Melasma, sun damage, and post-inflammatory marks need a careful protocol on Fitzpatrick III to V skin.
Pigmentation in Middle Eastern and South Asian skin is one of the most common reasons clients come to see us. It is also one of the easiest things to treat badly. Aggressive lasers, the wrong peel, or skipping the priming phase can trigger rebound pigmentation that takes months to settle.
The first principle is to slow down. Skin tones rated Fitzpatrick III to V need to be primed with tyrosinase inhibitors, hydroquinone or its alternatives, for two to four weeks before any active treatment. This reduces the risk of post-inflammatory hyperpigmentation, the very thing we are trying to treat.
For superficial sun damage and uneven tone, our depigmentation peel programme, what most know as Cosmelan, is the strongest tool. It is applied in-clinic, then continued at home for several months with a maintenance cream. Results are dramatic but the home protocol is non-negotiable, miss it and the pigment returns.
For melasma, the rules are different. Melasma is hormonal and chronic. We can lighten it significantly but it requires ongoing management, sun protection, daily home care, and periodic maintenance treatments. Q-switched laser at low energy, used carefully, is part of the long-term plan but not the first step.
Vascular pigmentation, like redness, telangiectasia, and rosacea-adjacent flushing, responds to a different family of treatments, AFT laser and dermalux LED, not the depigmentation protocols.
Two universal rules. SPF 50+ every day, every day, every day. And manage your expectations across months, not weeks. Pigmentation that took years to settle does not lift in a single session, no matter what anyone promises.
We are honest about timelines at the start. The clients who get the best results are the ones who commit to the full programme.