Recovery
Results
Treatment Time
Aftercare
Skin Remodelling
- Skin remodelling is the final stage of pigment control
- Remodelling addresses cellular aging
- By reducing the age of the deeper layers of skin, we reduce pigment production
- The most effective way to remodel skin is with a combination of injectables & lasers
- Skin care focuses on collagen remodelling & reducing of skin aging
At what part of our melasma treatment program do we start the bioremodelling journey?
Commonly when we understand what your pigment responds to, typically at the second or third visit. Once your primary pigment has subsided, we then introduce injectables to remodel your skin.
For mature onset melasma on the background of photoaging, we may introduce dermal remodelling injectables in your first session. Your clinical will discuss this with you during the consultation.
What do bioremodelling agents achieve & why are they important in melasma?
These agents help reverse the natural aging process of the skin, improving its resilience and prolonging melasma remission, while also rejuvenating overall appearance.
They work by stimulating collagen synthesis and remodeling the dermal matrix — the skin’s structural scaffolding. This dermal renewal sends biochemical signals to the upper skin layers, reducing pigment production and promoting a clearer, more radiant complexion.
What classes or levels of bioremodelling are there?
Bioremodelling can be classified according to their potential to stimulate collagen & remodel matrix.
- High level (lasers, polymer injectables)
- Moderate level (monopolar RF, pico fractional lasers)
- Low level (polynucleotide injectables, HA heat stabilized injectables, clinical peels)
- Very low level (exosomes & high strength prescriptive retinoids)
- Extremely low level (retinol, vitamin C & over the counter skin care products)
How long does dermal remodelling take?
This phase of melasma treatment takes the longest to complete, averaging 8 months from your first visit.
Not everyone requires this step as you may elect to commence this at the start or the end of your pigment removal journey.
Why are injectables better than remodelling compared to skin care?
Injectables provide compounds directly into the deeper layers of skin, by passing the upper layers of skin. Remember, the skin’s immune system is designed to protect itself from the outside. This includes topical ‘actives’ found in skin care.
What injectables do we use to efficiently remodel skin?
Our clinics are at the cutting edge of injectables, employing a range of agents including poly-L-lactic acid, polynucleotides, heat stabilized hyaluronic acid complexes, polycaprolactone, poly-D-L-lactic acid as well as calcium hydroxyapatite & hybrid injectables.
Polymer based injectables provide the highest level of biostimulation, however they have more side effects compared to HA hybrid complexes & polynucleotides.
The ideal injectable depends on many factors including the degree of sun damage, volume loss, skin quality issues, facial shape, as well as laxity. The algorithm is complex.
What lasers & devices provide the highest level of bioremodelling?
Selecting the best devices for collagen remodeling in melasma prone patients is important as many high level devices can worsen pigmentation. Knowing what device & settings to use is important for both results & safety.
- CO2 lasers provide the best remodelling
- CO2 lasers provide the highest risks of melasma flares
- Fractional short pulse lasers are a good compromise
- Non-ablative lasers, in the correct settings are also employed to remodel the dermis
Can I elect to use lasers only without injectables?
Whilst it is possible to build a wall just out of bricks without cement, the end result won’t be great. This applies to the combination of injectables & lasers as they complement each other. Lasers work on a different pathway to stimulate collagen as compared to injectables.
If you have mature age melasma & pigmentation, you need all the help you can get to stimulate collagen & remodel skin. If you are struggling with this concept; you can search AI (Chat GPT or Google AI) to understand the concepts of dermal remodelling, taking into account the most effective & efficient methods to increase collagen & elastin production.
Note: injectables are not routinely employed in early onset melasma (without photodamage), however they are advised if you have a). Photodamage b). Late onset (over 35 yo) melasma.
Does Cosmelan peeling effectively remodel the deeper layers of skin?
No. Cosmelan is designed primarily as a way to remove unwanted superficial pigmentation including melasma & post inflammatory hyperpigmentation. It is useful in 60% of melasma cases, however the Cosmelan kit does not take into account the long term goal, namely dermal remodelling.
What is the role of skin care in the bioremodelling phase of melasma treatment?
We prescribe different ingredients in this phase of remodelling including ingredients that build collagen (retinol, retinoids, ascorbic acid, glycolic acid) in addition to ingredients the protect the skin from oxidative stress (vitamin E, melatonin, polypodium). In mature onset melasma we also prescribe a class of topicals called senolytics, which reverse cellular aging.
The exact combination depends on your skins’ sensitives, pigment type, skin type & physiological age. Timing is critical.
What is the best skin care ingredient for skin rejuvenation?
Retinoids are best for this job of skin remodelling. Prescription retinoids such as Retrieve (tretinoin) are more powerful than over the counter retinol. Retinoids work by increasing collagen production, however in comparison to lasers & injectables they are much less powerful bio remodelling agents.
Senotherapeutic agents are also prescribed in phase 3 of melasma treatment. The exact nature & concentration depends on your age, degree of sun damage & skin quality.
What types of chemical peels can remodel the dermis in patients with melasma?
Chemical peels are an effective way to remodel the deeper layers of skin in pigment prone patients. Peels are classed according to the depth and include superficial (glycolic, lactic, mandelic, retinoic acid, Jessner), medium depth (TCA, Jessner TCA, low concentration phenol) & deep (high concentration phenol, croton oil & high concentration TCA).
In practice, lasers are better than peels, however for deeper dermal melasma, phenol peels can be effective, however the risks of permanent hypopigmentation limits its use.
Can exosomes remodeling skin & reverse cellular aging?
Without doubt, exosomes have the potential to reverse skin aging. In the context of melasma they work by-
- Changing signalling (via micro RNA 675), which modulates pigment production.
- Changing the cross talking between cells (collagen producing cells, blood vessels, mast cells, skin cells & pigment producing cells).
- Upregulating collagen production in the dermal layers of skin.
In clinical terms, as compared to injectables & lasers, exosomes are relatively weak in reversing skin aging. We don’t routinely perform exosomes as first or second line melasma therapy, however exosomes can be considered if you fail medical therapy, pico lasers, injectables & senotherapeutic topicals.
What is the role of HIFU remodel the dermis?
In the correct settings, HIFU is a useful adjunct for skin remodelling as ultrasound spares the upper layer of skin, whilst simultaneously targeting the deeper dermal layers.
This device uses focused soundwaves, which generate less heat compared to lasers.
In the context of dermal remodelling for melasma, HIFU Ultraformer MPT –
- Requires 2-4 sessions
- Requires a modified treatment protocol for remodelling (settings dependent) ‘
- Is a useful adjunct to other treatment modalities for biostimulation
- May give a flare of pigment in the incorrect settings
- May ‘melt’ fat in the incorrect settings & technique
