plus medial therapy; 80+% chances of working (to clear melasma)
• Cosmelan peel; 60%
• Nano lasers; 60-75% 
• Microneedling with or without PRP for melasma; less than 30% chances of improving 

Though we are not against microneedling PRP (we do this primarily for hair), there are far better & safer alternatives for melasma. 

*Microneedling PRP offered in both Brisbane & Sydney clinic. 

Why did my melasma not go away / respond to pico laser?

Not all melasma responds to lasers, however at The Melasma Clinic we have a response rate of over 80%. Top reasons why melasma does not respond to lasers are-

• Settings matter – a lot! Lasers are merely tools, the settings are critical for results. This includes power, spot size, shot count, wavelength, pulse duration, pass speed, & technique. Much like a pair of scissors for cutting hair, how you use it is more important than what you use. 
• Pigment corrector selection; is also important. The ideal topical depends on the phase of melasma treatment & your innate skin sensitivities. We then formulate a concentration of the best ingredients based on the above factors. 
• Radiation protection is critical, everything from UVB, UVA, high energy visible to IR. Your clinician will provide you a comprehensive guide based on the above. 
• Misc. factors include; application technique, depth of melasma, tachyphylaxis, ochronosis & more. 

It is important to understand that we still do not have a 100% hit rate with melasma, as 20% of cases fail to respond, even if all the above factors are taken into account. 

Can I get melasma treatment in Summer?

Melasma is caused by 3 things, with unequal contributions for each individual, namely genetics (we can’t change that), hormones (we don’t endorse removing your ovaries) & sun exposure (something we control). If you like the sun, it may pose a big problem, especially if you do not sun protect (absolute sun protection, not relative to your standards). 

If you are well protected in the Summer months, it will not pose a problem, however if your sun protection is mediocre, the chances of us making a big impact on your melasma goes from 80% to less than 20%. 

When is the best time to get melasma treated?

If you are good with your photo-protection, any season is fine, granted there is season variation with radiation. Longer summer days means you will be exposed to UVB, UVA & visible light for longer, however if your protection is adequate, your melasma should respond nicely to treatment. 

Pico lasers are safe to perform in the summer months as ideal candidates practice strict & absolute protection from the sun. 

Can I get melasma treated if I like the sun?

Yes, but you may be pissing in the wind. Melasma is caused by 3 things, with unequal contributions for each individual, namely genetics (we can’t change that), hormones (we don’t endorse removing your ovaries) & sun exposure (something we control). 

If you like the sun, it may pose a big problem, especially if you do not sun protect (absolute sun protection, not relative to your standards). For sun lovers, the chances of us making a big impact on your melasma goes from 80% to less than 20%. 

Can melasma be hormonal?

The three causes of melasma are genetics (your DNA, not just your family), radiation (includes UV, visible light & IR) & hormones. 

Hormonal contributions include pregnancy & in some cases the oral contraceptive pill. Both contributions may initiate melasma, but in most cases they do not propagate it. Some cases of melasma settle once the hormonal drive is removed. 50% of pregnancy associated melasma will persist after 12 months postpartum. 

Can melasma be due to thyroid disease?

There is a correlation between melasma & thyroid disorders, especially hypothyroidism or underactive thyroid. There are increased antibodies in some cases of melasma. If you keep your thyroid function within normal limits, it can help manage your melasma. 

Thyroid function tests can be arranged by your treating GP or endocrine specialist. 

Can melasma be treated internally?

Fluffy non-scientific treatments are not offered at The Melasma Clinic. For holistic, alternative methods, you are best seen by a naturopathetic practitioner. They can discuss alternative medicine practices including diets, supplements, acupuncture, meditation, chanting & herbal remedies. 

*The caveat is that some cases of pigmentation/melasma can be associated with internal disturbance in hormones such as cortisol, thyroid hormones & adrenal dysfunction. In cases of endocrine dysfunction, our dermatologist can liaise with an endocrine specialist or a medical dermatologist to investigate & manage these conditions. Not all cases of ‘internal dysfunction’ are fluffy. 

Will melasma go away if I stop the pill?

Possibly. In 20-30% of cases melasma may lighten once the pill is ceased. It can take up to 12 months to see the effects. The OCP is more frequently associated with initiating melasma. 

Non-hormonal forms of contraception are recommended if you suffer from melasma. Discuss this with your gynecologist. 

How do I prevent melasma from coming back?

The bad news? In most cases, melasma is chronic (relapses are common), the exception is that in 50% of pregnancies, melasma may fade significantly within 6 to 18 months. 

The natural history of melasma is to resolve over a period of 20 to 30 years, however there are strategies to increase your remission rate. They include-

• Adequate photoprotection against UVB, UVA & VL or visible light (the most important factor that is commonly overlooked). 
• Pigment inhibitors that include azelaic acid, arbutin, ascorbic acid & more.
• Lasers & novel chemical peels in a rotational manner. 

At The Melasma Clinic we customize a melasma maintenance program that takes into consideration your skin type, goals, & your unique melasma pattern to ensure that you will remain pigment free for longer. 

Can microcurrent flare up melasma?

Microcurrent does not flare up melasma (based upon scientific evidence). The amount of heat generated is negligible, additionally there are no light sources with microcurrent treatments. 

*This refers to microcurrent devices like the Zipp, Foreo Bear & others. Some microcurrent devices contain light sources. If you have a multi-modality microcurrent device, LEDs in the blue light spectrum will flare up melasma. 

Can LEDs flare up melasma?

It depends on the wavelength of light & the intended use. The wavelength to absolutely avoid is blue light at around 410 to 430+ nm. Blue LEDs stimulate pigment cells to increase their melanin production, making melasma worse. 

Light in the longer wavelengths can potentially flare melasma via the generation of heat, especially in the IR or infrared wavelengths. Keep your application times short & your wavelength selection precise & chances are your pigment won’t flare. Review this website for more information on how the clinic uses LEDs in the context of melasma treatments. 

Can blue light flare up melasma?

Absolutely. Blue light lies in the HEV or high energy visible light spectrum. Of all the colors, this is the one to avoid, especially if you have ethnic or dark skin. 

Melanocytes (pigment cells) contain a receptor that is super sensitive to blue light called OPSN. Blue light in the 410-430 nm spectrum stimulates the receptor to produce melanin, this makes melasma worse. 

* Red, yellow, & orange light can marginally improve melasma, however the energy levels must be conservative- less than 20 mj/cm2. Higher energy levels can also stimulate melanin production. 

Can mobile phones flare up melasma?

No, the background HEV or high energy visible light (Blue) from home electronic equipment such as mobile phones & monitors have too little energy to flare melasma & pigment conditions. You are far more likely to get melasma flares from HEV or blue light found in visible daylight. Additionally, LED masks (blue not red/amber/yellow/orange) can potentially flare up melasma pigment. 

*To protect against HEV, you must have one of two filters- firstly iron oxide, secondly pigment grade titanium dioxide. We have programed this Chat Bot to guide you through what is required to protect against visible light, so ask away. 

Can cooking flare up melasma?

Absolutely. Heat sources such as stoves, ovens & fireplaces are hidden sources of infrared radiation. 

Cooks suffer from melasma (esp. In Asian & Middle Eastern culture), as they are continually exposed to copious amounts of infrared radiation. You can purchase special IR shields online. 

Can saunas flare up melasma?

Definitely. IR or infrared heat – radiation from saunas are one of the hidden flare up factors for melasma. Heat is also found via cooking. Unlike UV radiation from the sun, infrared radiation is much harder to shield from. There are several IR shields available online. 

Can melasma come back after pico laser?

Yes. Melasma is a chronic condition, much like high blood pressure, diabetes & arthritis. Recurrence is possible, however in most cases we have remission rates of 1-2 years. Some shorter, some longer. 

How often can I have pico laser?

It depends on the settings & operator. Generally every 2.5 to 52 weeks (yes it is that variable). For melasma we generally treat at 3 week intervals. For skin rejuvenation, once sorted your skin can be great for up to 3-5 years. 

Are we experienced in treating dark skin?

Yes. In fact 30% of our melasma patients are ethnic. We also perform skin rejuvenation in all skin types, including darker skin patients. Our clinicians have extensive training in Asia. In fact we lecture in Asian countries. 

Do we perform anti-wrinkle injections or soft tissue fillers?

Yes, the clinic does perform anti-wrinkle injections & dermal augmentation using fillers. Dr Kate or Dr Vee will have appointment slots, whilst Davin & Van may open up slots…occasionally. 

How to treat dark acne scars at home?

More information on Dr Davin Lim’s website; drdavinlim.com 

Briefly, here is the summary-

1. Sunscreen.
2. Vitamin C in the morning, Differin Gel in the evening. 
3. Add azelaic acid as tolerated in the evening, pulse glycolic acid serum every 7 to 10 nights. 

With the above you may get some marginal improvement, however for more effective treatments, pico lasers can resolve post inflammatory hyperpigmentation 10 times faster than home remedies. 

Where to find iron oxides?

Iron oxide can be found in mineral make up, tinted sunscreens & in most types of liquid foundation. 

For tinted sunscreens, the challenge is to find a good color match for your skin tone. Hence a quick & easy hack is to use normal untinted sunscreen and combine it with mineral makeup (high in iron oxide) that matches your skin tone. 

Sunscreens that contain iron oxide include Melan 130, Daily Face & La Roche Posay Tinted ranges. 

Where can I find the concentration of iron oxide?

You can’t. Iron oxide is not listed as an active ingredient in sunscreens, nor is it listed as a concentration in mineral or foundation make up.

The rate limiting factor of iron oxide concentration is how it sits/blends/looks on your skin. This is determined by the mix of red/yellow/ and black iron oxides. Darker skin patients will have higher concentrations, lighter skin patients will have lower concentrations. 

The actual difference in visible light attenuation is around 6%, namely light skin attenuates 92%, dark skin makeup attenuates 96%. From a practical standpoint, the variation is very small & in the context of compliance (cosmetic elegance), finding a suitable color match is more important. Just wear it. 

Is BB Cream good?

It depends on the SPF rating (as this dictates UVB protection) as well as UVA protection. The problem with BB cream is that you are limited to the color match for your skin tone. You need at least an SPF 50 BB cream if you have pigmentation issues. 

La Roche Posay Uvidea XL is SPF 50 but only has 2 tints. In contrast Sheer Glow Nude by Nature has 5 tinted skin shades but only has an SPF of 8. 

Is blue light bad for melasma and pigmentation?

Yes. Blue light is known as HEV or high energy visible light. It can worsen pigmentation, especially in darker skin types (OPSN receptor for blue light is prevalent on pigment cells in ethnic skin). If you suffer from melasma or PIH, you need blue light photoprotection. 

You can protect against blue light with several methods-

1. The best is iron oxides found in tinted sunscreen & mineral make up. 
2. Tinted windows (attenuates up to 70% of visible light in Australia). 
3. Pigmentary grade sunscreens with big particles of zinc or titanium. These sunscreens are cosmetically not acceptable for everyday use. 
4. Avoiding LED sources with blue light in the 410 to 430 nm spectrum. TVs & monitors have blue light radiation, but the amount is too small to worry about. 

Red, orange, yellow, green & amber LEDs are much safer than blue light if you suffer from pigmentary conditions. 

How many times a day should I use sunscreen?

At least twice a day. If you suffer from melasma & pigmentation, this is the minimal frequency  you should apply. It is not negotiable. The argument that you ‘never/don’t/hardly ever see the sun or go outside’ does not hold out. If you can see light, you are getting variable amounts of radiation, especially  HEV or blue light. 

Solar radiation (not just UVB, UVA) is prevalent in activities of daily living. Even if you don’t sit next to a window or rarely venture outside, the cumulative doses of radiation counts. Get in the habit of wearing sunscreen or your pigment treatment journey will be very frustrating (& very expensive).  

What is the best sunscreen?

A short answer is: SPF 50 + that is tinted, providing the tint fits your skin tone (color matching). Finding an SPF 50+ is easy, brands like Melan 130, La Roche Posay, Invisible Zinc, SkinCeuticals & others make great products. Finding a suitable color match is more difficult. 

If you do not have a good color match, find one that is UNTINTED & augment this with mineral makeup as it has iron oxides. This is the key ingredient for patients with pigmentation, including melasma. 

95% of patients do not have sunscreen application down pat prior to seeing us, so get this right before embarking on treatments. It is vitally important for results. Concentrate on how to use sunscreen & not on the brand. A simple guide is the ‘2 rule’. 

• Apply 2 finger lengths of sunscreen.
• Apply 2 times a day.
• Have 2 types of sunscreen available, depending on your activity level. One waterproof, & the other for daily use.

How much sunscreen should I use?

• Apply 2 finger lengths of sunscreen.
• Apply 2 times a day.

A 50 ml bottle should last you less than 2 weeks if you are on the conservative side of things. 

Do I need to use sunscreen at night?

No, there is no sun at night. Radiation from the stars & the moon, in addition to light sources is negligible, so you can get away without wearing sunscreen at night. 

Can I get laser hair removal or waxing if I have melasma?

Yes, providing your hair removal laser operator knows what they are doing. If wrong settings are used, your melasma will get worse. Your operator will know how to –

1. Use 1064 over 755 wavelengths in the context of skin types. 
2. Use sensible settings. 
3. Discuss ways to reduce pigment output after hair removal.

*Lasers are preferred over waxing for hair removal as the former is safer (when used correctly). 

**We do not offer laser hair removal in Sydney, we do offer this service at Cutis Dermatology in Brisbane. You do not need to see a dermatologist for this service, book in with our experienced dermal technician or nurses. 

Do we do CO2 lasers?

Yes, Dr Davin Lim performs CO2 lasers. Depending on the intensity & indication, lasers are conducted in our suites or a day theater (under sedation). CO2 is quite a few steps up from pico laser resurfacing. It is not used in melasma patients. 

As a guide-

• CO2 suitable for lighter skin types
• Associated with skin recovery of 7 to 14 days
• Redness post CO2 last 2 -16 weeks
• The procedure cost between $3690 to $14,990 per session

Do I really need to take tranexamic acid tablets?

We practice peer reviewed medicine based upon evidence in scientific journals. The risk to benefit ratio has been calculated by your physician. If you have been prescribed oral tranexamic acid, it will give you the highest probability of pigment clearance. If you decide not to take them, the probability of pigment clearance goes from 80% to around 40-50%. Ultimately the choice is yours.  

How long should I take tranexamic tablets for?

Keep taking them until your clinician weans you off the tablets. Typically, this takes 3 to 9 months. They will guide you according to your progress. 

Most often they will taper your dose to 2-4 tablets per week, when it is time to do so. We have ensured that you have been given lots of repeats to last at least 300 days. 

*This is the default answer, however your clinician would have specifically addressed the duration of treatment. 

What happens if I stop taking tranexamic acid tablets?

This answer is based upon probability & not possibility. The probability of pigment clearance goes from 80% to around 40-50%.

If your pigment flares up again (which is normal), we will probably extend the course of tablets in addition to finding out the lowest possible dose for the best pigment suppression. 

*This is analogous to treating diabetes or blood pressure, namely tablets can help & coming off them may make the condition worse, some patients require long term use. 

What happens if I have side effects to tranexamic acid tablets/ how to deal with tranexamic acid side effects?

If you have migraines, cease immediately, if you have other side effects (tummy upsets, irregular periods, cramps), do the following- 

•     Take ½ the recommended dose (written on your prescription).
•     Wait 3-7 days to see if the side effects go away with this lowered dose. 
•     Continue to this dose till your review. 
•     If you still have side effects, further half this dose, ie. Take ¼ of the original prescribed dose.
•     If you still have side effects, stop the tablet.