Melasma and hyperpigmentation · Upper East Side, New York

Melasma and Hyperpigmentation Treatment in NYC

Clear, even skin, cared for over time.

Melasma is one of the most common reasons women come to see me, and I love helping skin look clear and even again. It responds best to steady care: daily protection, the right topical plan and gentle in-office treatments, chosen with care for every skin tone.

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Starts with: Daily sun protection
At home: The right topical plan
In office: Peels, gentle lasers and light
First results: About 1 to 3 months
Approach: Long-term care

What melasma is, and what it isn't

Melasma causes brown or gray-brown patches, usually on the cheeks, forehead, upper lip or chin. Sunlight, hormones such as hormonal contraceptives or pregnancy, heat and even stress can trigger it. When pregnancy or a medication is the trigger, melasma may fade afterward. It can also last for years.

Not every dark spot is melasma. Sun spots, marks left after acne or irritation, and sometimes a skin cancer can look similar. That's why I want to look at any spot before you start fading it.

Your plan, in three steps

Protect daily

Broad-spectrum SPF 30 or higher, reapplied through the day, with a hat and shade.

Treat at home

A prescription or professional-strength routine chosen for your skin.

Add in-office care

Peels, gentle lasers and light, used carefully once your routine is working.

Step one: protect your skin every day

Sunlight makes skin produce more pigment, which can darken existing patches and cause new ones. For melasma, I prefer sunscreens with zinc oxide, titanium dioxide and iron oxide. My Vitamin E-ssential Sunscreen SPF 44 is a mineral sunscreen with 10% zinc oxide and 5.5% titanium dioxide and a sheer tint. More options are in my sunscreen collection.

Step two: the right topical treatment

Depending on your skin, I may recommend topical or oral tranexamic acid, hydroquinone (now prescription only), tretinoin with a mild corticosteroid or a triple combination cream, gentler options such as azelaic acid, kojic acid or vitamin C, or cysteamine. In a randomized trial of 50 people with melasma, a 5% cysteamine cream used nightly for four months lowered melasma severity scores more than a placebo cream. I offer Cyspera, a cysteamine product. For maintenance, some patients like my Triple Brightening Complex or Light & Bright Brightening Pads, which are hydroquinone-free. My discoloration solution set groups these together.

Step three: in-office treatments, used carefully

The options I use include a chemical peel, Clear + Brilliant, UltraClear, MOXI and microneedling. For sun spots rather than melasma, my XPL can be an option. With melasma, more aggressive is not better. Heat and inflammation can make pigment worse, so I choose devices and settings tailored to your skin tone and type. See caring for every skin tone and laser treatments.

When melasma is stubborn

Tranexamic acid, a prescription medicine, may help when melasma needs more support. It can be applied to the skin or taken as a pill. In a placebo-controlled trial of 44 patients, those who took tranexamic acid twice daily for three months had a 49% drop in melasma severity scores, compared with 18% in the placebo group. Three months after stopping, the improvement had partly faded, to 26% versus 19%. That pattern is why I talk about melasma as long-term care. Tranexamic acid isn't safe for everyone, so I review your health history first, including any history of blood clots.

What to expect

I
We look together
We look at your face together, and you tell me your goals and the features you love. Mostly, I listen.
II
Your plan for the year
I do a full assessment, studying your face at rest and while you talk. Then I walk you through your complete plan, from skin care and your at-home routine to in-office treatments, and map it into a calendar for the year so you can plan ahead and look forward to every visit. My assistant takes notes, reviews the plan with you and gives you a printed copy, plus one by email, before you leave.
III
Your routine, then follow-up
Your plan starts with daily protection and the right topical routine, and in-office treatments are added carefully when your skin is ready. Afterward we stay in touch and follow your calendar together, helping you reach your goals and making every decade your most beautiful best.

What to expect from results

With a steady plan, it usually takes about 1 to 3 months to begin to see results, and it can take longer if you've had melasma for many years. Many patients see real improvement, and the plan keeps going to protect it.

Your questions, answered

Can melasma be cured?

Melasma can fade, and it sometimes goes away after a trigger such as pregnancy ends, but it often comes back. Most people do best treating it as a long-term condition with daily sun protection and a maintenance plan.

What triggers melasma?

Common triggers include sunlight, hormones such as birth control pills and pregnancy, certain medications, heat and even stress.

What is the best sunscreen for melasma?

A broad-spectrum sunscreen with SPF 30 or higher every day. Formulas with zinc oxide, titanium dioxide and iron oxide are often recommended, and a tinted sunscreen can help.

Do lasers help melasma?

Sometimes. Laser and light treatments can improve results for people already using a topical treatment and sun protection. The wrong device or settings can make pigment worse, so treatment should be done by a board-certified dermatologist.

How long does melasma treatment take to work?

Most people begin to see results in about 1 to 3 months with a consistent plan. Long-standing melasma can take longer.

Is tranexamic acid safe for melasma?

It can help stubborn melasma, but it isn't right for everyone. I review your health first, including any history of blood clots.

Is melasma treatment safe for my skin tone?

Yes, with care. Heat and inflammation can make pigment worse in any skin, so I choose gentle devices and settings tailored to your skin tone and type, and build on a steady topical routine.

Is every dark spot melasma?

No. Sun spots, marks left after acne or irritation, and sometimes a skin cancer can look similar, so I look at any spot before you start fading it.

Medically reviewed by Doris Day, MD, FAAD · Last reviewed October 10, 2026

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