Melasma is a common condition of symmetric brown or gray-brown facial patches, driven by hormones and sun exposure. 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.
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 notice | Usually means | The route that fits |
|---|---|---|
| New or active patches | Pigment being actively made | Sun protection and topical care first, always |
| Patches that persist on a good routine | Surface pigment to lift | A gentle chemical peel, carefully dosed |
| Uneven tone alongside the patches | Tone and texture | Collagen-building microneedling to even the skin |
| A richer skin tone | Higher risk of worsening | Conservative, tone-safe treatment and close follow-up |
| Discrete brown spots, not patches | Likely sun spots instead | The 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.
- What it is
- Symmetric brown or gray facial patches from overactive pigment
- Driven by
- Hormones (pregnancy, estrogen) and UV and visible light
- Foundation
- Daily broad-spectrum sun protection and topical care
- Realistic goal
- Lightening and control, not one-time erasure
- Treated by
- Dr. Allison Pontius, board-certified facial plastic surgeon
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.