LJC’s esthetician and skin care expert Cameron Vessey takes us through treatments for melasma that actually work, including hydroquinone, kojic acid, azelaic acid, the Cosmelan peel, and lasers like Moxi or Halo.
Melasma is a chronic condition of patterned pigment, for example, the occurrence of a dark “mustache” or circles on the cheeks. Although those with melasma cannot expect to ever stop treating it, this condition can be very well controlled.
For so many women who suffer from melasma, often for many years, it is an emotional and rewarding experience to learn that it’s possible to treat and be rid of it. Hear Cameron’s advice for how to prevent melasma in the first place, how to stop it from progressing if you think you’re starting to see it, and what to avoid to make it worse.
Speaker 1 (00:07):
You’re listening to the La Jolla Cosmetic Podcast.
Monique Ramsey (00:15):
Welcome everyone to the La Jolla Cosmetic Podcast. I’m your hostess, Monique Ramsey. And today we’re going to talk about three treatments for melasma that actually work. And our guest today is esthetician, Cameron, our master of the esthetician space and all things skincare. Welcome back.
Thank you so much, Monique. I’m so excited to be back.
Monique Ramsey (00:39):
Thanks. So let’s talk a little bit about melasma. What is it and what does it look like?
So, melasma is a chronic condition, and the easiest way to explain it is patterned pigment. So when people have discoloration, it’s more spots or what have you. With melasma, it looks kind of like a darker mustache. There’s melasma like patterned big circles on the cheeks or the forehead. So it’s a pattern pigment. And it is a chronic condition. And what we like to do is help you to control and suppress that pigment.
Monique Ramsey (01:19):
So now is there a certain type of skin that gets it, or person, age or?
It sometimes is referred to as the pregnancy mask. So a lot of hormones or what have you, when women go through hormonal changes they can get that. Men can also get melasma as well. It typically is darker skin type, like skin type for, what have you, Hispanic, Middle Eastern, Native American. Melasma for skin types that are a lighter skin type, you do have that as well, but it’s typically found in darker skin types.
Monique Ramsey (01:55):
Interesting. Okay. We’re going to work our way up the ladder of lightest to heaviest. So the first way that you can treat melasma is with products. So let’s talk about what products work to treat melasma?
Absolutely. One of the things I do want to say about melasma as well, and here’s one of the easiest ways to treat it too, is that heat activates the melasma. So for example, people who have melasma, you don’t want to do hot yoga. You don’t want to go into steam rooms or saunas. When you work out, I have a lot of patients, after they work out, what I’ll have them do is put a cold towel on their face to cool their face down. So actually a lot of people think it’s the sun that activates it. It’s really the heat. So no hot water on your skin when you’re washing your face, just tepid water, not hot water. So that’s a way that you can also help it too.
Monique Ramsey (02:52):
I love that. That’s an awesome tip. Getting into products. Let’s talk about that.
So if you have melasma, you will forever be on a product that controls and suppresses that melasma. What people will typically do is they’ll do a treatment, but they won’t do an ongoing product to help control that. But the gold standard for melasma really is hydroquinone. Now with melasma, the heat is the inflammation which activates it. So you don’t want to do a really strong hydroquinone. You may want to just do a 6% because you have to play with it. You don’t want to aggravate the melasma, but hydroquinone is the gold standard. And what that does is it inhibits your tyrosinase, which actually is what makes pigment. And so it inhibits that area so that you don’t get darker.
Monique Ramsey (03:44):
So the ingredient that’s going to be targeting the melasma is the hydroquinone. So how long would it take for somebody to maybe see a noticeable result with that product?
Monique Ramsey (03:55):
Three months. Okay. And that’s daily, using it every day?
That’s using it every day. So the typical protocol that we do for melasma is we do six months on hydroquinone and then two months on a non hydroquinone lightener. So hydroquinone is so good at what it does that when you abruptly stop it’s like you have what we call, rebound. It’s like the pigment comes back. So what we do is, for months five and six, we have patients use a non hydroquinone lightener in the morning, I.e. Even to SkinBetter Even Tone, or SkinMedica Lytera, there’s Al Arbutin, there’s Al azelaic acid. There’s a non hydroquinone lightener in the morning. And then hydroquinone at night for two months, and they may cycle completely off for two months and use the non hydroquinone lightener morning and night, and then cycle back on after that two months. So it just depends on how well you control that and how well you’re taking care of your skin, because some people only need to do three month increments of the hydroquinone. And if someone is very active in the summer, we prefer to have them on a non hydroquinone lightener during that time.
Monique Ramsey (05:05):
And why is that?
Just because with hydroquinone, especially if you’re using it in high dosages, it’s not good to be out in the sun. So if you have a very active lifestyle, we prefer to have you on a non hydroquinone lightener because you can go to the beach, it’s not a problem.
Monique Ramsey (05:21):
And so now I’ve heard something called kojic acid. Is that something that’s… And from what I understand, that’s something that’s an alternative to hydroquinone, do you like it or is it something that…
Yeah, I mean kojic acid is an alternative just like Lytera, and skin better even tone Al Arbutin, Al azelaic acid, yes, kojic acid is definitely an alternative, but I will say nothing works like hydroquinone. You know when you do different workouts to shock your muscles, that’s what we do with hydroquinone. So we may start someone who’s never used hydroquinone before and start them at a 6% at night only. And then after that we might say, okay, you know what? And especially if this is in the winter, I might pop you up to a 10% in the morning and then I’ll do a nighttime pad and I’ll add retinol in that nighttime pad. And then I bring it back down. So it’s almost forcing your skin to do what I want it to do.
Monique Ramsey (06:19):
Oh, okay. So that’s the pads that people can purchase with us, and you’re customizing the solution. So if you can describe for everybody how that works.
Sure. So what I tell people though, is that when you’re using the hydroquinone I don’t want someone just to come in and buy them willy nilly whenever they want to. And the reason why is because you must take a break from hydroquinone. So for skin types that are darker, it can really damage your skin if you don’t take that break. So most of my patients will see me regularly so that we can, again, keep them on a regimen that keeps their skin safe.
So for the solution, it’s a liquid solution, and there’s 60 pads in one container. And so we mix that solution depending on if we want a 6%, 8% or 10% or 4% hydroquinone solution. So we mix that up and then pour the liquid over the pads. So if you’re using it twice a day, it would be a one month, if you’re using it only at night, it would be a two month.
And then sometimes what we’ll do is we’ll not only have the hydroquinone, what’s great, hydroquinone and retinol, retinol of course is for that cellular turnover, retinols drive everything deeper. What’s great about having that combination is that retinol’s going to drive that hydroquinone deeper so you get a better reaction. And that’s how we switch it up as well. So we could do a 0.25% retinol with the hydroquinone and a 0.5%.
Monique Ramsey (07:47):
Oh, okay. So it’s very customizable.
And they’re textured pads. So what’s great is that you can use them on your face. And then let’s say you have a little bit of pigment on your decolletage. Let’s take it down there. How about the backs of the hands? Let’s take it there.
Monique Ramsey (08:02):
Okay. I’m excited. I’m ready to come and get a jar. All right. So now let’s get on to the next level that people might want to try to help combat melasma. And that would be peels. And so tell us about which peels are most effective on melasma?
It really depends on what a person is able to do and what their commitment is to, because it’s not only what’s the best, it’s what’s best for your lifestyle. So that’s really important. So there’s some people who just simply cannot, because of their jobs, do downtime. So we would then do I think the Diamond Glow with the combination of the hydroquinone at home with the skin brightening infusion, with the Diamond Glow and the Illuminize is a great option.
Then we go on and have the other peels. And with melasma, it’s not just one peel. It’s going to be a series depending on how deep that melasma is, what kind of result, the perfect DermaPeel is a wonderful peel as well for melasma, I would say that you would do a series of three, done six weeks apart, also doing the hydroquinone protocol at home as well. So with that peel, it actually has glutathione in it, which is a really strong antioxidant. It works really well. We also have boosters that we can do that can activate that peel even more so you get a better result.
And then also one of my favorites is the Cosmelan. So Cosmelan is really wonderful because you do not have to pretreat with the Cosmelan on, but it is a commitment. So many people who come in with melasma, it’s something that they’ve been struggling with for a long time. And people get very emotional about it. So, I have a lot of women who come… And men come in, who are really committed, which is great. So with the Cosmelan protocol, you do not have to pretreat. And what I mean by that is that if you’re a darker skin type four through six, you have to pretreat with hydroquinone to suppress that pigment so that you don’t have post-inflammatory hyperpigmentation, but with Cosmelan on you don’t have to pretreat it at all. People come in and we do photos. We really love to do photos to see the before and afters. But with Cosmelan it is a process. The first process is that we do a mask over the entire face. And it’s brown. And we put this all over your face.
Monique Ramsey (10:39):
It’s not even just brown, like a nice chocolate brown. It’s sort of this like yellowy, orangey brown. It’s really pretty. Interesting. Like what color. It’s like, Ugh. Wow.
It’s not that great. Especially funny when people have to walk out of the office like that, but it goes all over the face. And it actually will be staying on anywhere from eight to 10 hours, depending on your skin type. So you really want to make sure that you do that in the morning because you have to leave that on. The patient then goes home with that on and then they will wash that off. And then they do the post-care.
In the post-care there’s a product called Cosmelan 2. And the Cosmelan 2 is really the treatment that is going to help with the melasma. So it’s a mixture of RetinA, hydroquinone, hydrocortisone, but it can be tough to use. So after you’ve completely peeled, you’re going to start using this, and you use like a pea size, both morning and night. And you have to be really committed.
Monique Ramsey (11:44):
And in what way is it tough, does it sting or just it being tough in that you have to make sure you’re doing it twice a day?
Tough because it makes you red and flaky. So a lot of people, everyone is different. I have some patients who had no problem using it twice a day, and then others who can’t do that. So it’s something that you have to really play with. So about 20 days after your first peel, you come back in and what we do is we look at your skin together and we will then spot treat those patterned melasma places. And so we’ll spot treat those areas and you’ll leave it on longer this time for the second peel. And then anywhere from 10 to 12 hours. And then you go home, after you peel, you continue with that Cosmelan 2. So this whole process can be about five months, four to five months.
Monique Ramsey (12:34):
It’s worth it?
The results are amazing. Patients who are consistent and compliant with this. I’ve had patients cry, because all they see when they look at themselves is this melasma, and I have had women break down in tears just, oh my God, my skin has never looked this good. And when you’re able to do that for someone who’s been suffering with this for so long, it’s just really gratifying.
Monique Ramsey (13:01):
Wow. Now let’s say, you say, yes, I’m committed. I want to do the Cosmelan. And you go through that four to five month treatment. Is that something that then they would do every year or is that something that they would only need to do one time?
That’s a great question, Monique. And I’ll tell you what it is. It’s all about your home care. It all depends on you. Some people are great with their home care, and they’re able to have the results for a much longer period of time. And then there’s some people who, they don’t continue with hydroquinone or a non hydroquinone lightener and their pigment comes back because remember, it’s very deep down in the dermis and as your cells turn over, it’s going to bring that pigment up.
Monique Ramsey (13:45):
But one more question. So when they have the Cosmelan peel, how long after, let’s see you have it on that day and you wash it after the specified period of time, when do you start peeling and when do you finish peeling, approximately?
So approximately you’ll start peeling 48 hours, after you have washed that off it’s 48 hours from that time. And you peel anywhere from five to seven days. Sometimes it can be a lot of peeling, and then sometimes it’s just mild flaking. That does not mean that someone is not getting a great result. It’s just it may be that you are great about using your retinol and you’re not going to slough off as much.
Monique Ramsey (14:28):
And so during that time, if you were thinking about your lifestyle and work or social events, could you put makeup on or you wouldn’t even probably want to.
You know what? Everyone’s idea of what downtime is is completely different. Downtime for us, during the pandemic, sure. Not a problem, because we could wear masks. Now, if you were going to some formal event, I would probably say no.
Monique Ramsey (14:54):
Do you ever have patients graduate up the peel ladder? So maybe they might start with that Diamond Glow and Illuminize peel and then maybe a few months later they go, okay, now I want to have the Perfect Derma Peel and then they move to Cosmelan. Or is it more depending on what their lifestyle is, where they start?
It depends on what their lifestyle is. Again, you have patients who’ve come in, who’ve done things in the past and who are willing to do the downtime. I think one of the things that we do here at LJC is that we really prepare patients and let them know exactly what they’re going to be facing while they’re doing these protocols in the home time, because then they can make that decision.
Monique Ramsey (15:37):
Okay. So then the next up the ladder, one more step is lasers. So when do you say, as the esthetician I’ve done all I can, a peel isn’t going to cut it. You need the next step. Or does that ever happen? Is it?
Oh, yeah. That’s one of the reasons that I love working and being a medical esthetician. I think it’s really important because there are things that as an esthetician I cannot do. And that’s why I have my other providers. And many times I’ve brought in my other providers and I’ve done a Cosmelan on a patient. She’s gotten great results, but she wants more. And so I’m like, okay, what we’re going to do is I’m going to bring in one of my other providers and we’re going to do a series of MOXI, maybe we’re going to do the HALO. There are certain lasers that work well with melasma, and then certain ones that don’t. IPL, you do not do that on melasma. It will make it worse. But I will tell you using the MOXI, which is a low level laser, as well as the HALO. Those are great for breaking up that melasma. And oftentimes it will bring the other providers in and say, this is what I think. And we collaborate on a plan together and work together to get the best results for our patient.
Monique Ramsey (16:47):
And then what do you help with, after a laser treatment what happens next?
So after a patient has a laser, one of the things I love about LJC is we really walk people through everything. We really hold their hand and we want to treat them like our sister or brother. So after they go home, the providers are really great about following up with them, making sure that they’re okay, and then two weeks post laser, they make an appointment to come and see me.
And so we do a post laser hydration treatment. So this appointment is really about us getting to see the patient’s skin. We want to take the two week post photos to see how they’re healing, to see that going well. So really it’s not about really touching the skin a lot. I use a hydrating serum. I use a calming mask, and we use steam just to really slough off any of the residual dead skin, any of the men’s that’s on the skin, and just calm the skin down. It’s also a chance for the provider to be able to see the patient. And most importantly, it’s about us going over a plan, a skincare protocol that is going to enhance their laser results. So after they get a laser, they are in what we call Neo collagenosis. They’re producing collagen from the inside out. We want to get them on products that are going to help that collagen and elastin stimulation from the outside in. We want to maximize their results.
Monique Ramsey (18:28):
So let’s talk about prevention. So one of the things you were saying earlier about not doing hot yoga or not doing things that are going to inflame the melasma, is there anything people can do to prevent it from happening in the first place?
You know what? Yeah. You wear sunscreen. Start wearing sunscreen at a very young age, always wear a hat, not a baseball hat, not a visor, a full brimmed hat. Reapply that sunscreen when you’re outside every 80 to 90 minutes, use a zinc oxide based sunscreen. One product that I really love is the SkinBetter Alto Defense. It is a really potent antioxidant, but it’s also an anti-inflammatory. And remember we talked about with melasma being that you don’t want to inflame the melasma and that will make it heat up and get worse. So I think that’s a great anti-inflammatory as well.
Monique Ramsey (19:27):
Now, if somebody’s currently pregnant, who is listening today, is there anything that they can do to slow it down? Kind of the same things you just mentioned or, and I’m assuming when you’re pregnant, you maybe can’t use certain products. Is that right?
That’s absolutely right. But you can use Lytera, SkinMedica Lytera. That’s a lightener brightener. You can use SkinBetter Even Tone, you can use kojic, you can use Al azelaic. You can use those products. The only thing you cannot use when you’re pregnant is you cannot use any alpha hydroxy, beta hydroxy acids, no glycolic, salicylic, lactic, no retinols and no hydroquinone. But everything else you can. And there’s a lot of other things.
Monique Ramsey (20:16):
Now if someone’s out there listening, what advice would you give them? Does either stop it from getting worse or to take the first steps in treating it.
Don’t let that melasma go. When you start seeing that happening, catch it then and there, because it’s just going to get worse if you don’t do anything about it.
Monique Ramsey (20:36):
Now, when they’re wanting to come in, have a consultation about that, are you doing those consultations in person or on Zoom or?
I think I’m going to be going back to doing Zoom consults on Wednesdays. I also have patients who come in and will get one of the things that they can get is a diamond glow or a signature HydraFacial, and the people who are at my front desk, they give them a little extra time so I can really talk to them. What I like about being able to meet someone in person and doing a facial on them. I need to feel your skin. I can’t see a lot of stuff. I can’t feel congestion underneath. And so I really like when people just schedule a facial and then we kind of go from there. It’s not a one time thing. It’s a relationship that we build together. I get to know them. They get to know me, and we’re in for the long term.
Monique Ramsey (21:30):
And you know, I see so many of your reviews come through. It’s so cute. People will just talk about how you’ve gotten them onto a regimen that makes them happy, that their skin never looks so good. And it means they don’t want to stop coming. You want to keep that status quo of your beautiful skin. You guys can read reviews about Cameron’s specifically on our website and we’ll have those in the show notes.
Monique Ramsey (21:56):
Now, if you’re listening today, we want to ask you a special favor. If you love La Jolla Cosmetic and our podcast, and if you’ve learned something from it today, if it’s helped you make a decision, or it’s helped you decide what you need to start doing. Tell your friends, you write a review of the show on Apple Podcasts or Goodpods, or wherever you’re listening, because we love reviews. And we love to hear from you. And so Cameron, what’s your main takeaway you want people to have from today?
My main takeaway is that your face deserves the same kind of self care. And it’s not about vanity, it’s really about your skin health. And I want people to walk away with that, and your skin is the largest organ of your body and we’ve got to take care of it. And if you take care of it’s going to take care of you.
Monique Ramsey (22:52):
Oh, I love that. So any other tips you want to give us or is anything else that we didn’t cover?
Sunscreen, sunscreen, sunscreen, sunscreen, and sunscreen and sunscreen and hats.
Monique Ramsey (23:05):
And do you have a favorite one or does it depend on the person?
I love EltaMD. EltaMD has a ton of sunscreens that are wonderful, and it’s all about reapplication. And don’t be afraid of skincare. There’s a lot of false information out there, but we really give you the real dish on what you need for your skin. No smoke and mirrors, but medical grade skin care is so different because there’s science and clinical studies behind it. So don’t Pantene your face.
Monique Ramsey (23:44):
Well, did you make that up? I love that.
No, I actually had a hair stylist come in and I said, “You would never use Pantene on your hair. Would you?” And she said, “Oh my God, no, absolutely not. Because there’s, salon products that are much better.” And I said, “Well, why are you Pantene-ing your face?” And she said, “Oh my God, I get it.”
Monique Ramsey (24:04):
It’s a valid point. And even, gosh, you can go to a CVS or something and get ponds or oil of Olay. And it’s not just about the price, because you could go to Neiman Marcus or Nordstrom and get some really, really expensive skincare. But it’s not medical. You’re thinking you’re paying more. It must work. Not necessarily.
Well, one of the things that I just want to say that’s so interesting is that you want collagen and elastin stimulators. And I will tell you that really, my favorite are growth factors. And you need human growth factors for that. It’s not human growth hormones, but it’s human growth factors. So everything over the counter from Neiman Marcus to Sephora, they’re plant growth factors, your DNA does not recognize that. And that makes sense. Doesn’t it?
Monique Ramsey (24:54):
Yeah, it totally does. When I learned that, my mind was blown. I was at a SkinMedica conference and they talked about it and they’re like the lock and key don’t fit.
Monique Ramsey (25:04):
And it’s lovely that it’s natural or came from the sea or whatever, but that doesn’t mean your body’s going to be able to do something with it.
That’s absolutely right.
Monique Ramsey (25:13):
I’m glad you brought that up. That’s really important. All right, everybody. Well, thanks for joining us. Thank you Ms. Cameron.
Thank you so much, Monique.
Monique Ramsey (25:22):
And I know you’ve got a patient in a few minutes, so I’ll let you go, but thanks for being here, and I hope you come back soon and talk about something else.
Speaker 1 (25:38):
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