Melasma affects millions, but it is manageable. Learn what triggers it, how the Candela PicoWay® and Nordlys® systems treat it without heat, and what a comprehensive melasma management plan looks like at 86INK in Tulsa.
What Is Melasma?
Melasma is a common form of hyperpigmentation that appears as brown, gray-brown, or tan patches on the face — most often on the cheeks, forehead, upper lip, nose bridge, and chin. It is far more prevalent in women than men, and it disproportionately affects people with medium to darker skin tones (Fitzpatrick types III–VI), though it can appear in any skin type.
Unlike a sunspot or post-inflammatory mark, melasma originates deep within the skin. Melanocytes — the pigment-producing cells in the epidermis and sometimes the dermis — become chronically overactive, producing excess melanin in a diffuse, irregular pattern. This depth and diffusion is precisely what makes melasma so resistant to simple topical treatments and why a multi-modal approach is essential for lasting improvement.
What Triggers Melasma?
Understanding your personal triggers is the first step toward effective management. The four most common drivers are:
Sun exposure is the single most powerful trigger. Ultraviolet and visible light (including blue light from screens) stimulate melanocyte activity. Even brief, unprotected exposure can undo months of treatment progress — which is why daily, broad-spectrum sun protection is non-negotiable in any melasma protocol.
Hormonal fluctuations are the reason melasma is sometimes called the "mask of pregnancy." Estrogen and progesterone sensitize melanocytes to light, making pregnancy, oral contraceptives, and hormone replacement therapy significant risk factors. In many cases, addressing the hormonal driver — in consultation with your prescribing provider — is a prerequisite for sustained results.
Genetics play a meaningful role. If a parent or sibling has melasma, your risk is elevated. This hereditary component also explains why some patients see rapid recurrence after treatment while others maintain clearance for years.
Heat is an often-overlooked trigger. Infrared radiation from the sun, hot yoga studios, saunas, and even cooking over a stove can independently activate melanocytes. This is a critical consideration when selecting a laser platform: treatments that generate significant heat can paradoxically worsen melasma, which is why we do not use ablative or high-heat devices for this condition at 86INK.
The PicoWay® Approach: Picosecond Precision Without Heat
The Candela PicoWay® laser is the cornerstone of our melasma treatment protocol at 86INK. What sets it apart from older laser technologies is its delivery mechanism: ultra-short picosecond pulses — one trillionth of a second — that shatter pigment through a photoacoustic (pressure-based) effect rather than a photothermal (heat-based) one.
This distinction matters enormously for melasma. Traditional Q-switched nanosecond lasers generate enough heat to risk post-inflammatory hyperpigmentation (PIH), a rebound darkening that can be worse than the original condition — particularly in darker skin tones. PicoWay®'s picosecond pulses break pigment into microscopic particles that the immune system clears naturally, while keeping thermal injury to surrounding tissue minimal.
The PicoWay® Resolve™ handpiece is particularly well-suited for melasma. It delivers fractional, non-ablative energy in a precise array of micro-columns, treating pigment while leaving the surrounding skin intact. This fractional approach accelerates collagen remodeling alongside pigment clearance, improving overall skin texture and tone at the same time.
For melasma, we typically recommend a series of four to six PicoWay® Resolve™ sessions spaced four to six weeks apart, combined with a medical-grade home care regimen. Results are gradual and cumulative — patients generally notice meaningful lightening after the second or third session, with continued improvement between visits as the immune system continues clearing fragmented pigment.
Nordlys® IPL for the Vascular Component
Melasma is not purely a pigment problem. Many patients also have a vascular component — dilated superficial blood vessels that contribute to the reddish or warm undertone visible beneath the brown patches. Treating only the pigment while leaving the vascular component unaddressed often results in incomplete clearance.
The Candela Nordlys® system, using its SWT® (Selective Waveband Technology) IPL handpiece, allows us to precisely target oxyhemoglobin in superficial vessels while minimizing energy delivery to epidermal melanin. When indicated, we incorporate Nordlys® IPL sessions into the treatment plan to address this vascular layer, resulting in a more complete and even outcome.
The combination of PicoWay® Resolve™ for the pigment layer and Nordlys® IPL for the vascular layer represents a comprehensive, dual-modality approach that addresses melasma at its full structural depth.
What to Expect During Treatment
Your first appointment begins with a thorough skin assessment using a Wood's lamp and clinical evaluation to determine the depth of your melasma (epidermal, dermal, or mixed), identify your Fitzpatrick skin type, and review your current skincare and medication history.
Each PicoWay® Resolve™ session takes approximately 20 to 30 minutes. Most patients describe the sensation as a series of quick snapping or prickling feelings — generally well-tolerated without topical anesthetic, though numbing cream is available if preferred. Immediately after treatment, the skin may appear slightly pink and feel warm, similar to a mild sunburn. This typically resolves within a few hours.
In the days following each session, you may notice the treated pigment temporarily darkening before it lightens — a normal part of the clearance process as fragmented melanin migrates toward the surface. Strict sun avoidance and SPF 50+ application are required throughout the treatment series and for several weeks after the final session.
A Comprehensive Melasma Management Strategy
Laser treatment alone is not a cure for melasma. Because the underlying melanocyte hyperactivity persists, a comprehensive strategy that addresses triggers, supports the skin barrier, and maintains results over time is essential.
Daily broad-spectrum sunscreen (SPF 50+ with UVA, UVB, and ideally visible light protection) is the single most important step. Mineral sunscreens containing zinc oxide or titanium dioxide are preferred for melasma-prone skin because they reflect all wavelengths, including visible light. Reapplication every two hours during outdoor exposure is critical.
Medical-grade topicals prescribed or recommended by your provider — such as tranexamic acid, azelaic acid, kojic acid, or niacinamide — can suppress melanocyte activity between laser sessions and help maintain clearance afterward. We will review your current skincare regimen at your consultation and make specific recommendations based on your skin type and sensitivity.
Hormonal review is worth discussing with your OB-GYN or primary care provider if you are on oral contraceptives or hormone therapy and your melasma is not responding to treatment. Switching formulations or delivery methods sometimes makes a significant difference.
Maintenance sessions — typically one to two PicoWay® Resolve™ treatments per year — help sustain clearance and address any recurrence before it becomes established. Many of our melasma patients incorporate a maintenance session into their annual skincare routine, much like a professional dental cleaning.
Melasma is a condition that rewards patience, consistency, and the right clinical partnership. At 86INK in Tulsa, every melasma treatment plan is designed by Leisha Lawson, FNP-C — a board-certified nurse practitioner with deep expertise in laser medicine and skin of color. Book your complimentary consultation to receive a personalized assessment and treatment roadmap. Call or text us at (918) 625-1480, or visit us inside Elite Wellness + Aesthetics at 11917 S Norwood Ave, Suite 112, Tulsa, OK 74137.
