Pigmentation is the most common concern we see, and melasma is the most frustrating version of it — because people do get results, and then it returns, and they conclude the treatment failed. It did not. Melasma is a chronic, relapsing condition, and understanding that changes how you approach it.
Melasma versus other pigmentation
Melasma appears as symmetrical brown or grey-brown patches, usually across the cheeks, forehead, upper lip and jawline. It is driven by a combination of sun exposure, hormones — pregnancy, oral contraceptives, thyroid issues — and genetic predisposition. Heat matters too, which is why it is stubborn in Ahmedabad's climate.
This is different from sun spots, from post-inflammatory pigmentation after a spot or an injury, and from periorbital darkening. They look similar to the untrained eye and respond to completely different treatments, which is why self-treating from the internet so often backfires.
The single most important factor
Sun protection. Not as an afterthought — as the treatment. Any in-clinic procedure without rigorous daily sun protection is money spent on a result that will unwind within weeks.
That means a broad-spectrum sunscreen of SPF 30 or higher, reapplied through the day, and ideally one with iron oxide, which blocks visible light. Visible light drives melasma and ordinary sunscreens do not filter it. Physical shade, a hat and avoiding peak sun still matter on top of this.
What we use in clinic
Treatment is layered and conservative. Aggressive approaches provoke inflammation, and inflammation makes melasma worse — this is the trap.
- Topical prescriptions. The foundation. Usually the first thing we start and the last thing we stop.
- Chemical peels. Carefully selected for skin type. The wrong peel at the wrong strength on Indian skin causes post-inflammatory hyperpigmentation and sets you back months.
- Mesotherapy. Delivers brightening actives into the skin where topicals struggle to reach.
- Laser. Used cautiously and rarely as a first line for melasma specifically. Some lasers worsen it.
Why "instant fairness" treatments are a bad idea
Skin-lightening creams sold without prescription frequently contain unlabelled steroids or mercury. They produce fast visible lightening followed by steroid-induced rosacea, skin thinning, and rebound pigmentation that is considerably harder to treat than the original problem. We see the consequences regularly.
A realistic expectation
With a proper plan, most patients get substantial fading within three to six months, and then maintain it. Flares happen — after a summer, after a pregnancy, after a holiday. Maintenance is part of the plan, not evidence that it failed.
If your pigmentation has not responded to what you have tried, it may simply be the wrong diagnosis. Book an assessment at our South Bopal clinic and we will tell you which type you have before recommending anything.
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