Laser Treatment for Melasma: Which Lasers Help and Which Make It Worse?

They can fade it, but the evidence puts them second to creams.

In a 2020 evidence-based review of 113 studies and 6,897 participants, hydroquinone and triple-combination cream were the most effective, best-studied melasma treatments, and the authors concluded that chemical peels and laser- and light-based therapies are "equal or inferior to topicals" with a higher risk of adverse effects.

The American Academy of Dermatology (AAD) describes the add-on role the same way: a few studies have found that adding a laser or light treatment can improve results for patients who are already applying topical medication and protecting their skin from the sun.

The AAD also notes that melasma treatment usually takes 3 to 12 months to show results, so a laser course is a slow, incremental step in a longer plan rather than a single appointment.

What the evidence does not show is a laser that cures melasma.

Recurrence rates remain high with all melasma treatments, which is why the studies the AAD cites tested lasers in people who were already applying topical medication and protecting their skin from the sun — on top of those steps, not instead of them.

Our melasma treatment guide covers the condition itself — what it is, the prescription creams and what the research ranks first.

Intense pulsed light (IPL) is not a laser.

The American Society of Plastic Surgeons defines IPL as a minimally invasive, non-laser light treatment that emits multiple wavelengths which are absorbed and converted to heat, targeting pigment, blood vessels and hair follicles; BBL is a type of IPL — specifically Sciton's brand of it.

Heat aimed at pigment is also where the risk sits.

The adverse-effect risk that reviews document for laser and light therapy in melasma — higher than for topicals — includes post-inflammatory hyperpigmentation, a darkening of skin after inflammation.

Melasma is pigment, so a device built to heat pigment can darken it as well as fade it; that is the trade-off the studies measure.

The blanket claim that IPL makes melasma worse is not supported, though.

A 2020 meta-analysis of 8 studies and 215 patients found IPL-based combination therapy reduced MASI scores, a melasma severity measure — but it was combination therapy, paired with topical treatment, and the adverse-effect warning stays in place in the same literature.

On the low-energy side, a 2023 network meta-analysis of 39 studies and 1,394 participants ranked low-energy Q-switched Nd:YAG laser plus topical medication first among laser-related melasma therapies, ahead of oral tranexamic acid and microneedling plus topicals.

Read that winner carefully: the top-ranked option is laser plus topicals, not laser instead of them.

The devices people ask about by name fall into two groups: those whose cleared or maker-listed indications name melasma, and those whose indications, as we found them, do not.

PicoSure (Cynosure) is a 755 nm Alexandrite picosecond laser with optional 532 nm and 1064 nm delivery systems, 510(k)-cleared for tattoo and benign pigmented lesion removal — and its cleared 755 nm indication explicitly includes melasma, along with nevus of Ota and nevus of Hori.

Skin-type limits apply: the 532 nm delivery system is cleared for skin types I–III only, and the acne-scar and wrinkle handpieces for types I–IV.

PicoWay holds a similar melasma clearance, and neither device is FDA-approved — 510(k) clearance is the device pathway.

Fraxel's melasma listing belongs to one wavelength.

Solta lists the 1550 nm wavelength for skin resurfacing including dyschromia, age and sun spots, actinic keratosis, melasma, wrinkles around the eyes, acne scars and surgical scars, while the 1927 nm wavelength's list covers actinic keratosis and pigmented lesions such as age spots, sun spots and freckles.

Melasma is tied to 1550 nm, not to the brand name generally.

Moxi's regulatory status is the one to read closely.

Sciton describes Moxi as a fractionated non-ablative 1927 nm laser and says a treatment takes 8–10 minutes, with 2–4 treatments recommended — those are Sciton's figures.

The 510(k) for Sciton's JOULE 1927 nm laser (K182173, cleared 6 Mar 2019) covers soft-tissue coagulation, actinic keratosis and benign pigmented lesions such as lentigos, solar lentigos and freckles; melasma is not listed.

That document names the 1927 nm laser rather than the Moxi trade name, and our research did not locate a Moxi-specific 510(k) summary, so we describe the clearance at the wavelength level — it is fair to ask a practice which clearance its Moxi is marketed under.

Our Moxi guide has the full picture.

Clear + Brilliant is cleared even more generally, for "dermatological procedures requiring the coagulation of soft tissue and general skin resurfacing procedures," with no conditions named.

Its own Important Safety Information goes further: a person diagnosed with — or possibly having — melasma may not be an appropriate candidate.

So for anyone searching "clear and brilliant melasma," the honest answer is that the manufacturer's safety information puts melasma on the caution list, not the indication list.

Details in our Clear + Brilliant guide.

Laser Genesis is in the same bucket.

It is a Cutera treatment using non-ablative 1064 nm Nd:YAG, and the cleared indications Cutera lists for it include wrinkles, benign vascular lesions including rosacea, scars, hair reduction, warts and mild-to-moderate inflammatory acne — the indications our research recorded do not name melasma.

Our Laser Genesis guide covers what it is cleared for.

A cleared indication is not a promise of a result, and a use that is not in the clearance is not a cleared use — for that device, it is off-label.

The relapse evidence in the next section applies to every device on this list either way.

Recurrence is the finding the studies keep returning.

A 2022 systematic review reports that recurrence rates remain high with all melasma treatments, that no single treatment is universally effective and that combination therapies gave the best results.

Reviews describe recurrence as "high" without pooling one percentage, and we could not confirm a specific relapse rate to quote.

Even the prescription triple-combination cream is labeled as temporary.

Tri-Luma is FDA-approved for short-term treatment of moderate to severe facial melasma with sun avoidance; its label says it is not indicated for maintenance and that melasma usually recurs after stopping it.

For laser patients this stacks up plainly: the studies the AAD cites added lasers for people already using topical medication and sun protection, and nothing in those findings retires the topicals afterward.

One label caution belongs in any maintenance conversation: the Tri-Luma label warns that hydroquinone can cause exogenous ochronosis, a gradual blue-black darkening of the skin.

Med spas price these treatments per session, and the manufacturers' protocols are multi-session by design: Sciton recommends 2–4 Moxi treatments, Solta puts Clear + Brilliant at 4–6 treatments for visible results, and Solta says up to five Fraxel treatments may be appropriate.

Number of sessions is a main price driver.

Insurance will not help: the AAD notes melasma treatment is generally not considered medically necessary, so most insurers will not cover the cost.

As for a national number, we could not confirm one.

ASPS's 2025 statistics release does not report minimally invasive procedure counts or fees, so there is no current ASPS average for these light-based treatments, and no reliable national average for melasma laser sessions turned up in the sources we checked.

Pricing is set office by office — when you compare quotes, ask which device, how many sessions and what the per-session price is.