Symmetric patches
Brown to gray-brown patches, usually matched on both sides of the face.
Medical Dermatology
Melasma & pigmentation
Melasma causes stubborn brown or gray-brown patches, most often on the face. It's very common and very treatable — but because the wrong treatment can make it darker, melasma rewards a careful, dermatologist-led approach.
Overview
Understanding melasma
Melasma appears as symmetric patches of darker pigment, usually across the cheeks, forehead, upper lip, and bridge of the nose. It's driven by a combination of sun and visible light, hormones, heat, and genetics — which is why it's especially common in women, during pregnancy (the so-called “mask of pregnancy”), and with hormonal changes.
What makes melasma unique among dark spots is how easily it can be provoked. Heat and inflammation alone can push the pigment-producing cells to make more pigment — so a treatment that would fade an ordinary sun spot can actually deepen melasma. The goal isn't just to lighten patches; it's to calm the pigment pathway and protect your skin so results last.
Why melasma deserves a dermatologist — not only a med spa
Melasma is a medical condition, not just a cosmetic one. Who treats it — and how — genuinely changes the outcome:
- A board-certified dermatologist first confirms it truly is melasma, and not another form of pigmentation that would be treated differently.
- Melasma is exquisitely sensitive to heat and light — so aggressive lasers, IPL, and one-size-fits-all devices can trigger a rebound that leaves skin darker than before.
- The most effective plans are medical: prescription-strength topicals and, when appropriate, oral therapy — options a med spa generally can't offer.
- If a flare or post-inflammatory darkening does occur, a dermatologist is equipped to recognize and manage it, rather than making it worse.
A calm, layered approach that actually holds
Melasma is managed over time, not erased in a single visit. We build results gradually and protect them:
- Start by calming the pigment pathway with proven prescription topicals and, in the right patients, oral tranexamic acid.
- Layer in gentle, carefully chosen in-office treatments — never the aggressive settings that provoke melasma.
- Anchor everything in disciplined sun and visible-light protection, the single most important step in keeping patches from returning.
- Maintain with a simple, skin-friendly routine so your progress lasts for the long term.
Melasma is where our medical and cosmetic care work hand in hand: prescription therapy calms the pigment, while carefully chosen options from our aesthetic dermatology menu — professional chemical peels and gentle, dermatologist-selected lasers — refine and even your tone. Because the same dermatologists lead both, your cosmetic treatments are chosen to complement your melasma plan, not compromise it.
What melasma looks like
What we look for
Sun-exposed areas
Most common on the cheeks, forehead, upper lip, and nose.
Hormone-related flares
Often triggered or worsened by pregnancy or hormonal changes.
Worsens with sun
UV and even visible light can deepen the pigment quickly.
How we treat it
Your treatment options
Melasma is managed, not cured overnight — we build a steady, skin-safe plan, layer treatments thoughtfully, and protect your progress. Every plan is tailored to your skin type and the depth of your pigment.
Prescription topical therapy
Dermatologist-directed lightening agents — including hydroquinone and triple-combination formulas — to calm and fade pigment gradually, with structured, supervised use.
Tranexamic acid
A leading advance in melasma care — topical, and for appropriate patients oral tranexamic acid — that targets the pigment and vascular pathways behind stubborn, recurrent melasma.
Non-hydroquinone brighteners
Modern options such as cysteamine and other tyrosinase inhibitors for long-term care or for patients who prefer an alternative to hydroquinone.
Iron-oxide tinted sunscreen
Broad-spectrum SPF with iron oxides to shield against visible light and heat — the cornerstone of any melasma plan and the key to holding results.
Professional chemical peels
Carefully chosen peels that lift excess pigment gently — matched to your skin so they help rather than provoke a flare.
Carefully selected lasers & devices
For the right candidate, gentle laser or light therapy chosen and dialed in by your dermatologist — using conservative settings, since aggressive lasers and IPL can worsen melasma.
Maintenance plan
A simple, skin-friendly routine to hold your results and keep patches from returning over time.
When to see a dermatologist
If brown patches aren't improving — or products or spa treatments seem to make them worse — a board-certified dermatologist can confirm the diagnosis and build a plan that fades pigment safely instead of provoking it.
Schedule with JuniperCommon questions
Melasma FAQ
Can melasma be cured?
Melasma is managed rather than cured overnight. With a dermatologist-led plan — pigment-calming prescription therapy plus disciplined sun and visible-light protection — patches fade gradually, and a maintenance routine keeps them from returning.
Why can a med spa make melasma worse?
Melasma is highly sensitive to heat and light, so aggressive lasers, IPL, and generic device settings can trigger a rebound that leaves skin darker than before — especially in deeper skin tones. A board-certified dermatologist first confirms the diagnosis, then chooses gentle, appropriate treatments and can manage any flare. Because our dermatologists lead both the medical and cosmetic sides, cosmetic treatments are selected to help your melasma, not risk it.
Does tranexamic acid help melasma?
Yes — tranexamic acid has become one of the most valuable tools in melasma care. Used topically, and in appropriate patients orally, it targets the pigment and vascular pathways behind stubborn melasma and works well alongside prescription topicals. Your dermatologist determines whether oral therapy is right and safe for you.
Why does my melasma keep coming back?
Melasma is driven by sun and visible light, hormones, heat, and genetics, so it can flare with UV exposure, hormonal changes, and even heat. Consistent broad-spectrum sunscreen with iron oxides and a maintenance routine are essential to holding your results.
Are lasers safe for melasma?
They can help the right patient, but only with the correct device and conservative settings — the wrong laser can worsen melasma. That's why laser is used as one carefully chosen part of a broader, dermatologist-led plan, with candidacy determined by your dermatologist rather than a one-size-fits-all menu.
Bend & Redmond · Central Oregon
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