The Proper Approach to Melasma Treatment

Hello! This is Jamsil Gounsesang Dermatology!

Every time you look in the mirror, melasma remains on your face like a stain,

and even when you put on makeup, it may not be fully covered and can look more

define under certain lighting. During seasonal changes or periods of fatigue,

it can seem to darken even more, so if care is neglected, it can quickly become noticeable.

When you search online, folk remedies such as aloe packs, potato packs, and

vinegar face washes are easy to find, but in reality their effects are

limited, and in many cases they can irritate the skin and even worsen melasma.

The problem is that melasma is not simply pigment that forms on the epidermis,

but a complex condition that arises as the deeper structures and environment

within the skin change together.

So why does melasma not go away easily, and why does it recur so often even

after treatment? Today, I will explain everything from the causes of melasma

to the treatment principles that reduce recurrence, as well as effective

approaches.

1. The Complex Reasons Melasma Develops

Melasma is not simply a condition in which the skin becomes darker after

sun exposure. In addition to ultraviolet exposure, it can easily develop during

periods of major hormonal change in women, such as pregnancy, childbirth, or

the time before and after menopause. If there is a family history, frequent

exposure to heat through one’s work environment, lack of sleep, or chronic

stress, the risk becomes even higher.

The problem is that the pigment does not accumulate only on the skin surface

(epidermis), but often settles deeply into the dermis. Pigment in the dermis is

closely connected to the skin barrier, blood vessels, and the surrounding

cellular environment, so it does not easily disappear with simple whitening

products or surface-level treatments alone.

Aloe, potato packs, and vinegar face washes, which are often mentioned as folk

remedies, may give a temporarily cool and brighter feeling, but if repeated over

time, they can irritate the skin and damage the barrier, potentially worsening

pigmentation. In particular, when deep melasma is present, such irritation can

trigger pigment responses in deeper areas and make the color darker.

2. The Real Reason Melasma Is Difficult to Treat

In many cases, only the visible melasma is considered and procedures target

melanin pigment alone. However, melasma is a condition in which pigment lesions

are intertwined with basement membrane damage, excessive vascular response in

the dermis, and abnormal proliferation of fibroblasts.

For example, if a strong laser is repeatedly directed only at the epidermis, the

basement membrane at the epidermal-dermal junction can be damaged. This

basement membrane is an important structure that supports the skin and prevents

melanin from flowing downward. If it is damaged, melanin can deposit more deeply

and melasma can worsen. This is what post-inflammatory hyperpigmentation (PIH)

is.

In other words, melasma treatment is not simply a matter of “removing pigment”;

it is a complex treatment in which skin structure must be restored and the

possibility of recurrence must also be reduced.

3. Treatment Principles That Also Consider Recurrence

In melasma areas, in addition to pigmentation, microvessels are often dilated,

or the collagen and elastin structure may be disrupted. Also, when fibroblasts

increase abnormally due to aging or damage, the signals that produce melanin are

easily activated within the skin.

If only the pigment is removed in this state, the internal skin environment

remains unchanged, so pigmentation can return over time. Therefore, melasma

treatment needs to remove pigment while also repairing the damaged basement

membrane, stabilizing vascular responses, and controlling excessive fibroblasts.

This comprehensive treatment approach lengthens the interval before recurrence

and helps maintain a lighter pigmentation state for longer.

4. Advantages of RF Microneedling Devices Such as Sylfirm

RF microneedling devices such as Sylfirm can help address these complex causes

of melasma at the same time. Fine needles (microneedles) are inserted directly

into the dermis and deliver radiofrequency energy. At this time, only minimal

heat is applied to the epidermis, while broad and even heat is delivered deep

within the dermis.

Patented devices spread this energy in a droplet shape, minimizing epidermal

damage while evenly stimulating the basement membrane, blood vessels, and the

collagen structure of the dermis. As a result, basement membrane recovery,

reduction of excessive vascular response, and control of excessive fibroblasts

occur simultaneously.

During this process, dermal regeneration is promoted, and not only pigmentation

but also associated skin concerns such as fine wrinkles, redness, and enlarged

pores may improve together. Above all, because it reduces epidermal damage, it

has the advantage of lowering the risk of PIH that can occur after traditional

laser procedures.

5. Why Choosing the Treatment Device Matters

For melasma treatment, the key is not simply choosing the strongest device, but

selecting one that can secure both safety and effectiveness according to the

patient’s skin condition. RF microneedling devices such as Sylfirm target

pigment, blood vessels, and skin regeneration together, allowing multiple causes

of melasma to be addressed at once.

However, even with the same device, results can vary greatly depending on the

operator’s skill, energy settings, and number of treatment sessions. If too high

a level of energy is used at once, there is a risk of epidermal damage and

worsening pigmentation; if too low, the effect may be insufficient. Therefore,

after sufficient consultation with experienced medical staff, it is safest and

most effective to gradually increase treatment intensity while monitoring the

skin’s response.

Melasma is a condition in which pigment is deposited deeply into the dermis due

to a combination of factors such as ultraviolet exposure, hormonal changes,

heredity, heat stimulation, and stress. Procedures that simply remove melanin

can increase the risk of basement membrane damage and recurrence, and may even

worsen pigmentation.

To reduce recurrence, pigment removal must be carried out together with basement

membrane recovery, reduction of excessive vascular response, and control of

fibroblasts. For this, RF microneedling devices such as Sylfirm may be helpful.

Ultimately, the key to melasma treatment is a “comprehensive treatment” that

restores not only the skin surface but also the internal structure, and safe,

durable results can be expected only when supported by devices suited to the

skin condition and the know-how of experienced practitioners.

The goal of melasma treatment is to prevent it from coming back

If melasma is seen only as a problem of removing the visible pigment in front of

you, it will quickly return, and repeated treatment may make the skin more

sensitive. The important thing is to accurately identify the causes of pigment

formation and improve the internal skin environment to create a state in which

melasma is less likely to develop.

If you are currently troubled by melasma, rather than expecting quick changes

through strong stimulation, choose a method that improves the skin all the way

down to its deeper layers. That way, you can achieve much more stable and

positive results in the long battle against melasma.

Thank you.

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This post is provided by Jamsil Gounsesang Dermatology for the purpose of

providing medical information in accordance with Article 56, Paragraph 1 of the

Medical Service Act. All procedures/surgeries carry the risk of side effects

such as bleeding, infection, and nerve damage, so please proceed carefully after

sufficient consultation with medical staff.