Treatment Options for Persistent Melasma

Every time you look in the mirror,

a faint brown mark

spreading across your cheekbones

You may have felt weighed down by those marks that show through again every afternoon, even after covering them with makeup.

My name is Yideuk Lee, and I care for patients’ skin at 이지함피부과 Gangnam Branch.

Today, I have prepared a story I especially want to share with those who have struggled with melasma for a long time—particularly those who have given up, thinking, “This will probably stay the same no matter what I do.”

Using the story of someone I met in the consultation room recently, I would like to calmly explain how to approach treatment options for persistent melasma.

Every afternoon,

the marks would reappear

After turning forty,

this person said they had visited one clinic after another

for nearly five years

because of the melasma that had appeared over their cheekbones.

They had tried various functional cosmetics

and consistently applied brightening ampoules,

but the results were only temporary.

“Even if I visit a clinic, it fades for a while

and quickly comes back,

so now I wonder if I should just

live like this.”

Their exhaustion

was evident in their voice

as they said those words.

It is understandable to feel resigned

when you have spent considerable time and money

but always seem to end up back where you started.

In their words that they had tried

everything said to be effective,

from pore strips to ampoules,

there seemed to be a long-suppressed hope:

“I wish things would be a little different this time.”

There is a reason it is particularly persistent

Melasma is a brown discoloration

that develops when melanin pigment

becomes excessively deposited in the skin.

However, even melasma can vary

in how deeply it is situated.

Freckles and spots are generally

located close to the skin’s surface,

so they may fade relatively easily,

but long-standing melasma often

has roots extending beneath the epidermis

into the dermal layer.

It usually spreads symmetrically

across areas exposed to sunlight for long periods,

such as the cheekbones, cheeks, and forehead,

and it is also characteristic for it to

become darker or lighter repeatedly

depending on the season or your condition.

It is similar to cutting grass only at the surface:

the roots remain and it grows back.

When hormonal changes,

long-term ultraviolet exposure,

and stress are added to this,

the pigmentation becomes even more stubborn.

The deeper and more easily recurring

the melasma is,

the more differently treatment options

for persistent melasma need to be planned

from the beginning.

The idea that it will stay the same is only half true

The thought that “it will stay the same anyway”

is half correct and half a misunderstanding.

If only the surface is treated,

the deeper pigmentation remains,

so it is true that it can quickly return.

However, when the approach is changed

to treatment options for persistent melasma

that target the roots,

the situation can be different.

Rather than trying to erase everything at once,

for stubborn melasma it is often better

to gradually lighten the pigmentation

while managing it so that it does not darken again.

The reason it improved and then repeatedly returned

was that the approach was not suitable,

not that their skin was unusually poor.

So there is absolutely no reason

to blame yourself for the time that has passed.

How deep pigmentation is treated

For pigmentation located deep in the dermis,

procedures such as laser toning (dual toning)

may be used.

The principle is to deliver light at specific wavelengths

in multiple sessions, gradually breaking the pigmentation

into smaller particles.

When there is widespread pigmentation or redness as well,

IPL may be used,

and after the marks have lightened,

brightening care can be added

to even out the overall tone.

Combining several approaches

according to the condition of the skin

is the basic framework

for treating persistent melasma.

The procedure may feel like

a light snap from a rubber band

or a stinging sensation,

so numbing cream can be applied if needed.

Immediately afterward, the pigmentation

may briefly appear darker,

but this is a natural part of the process.

Rather than relying heavily on a single procedure,

using different methods according to the depth

and extent of the pigmentation places less strain

on the skin and helps smooth and even out its texture.

When you let go of some impatience

I shared the same thoughts

with this person slowly and carefully.

Rather than expecting it to disappear all at once,

we discussed establishing a plan

to gradually manage the pigmentation

every few weeks and thoroughly block ultraviolet rays.

Even pigmentation that has worked hard to fade

can return if sun protection is neglected,

so this care is just as important

as the procedures themselves.

Of course, everyone’s skin is different,

so there are individual differences

in the speed and degree of improvement.

Still, I remember their expression for a long time— their resignation that “it will probably stay this way forever”

had changed into the hope that “perhaps it can gradually improve.”

Even long-standing marks have their own pattern

I want to tell you that there is no need

to let long-standing melasma lead you

to give up emotionally as well.

What matters is examining

how deeply your skin pigmentation is located

and consistently continuing

the treatment options for persistent melasma

that suit it.

The moment you let go of the misunderstanding

that “it will stay the same anyway,”

the time and emotional energy

you felt you had wasted may feel

a little less wasteful.

I hope this post can become

a small starting point for you today.

Questions often discussed in the consultation room

Q1. Why does persistent melasma

keep coming back?

Melasma is located deep in the dermal layer,

and hormonal changes, ultraviolet exposure,

and stress continue to stimulate the pigmentation.

Therefore, rather than ending with a single procedure,

it is better to continue care together

to help prevent recurrence.

Q2. Is it difficult to manage

with cosmetics or at-home care?

Brightening cosmetics may help

make the surface tone look brighter,

but it is difficult for them to reach

deeper pigmentation.

The skin tends to become more evenly refined

when surface care is combined

with procedures that address the pigmentation itself.

Q3. Are the procedures very painful?

A light snapping sensation,

like a rubber band,

or a stinging feeling may occur.

If you are sensitive to pain,

please let us know in advance.

Q4. What is different about receiving help

from a dermatology clinic?

The greatest difference is that the depth

and type of pigmentation can be examined first,

after which an appropriate approach

can be selected.

The intensity and intervals can be adjusted

according to your condition,

allowing you to continue care steadily

without overburdening the skin.

Q5. Can I continue treatment

during the summer?

It is possible, but ultraviolet rays are stronger

in summer, making it easier for pigmentation

to become darker again.

During this period, we recommend adjusting

the intensity and being more thorough than usual

with sun protection.

📍 Location | Room 502, 5th Floor, 429 Gangnam-daero, Seocho-gu, Seoul (same building)

· Near Gangnam Station and Sinnonhyeon Station

☎ Phone | 02-567-5900

🕐 Consultation hours

· Monday, Tuesday, Thursday, Friday 10:00–19:00

· Saturday 10:00–17:00

· Lunch break (weekdays) 13:00–14:30

· Closed Wednesdays, Sundays, and public holidays

On weekdays, there is a brief lunch break,

and the clinic is closed on Wednesdays,

Sundays, and public holidays.