Dr. Sam Lam Plastic Surgery Forum

Dr. Lam,
I am in my mid30s and have been fighting acne my whole life. I have been on accutane, retin A, everything...... The thing that works best for me is the birth control pill. When I get off I have horrible breakouts and dark pigmented scars within 2 months of quitting. The problem with the pill is that my melasma gets really dark on it. I recently had photofacial done at a skinlaser center in Houston and I had absolutely no results from it. If anything, my melasma is worse on my forehead and now there is some on my right cheek and chin, is this normal? Should I dare try it a second time or is photofacial just not for me. Could you give me some options/prices for this embarrassing problem?
Thank you so much for any suggestions.

Photofacials in many cases can help but will fail in the following circumstances:
1. an idiosyncratic response in which the areas turns darker instead of lighter (as in your case).
2. treating an area that is tanned that can predispose toward greater pigmentation since the melanocytes are activated.
3. improper laser usage (settings, too high typically)
4. the melasma is too deep and encompasses the dermis

In general, melasma is a product of both hormones and sun. Wearing a sunblock and staying away from too much sun will help. Birth control pills as you have found can control it. In addition, hormone balancing may help, as offered in my anti-aging and vitality center.

To make it simple, I would recommend triluma cream (prescription only) that can bleach the area. It will take 6 to 8 weeks to see the difference and is a lot cheaper. About 150 or so dollars (a bit less than that I think). I have found Triluma to work the best as compared with over the counter and with other prescription products. It works better because of the synergistic response of 4% hydroquinone (bleaching product), fluticasone (steroid) and retin-a. Remember you cannot be in the sun otherwise the product is unsafe because it can predispose toward a sun burn. In addition, the problem is that it will simply NOT work with sun exposure. Your dermatologist or PS can help prescribe it to you.
best,
sml