Symmetric shading across the cheekbones is nothing like the dots acne leaves behind, and only one of the two usually clears on its own in 3 to 12 months.
Published
Updated

Author
Wi Young-jin · Chief director
Seoul National University College of Medicine · Seoul National University Hospital Specialist
→
When you look in the mirror and think the brown marks spreading over your cheekbones have increased, you end up searching for "melasma skincare" or "pigmentation toner" right away. Then tranexamic acid serums, niacinamide ampoules, and arbutin creams all come up at once, making it hard to tell which one is right for your skin.
To start with the conclusion, these two ingredients work best in different situations. Tranexamic acid is more often used for melasma, where hormones and UV work together, while niacinamide is more often recommended for calming post-inflammatory hyperpigmentation (PIH) left behind by acne marks or after procedures. Even when the spots are both "brown marks," you need to first look at where they started from to know which ingredient will work better.
Melasma*: brown pigmentation that spreads symmetrically over the cheekbones, forehead, and upper lip. Pregnancy, birth control pills, and UV exposure all contribute. *Post-inflammatory hyperpigmentation (PIH): brown marks left behind where acne, procedures, or irritation have settled down. It is more common in East Asian skin.
Melasma* and PIH are pigments with different starting points
Although both are brown discolorations, melasma is a state in which melanocytes are chronically activated because hormones and UV exposure stimulate them together. That is why with routine brightening care, it often fades and then darkens again within a month or two. It tends to deepen in spring and summer and lighten a little in winter.
By contrast, PIH is a temporary buildup of melanin after acne settles or after laser procedures. If no further irritation is added, it usually fades naturally over 3 to 12 months. Unlike melasma, where the hormonal axis continues to stimulate pigmentation, PIH is a structure where a once-formed mark slowly clears, so the approach has to be different.

Tranexamic acid targets the chronic stimulation pathway in melasma
Tranexamic acid was originally used to reduce bleeding, but it entered melasma care after its effect of reducing signaling between melanocytes and the epidermis was confirmed. Topical serums and ampoules are the most common forms, and in dermatology clinics it is also sometimes administered by mesotherapy with microinjections or used orally for a short period.
With topical use alone, visible lightening usually takes 4 to 8 weeks, and without proper sun protection the results are not very good. So rather than tranexamic acid alone, we usually look at it as part of a combination: sun protection + topical brightening agents + laser toning when needed. For those who are pregnant or taking birth control pills, oral tranexamic acid is not recommended, so the path is usually topical treatment or procedures.

Niacinamide helps reduce melanin transfer in PIH
Niacinamide slows the step where melanin moves upward through the epidermis after it has been produced, helping PIH fade faster. Because it is gentle, one of its strengths is that it can be used relatively safely even on sensitive skin right after acne calms down. The most common products are serums and creams in 2–5% concentrations, and there is no major conflict in using it with vitamin C.
Many people see their tone even out within 4 to 12 weeks for acne marks, and it is also commonly recommended for post-procedure PIH. However, on melasma, it often cannot make a major difference on its own. While the hormones and UV exposure keep stimulating pigmentation, reducing melanin transfer alone is hard to keep up. If you remember that it is first-line for PIH and a supporting role for melasma, it becomes much less confusing.

Is using both ingredients at once the answer?
We often get asked, "Wouldn’t it fade faster if I combine them?" but there is no need to pile both ingredients onto the same spot at the same time. For melasma, it is usually more stable to focus on one track: tranexamic acid + sun protection first. For PIH, niacinamide + reducing irritation first. That approach usually gives more consistent results.
That said, some people do have both types of pigmentation. For example, melasma over the upper lip and acne PIH along the jawline can occur at the same time. In that case, we separate the care and apply different routines to each area. Please remember that even within the same face, each mark can have a different starting point.

Three things worth checking during your consultation
First, organize photos of the shape and location of the marks before your consultation. If they are symmetrically located on the cheekbones, forehead, and upper lip, melasma is more likely; if only acne sites or procedure sites are left behind as dotted marks, PIH is more likely. Second, if you mention hormonal factors such as pregnancy, birth control pills, or thyroid medication, it will be decided more quickly whether oral tranexamic acid is appropriate.
Lastly, set up a photo comparison schedule at 4, 8, and 12 weeks. Pigmentation hardly seems to change if you look at it week by week. If you take photos under the same lighting and angle each month, you can see for yourself whether it is improving. This article is general information, and the actual diagnosis and prescription should be made in consultation with a doctor who has examined your skin directly.
Frequently asked questions
Q. Does melasma not fade with niacinamide?
A. It rarely fades on its own. Because melasma is a type of pigmentation that is continuously stimulated by hormonal and UV-related factors, combining tranexamic acid, sun protection, and laser toning tends to produce more stable results. Please consider niacinamide as a first-line option for PIH and as an adjunct for melasma.
Q. Can I use vitamin C at the same time as a tranexamic acid serum?
A. There are no major conflicts when using them together. However, starting both at the same time can lead to cumulative skin irritation, so it is safer to use one first for about 4 weeks to let your skin adjust, then add the other.
Q. If neither ingredient shows any visible improvement, what would be the next step?
A. We need to re-evaluate the type of pigmentation first. Sometimes a spot is treated as PIH, but it is actually melasma; other times it may look like melasma, but it turns out to be solar lentigines (age spots). At a dermatology clinic, the priority is to reclassify the spots using a Wood’s lamp examination or comparison photos.
Q. I’ve been applying both ingredients, but I haven't seen any changes in a few days. Did I make the wrong choice?
A. It is still too early to tell after just a few days. Pigmentation typically fades in cycles of 4 to 12 weeks, so the most accurate way to check progress is to take photos under the same lighting and at the same angle once a month to compare.

Contouring & Volume
Glabella Botox Side Effects: Droopy Eyelids

Contouring & Volume
Juvelook Volume Not Working After 3 Sessions?

Contouring & Volume
Hip Dip Filler Before and After: 4 Checks

Body
Potenza Treatment Interval: Why 4 Weeks?

Lifting
Ultherapy Before and After: Why Wait 90 Days?

Contouring & Volume
Belotero Revive Cost: 2cc Price vs. 3 Sessions







