--- title: "Melasma" --- Melasma is patchy brown or gray facial pigment, usually symmetric across the cheeks, forehead, and upper lip. Hormones, from pregnancy or birth control, and ultraviolet and visible light drive it. It is chronic and tends to recur, and aggressive CO2 laser resurfacing or peels can worsen it, so the foundation is sun protection and topical care, with gentle in-office treatment layered on carefully. ## What it is Melasma is a pattern, and recognizing it changes how it should be treated. - Symmetric patches. Brown or gray-brown areas that appear on both sides of the face, typically the cheeks, forehead, upper lip, and bridge of the nose. - Hormone-linked. It often starts or worsens with pregnancy, the "mask of pregnancy," or with estrogen from birth control, and it is far more common in women. - Stubborn and recurrent. Even when it fades, it tends to come back, especially with sun exposure, which is why it is managed rather than cured in one go. Because some of the pigment sits deep in the skin, no treatment reliably erases it, and the realistic goal is to lighten the patches and hold them there. ## What causes it Melasma comes from pigment-making cells, melanocytes, that become overactive and deposit extra pigment. Two things drive that most: hormones and light. Pregnancy and estrogen-containing birth control are common hormonal triggers, and ultraviolet and even visible light switch the process back on, which is why sun exposure both causes and worsens it. It is more common in women and in medium to darker skin tones, and it can be genetic. The light sensitivity is also why melasma is so recurrent: a single unprotected weekend can undo months of progress, and why daily broad-spectrum protection is not optional but the base of every plan. ## How melasma is approached This is what the consultation sets, because melasma rewards patience and punishes aggression. What you noticeUsually meansThe route that fitsNew or active patchesPigment being actively madeSun protection and topical care first, alwaysPatches that persist on a good routineSurface pigment to liftA gentle chemical peel, carefully dosedUneven tone alongside the patchesTone and textureCollagen-building microneedling to even the skinA richer skin toneHigher risk of worseningConservative, tone-safe treatment and close follow-upDiscrete brown spots, not patchesLikely sun spots insteadThe sun damage and uneven skin path The value is not the list. It is that a physician resists the aggressive laser that can make melasma flare, builds on sun protection and topicals first, and adds gentle in-office treatment only where it helps, tuned to your skin tone. ## Why Santa Barbara Face & Body Melasma is the pigment problem most often made worse by treatment, because the strong lasers that clear sun spots can trigger melasma to rebound darker, and richer skin tones are the most vulnerable. Dr. Pontius treats it the careful way: sun protection and topical care as the foundation, gentle peels and microneedling layered on with restraint, and settings chosen to be safe across skin tones. Managing melasma well is a long game, and it is treated like one here. ## When it is worth a consultation **Worth coming in if you** - Have symmetric brown or gray patches on your cheeks, forehead, or upper lip - Noticed them start or worsen with pregnancy or birth control - See the pigment return every summer - Want a plan that treats melasma without making it worse **Better to talk it through first if you** - Are pregnant or breastfeeding, since some topicals are avoided and the pigment may fade after pregnancy - Have had melasma flare after a laser or peel before - Are not yet using daily sun protection, which is the foundation any treatment builds on ## What to expect from a visit Dr. Pontius confirms the pattern is melasma rather than sun spots or other pigment, factors in your skin tone and any hormonal triggers, and starts with the foundation: daily broad-spectrum protection and topical care. Gentle in-office treatment is added only where it will help without provoking a flare. You leave understanding that melasma is managed over time, what your daily routine needs to be, and a realistic picture of lightening rather than erasing. ## What we offer for this People come in about patches that will not budge, or keep coming back, and leave with a long-term plan built on protection and gentle treatment. The foundation and the in-office steps work together. > Melasma: Diagnosis and Treatment, American Academy of Dermatology (United States). Melasma is treated with sun protection and topicals, with chemical peels, microneedling, and laser or light as adjuncts; laser and light are added to a medication and sun-protection regimen rather than used alone. — [Melasma: Diagnosis and Treatment, American Academy of Dermatology](https://www.aad.org/public/diseases/a-z/melasma-treatment) > Melasma: Treatment, Causes and Prevention, Cleveland Clinic (United States). Melasma is driven by hormones and sun, is chronic and recurrence-prone, may fade after pregnancy, and some dermal pigment cannot be fully removed; daily sun protection is essential. — [Melasma: Treatment, Causes and Prevention, Cleveland Clinic](https://my.clevelandclinic.org/health/diseases/21454-melasma) ## Treating Melasma in Santa Barbara, CA Melasma can be stubborn, but a thoughtful, gentle plan can meaningfully even your tone and keep it that way. Here in Santa Barbara, Dr. Pontius treats melasma with care — combining the right treatments and skin care to brighten without irritation. If uneven pigment has been frustrating you, we'd love to help. Fill out the form below or call us at [(805) 764-9074](tel:+18057649074). ```ld+json { "@context": "https://schema.org", "@graph": [ { "@context": "https://schema.org", "@type": "MedicalCondition", "@id": "https://santabarbarafaceandbody.com/concerns/melasma/#concern", "name": "Melasma", "url": "https://santabarbarafaceandbody.com/concerns/melasma/", "description": "Melasma is the symmetric brown or gray patches that show up on the cheeks, forehead, and upper lip, driven by hormones and the sun. It is stubborn, prone to return, and easily made worse by aggressive treatment. 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At Santa Barbara Face & Body in Santa Barbara, California, a board-certified facial plastic surgeon manages it with daily sun protection, topical care, and gentle in-office treatment, chosen to be safe across skin tones, since melasma is prone to return and worsened by aggressive treatment." }, "isPartOf": { "@id": "https://santabarbarafaceandbody.com/concerns/melasma/#webpage" }, "url": "https://santabarbarafaceandbody.com/concerns/melasma/" }, { "@context": "https://schema.org", "@type": "FAQPage", "mainEntity": [ { "@type": "Question", "name": "Can melasma be cured?", "acceptedAnswer": { "@type": "Answer", "text": "It is managed rather than cured. Melasma is chronic and prone to return, especially with sun exposure, so the realistic goal is to lighten the patches and keep them controlled with an ongoing routine. Some pigment sits deep and does not fully clear, which is why expectations matter." } }, { "@type": "Question", "name": "Why does mine keep coming back?", "acceptedAnswer": { "@type": "Answer", "text": "Because light reactivates it. Ultraviolet and even visible light switch the pigment cells back on, so a few unprotected days can undo months of progress. Daily broad-spectrum sun protection is the single most important part of keeping melasma faded." } }, { "@type": "Question", "name": "Will a laser clear it faster?", "acceptedAnswer": { "@type": "Answer", "text": "Often the opposite. Aggressive CO2 laser resurfacing and peels can make melasma rebound darker, and richer skin tones are the most at risk. Gentle, carefully chosen treatment layered onto sun protection and topicals is safer and more durable than a strong device used in a hurry." } }, { "@type": "Question", "name": "Is my pigment melasma or sun spots?", "acceptedAnswer": { "@type": "Answer", "text": "Melasma is symmetric patches driven by hormones and light, while discrete brown spots from the sun are a different pattern with their own path. Telling them apart matters, because the strong treatments that clear sun spots can worsen melasma. A physician confirms which you have." } }, { "@type": "Question", "name": "Will it fade after pregnancy?", "acceptedAnswer": { "@type": "Answer", "text": "Sometimes. Melasma that appears in pregnancy can fade after, though it does not always, and treatment while pregnant is limited to options considered safe. 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