Before treating melasma,

you need to control inflammation first

Check this first before reading

Q. I’ve had more than 10 toning sessions,

so why does it still look the same?

A. Because the treatment is only trying to break up pigment.

You have to change the melanin-overactive environment first.

Q. Then what causes melasma?

A. UV light, hormones, and micro-inflammation

stimulate melanocytes

to create inflammatory pigment.

Bottom line.

Melasma is not a procedure that breaks pigment,

but a treatment that controls inflammation.

What determines the approach.

Toning alone, or combined anti-inflammatory, regenerative, and medication therapy.

What we'll cover today.

Which combination, and at what intervals,

to decide how to proceed.

Melasma treatment methods,

why doesn’t laser alone clear it?

Laser alone has clear limitations.

Most people who search for melasma treatment methods

and come here are already

have already had toning 5 or 10 times,

you know.

But many say it looks the same, or even darker,

and come to us.

Melasma is a state in which melanocytes become chronically overactive

and, through UV light, hormones, and micro-inflammation,

keep producing pigment.

Even if you break the pigment once, if the production factory remains the same,

it will quickly return.

This is where toning reaches its limit.

It uses low energy to gently break melanin,

but if the energy falls below the breakdown threshold,

there may be no change even after 100 sessions,

and if the energy is increased,

it can irritate the skin and make it darker.

So melasma should not be approached as "removing pigment,"

but as changing the environment that creates it.

Melasma is not a pigment disease,

it is an inflammatory condition

Dr. Wi Young-jin's

key insight

"When you see melasma as an inflammatory condition rather than a pigment disorder,

treatment starts to make sense.

When anti-inflammatory and regenerative treatments are used together,

it may look temporarily darker,

but the root cause is addressed in the end."

— Dr. Wi Young-jin (Beautystone Clinic, Hapjeong)

If you look closely at skin affected by melasma,

you'll often see increased microvessels

and a subtle redness underneath.

This is a sign of chronic micro-inflammation.

Inflammatory cytokines

keep waking up the melanocytes.

If you try to break only the pigment in this state,

the production speed is faster than the breakdown speed.

That’s why I often use the combination of

toning + Rejuran/Revive + medication.

Rejuran and Revive

calm micro-inflammation in the dermis

and help restore the skin barrier.

Tranexamic acid reduces the signaling

that allows UV light to stimulate melanocytes.

Hydroquinone ointment blocks melanin synthesis,

but it carries a risk of side effects with long-term use,

so treatment breaks are essential.

If you combine regenerative procedures,

melasma may look temporarily darker for 2 to 3 weeks.

This is a recovery sign caused by increased blood flow during dermal healing,

not a side effect.

You need to get through this phase before

you can see the pigmentation fade from the root.

Dr. Wi Young-jin's key takeaways

• Melasma is not a pigment-removing procedure,

  but a treatment that controls inflammation.

• If toning is repeated alone, the rate of production

  is faster than the rate of breakdown.

• Anti-inflammatory care, regeneration, and medication must be combined to fade the root cause.

Melasma treatment: anti-inflammatory and regenerative

How do you combine them?

The priority changes depending on redness and prior irritation.

The priority changes depending on redness and prior irritation.

In reality, two or three of these patterns

often overlap in one patient.

That is why, at the first consultation,

determining the right priority for you is the most important step.

Three frequently asked questions about melasma treatment

Q1. If I take tranexamic acid,

how soon will I see results?

Usually around the 2- to 3-month mark,

patients feel their skin tone becomes more even.

However, sun protection must be used together,

or the result will not last.

Q2. If I combine toning with regenerative procedures,

won't the cost go up too much?

Rather than doing 20 meaningless toning sessions,

finishing within 10 sessions by adding regeneration

is more cost-effective in the end.

When the production rate is faster than the breakdown rate,

addressing that first is the way to save money.

Q3. If I stop using hydroquinone,

will it come back?

With medication alone, it almost always recurs.

When you stop the medication,

you need to build support with toning and regenerative procedures

for the results to be maintained.

In the end, melasma is not about breaking pigment,

but about changing the environment that creates it.

In the next article,

'How far should sun protection go during melasma treatment

to prevent recurrence?' I'll explain.

This has been Dr. Wi Young-jin.

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