Melasma, freckles, and age spots are caused by overactive pigment cells. These cells produce melanin, a substance that darkens the skin. Freckles are tiny, brown spots that usually appear on sun-exposed areas early in life and fade over time. Age spots are generally seen later in life and tend not to fade. Melasma occurs most frequently in women of reproductive age. It is common in women with darker complexions who live in areas of intense ultraviolet (UV) radiation exposure.
All these skin discolorations can cause considerable cosmetic disfigurement and psychological distress. Studies have also shown that they negatively affect emotional well-being, social life, and leisure activities.
What causes Melasma?
The exact cause isn’t fully understood. Contributing factors include:
- Ultraviolet (UV) and visible light
- Hormones, such as pregnancy or hormonal contraception
- Genetic predisposition and darker skin types
- Some cosmetics, thyroid conditions and anti-seizure medicines
Melasma during pregnancy often fades within a year after delivery, but it may not disappear completely.
Clinical features
Melasma can present with irregularly shaped, hyperpigmented spots less than 5 mm. Depending upon the site of melanin deposition in the skin, the color varies from light brown to dark brown or ash/blue. The deeper site, such as dermal melanin, has a more grey/blue hue.
The spots are often confluent and symmetrically distributed. They are typically seen on sun-exposing skin areas of the face. Melasma caused by pregnancy usually regresses within a year after delivery.
Treatment Options
Treatments include skin-lightening agents, chemical peels, and laser and light-based therapy. Continued application of topical skin-lightening agents for up to six months may be required before a reduction in pigmentation occurs.
Therapy for melasma must be combined with sun protection measures, which include sun avoidance, wearing sun-blocking clothing and hat, and sunscreens that block both ultraviolet A (UVA) and ultraviolet B (UVB) with sun protection factor (SPF) 30 or higher. Sunscreen should be applied before going out and reapplied every two hours while being outdoors.
First-line therapies for melasma are skin-lightening agents and topical retinoids. Topical skin-lightening agents are the mainstay of treatment of melasma. Skin-lightening agents commonly used to treat melasma include Hydroquinone, Azelaic acid, Mequinol, and Kojic acid. Tretinoin stimulates the turnover of skin cells, decreases melanin transfer, and allows greater penetration of other active ingredients. Topical retinoids should not be started or continued during pregnancy because they are known teratogens and may cause congenital malformations.
New skin-lightening agents contain potent ingredients from natural plants from France, Spain, Africa, Canada, and the Swiss Alps. They inhibit the activity of tyrosinase and help melasma regress in fourteen to sixty days. They also claim to reduce some side effects seen in older skin-lightening agents.
Laser and light source-based therapy
Lasers and light-based therapies for treating melasma can be used in refractory cases.
HELIOS II: What is it, and how does it work?
Where creams and peels aren’t enough — or where the pigment sits too deep for them to reach — laser is the next step.
Helios II is a fractional Q-switched Nd:YAG system made by LASEROPTIK of Korea. It emits two wavelengths, and the target in both cases is melanin:
- 532 nm — treats shallower marks: freckles, sun spots, and red, orange or yellow tattoo ink
- 1064 nm — penetrates further, reaching dermal melasma and black or blue tattoo ink
Two design features matter for comfort. The fractional handpiece splits a single beam into 81 micro-beams, leaving untreated skin in between; less total heat goes in, and recovery is quicker. A diffraction optical element evens out the beam so energy lands uniformly rather than hot in the centre.
The system is also used for carbon “soft peeling”: a fine carbon layer is applied and then lifted off with a light pulse, taking dead cells, makeup residue, sebum and blackheads with it. Patients report tighter pores, a more even tone, less oil and a brighter finish, with no downtime.
What Helios II is used for
- Melasma
- Freckles
- Tattoos
- Nevus of Ota
- Becker’s nevus
- Lentigo
- Uneven skin tone
- Café au Lait spots
- Age spots
- Skin rejuvenation
Treatment Sessions
Often, eight or more treatment sessions are required to achieve maximum improvement, but with HELIOS II’s technology, three or five treatment sessions may be necessary for deeper skin lesions. Additional treatment sessions are usually separated by four to six weeks. Subsequent treatments may need higher laser energy settings to remove residual pigments.
Post-treatment Care
The preferred post-treatment care of the laser site consists of the daily application of a bland, occlusive ointment such as petrolatum to maintain wound moisture. Moisture promotes wound healing, and application should continue until the site is fully healed. Crusting and scabbing are normal and typically persist for one to two weeks. Cool packs may help minimize discomfort after treatment. Sunscreen and sun-protecting clothing should be used to minimize the risk of post-inflammatory hyperpigmentation. Strict sun protection should be continued for at least several weeks after treatment.
Safety of HELIOS II
HELIOS II is approved by the Thai FDA, US FDA, European Economic Area’s Conformité Européenne (CE marking of EEA), and Korean FDA.
Why Choose Kamol Hospital in Bangkok for Pigmentation Treatment
Melasma, age spots and post-inflammatory marks can look alike and respond very differently. Lasering deep melasma at the wrong setting makes it darker. Our doctors assess pigment depth and type before selecting an approach.
Helios II is a hospital-registered device operated under medical supervision at Kamol Cosmetic Hospital in Bangkok — not a rented machine run by a technician.
Fitzpatrick III–V skin carries a higher risk of rebound pigmentation after laser. Treating this every day, in a country where it’s the majority skin type, is a practical advantage.
Pigmentation work combines sun protection, topicals and laser in sequence. You’ll leave with a plan, and a coordinator to schedule it.
If you’re also considering non-invasive face and neck treatment, hand rejuvenation or nipple lightening, it can be scheduled in the same visit.
Frequently Asked Questions (FAQs)
Can melasma be cured permanently?
Melasma can be greatly improved, but it often comes back, especially with sun exposure or hormonal changes. Long-term sun protection and maintenance treatment help keep it under control.
Does the laser hurt?
Most patients compare it to a rubber band flicked against the skin, or light pinpricks. Numbing cream is applied for sensitive areas. Sessions are short.
How soon will I see a difference?
Superficial freckles and sun spots often darken, crust and flake off within one to two weeks of the first session, leaving clearer skin underneath. Melasma is gradual — expect visible improvement over several sessions.
Is it safe on dark skin?
Yes, with correct settings. The 1064 nm Nd:YAG wavelength is the standard choice for deeper skin tones precisely because it’s less likely to injure surrounding tissue. Assessment matters more than the machine.
Is Thailand a good place to have pigmentation treatment?
Bangkok has one of the highest concentrations of laser dermatology in Asia, and the local patient population is predominantly the skin types most affected by melasma — so the clinical experience base is deep. Costs are also well below Western equivalents, and multiple sessions can be scheduled inside a two- or three-week stay.
Can I get this done during a short trip to Bangkok?
A first assessment plus one or two laser sessions fits comfortably into a fortnight. For a full course, our Kamol Trip coordinators can either compress appointments or split them across two visits, with topicals continuing at home in between.
Can I have this treatment while pregnant or breastfeeding?
Please advise with our doctor. Retinoids and hydroquinone are avoided in pregnancy, and pregnancy-related melasma often fades on its own after delivery, so waiting is frequently the better call.
