Case study · 2025
Melasma
Reversal Course
Patient
N.O., 35
Discipline
Skin programme
Duration
11 months
A patient-led course that cleared stubborn cheek melasma by treating the triggers first and the pigment second.
01
The challenge
The patient developed melasma during her second pregnancy and had tried hydroquinone, peels and two sessions of laser over three years. Each treatment lightened the patches for a few weeks before they returned darker than before.
Her skin type carried a real risk of rebound pigmentation with anything heat-based, and she was wary of another round. The brief was steady, lasting improvement she could maintain herself, not a dramatic result that faded by summer.
02
The approach
We removed the triggers before we treated the pigment. Three stages across eleven months,
each reviewed under polarised imaging before moving on.
1
Protect
Daily tinted mineral SPF and a hormone review, so the pigment stopped being reinforced.
2
Suppress
A tranexamic and azelaic acid regimen, introduced one product at a time over twelve weeks.
3
Clear
Four low-strength, heat-free peels in the cooler months, never through the summer.
03
The result
Measured against polarised imaging at month eleven, pigment density across both
cheeks fell by two thirds and held through a full summer. She now maintains
the result at home.
-67%
Pigment density
11 mo
Staged over
Rebound episodes
Every other clinic tried to burn it off. This was the first plan that actually listened to my skin.
N.O.
Patient, West Hollywood
