melasma
Melasma typically appears as diffuse, symmetrical pigmentation on both cheeks with indistinct borders, and it may fluctuate with irritation.
MELASMA TREATMENT
Melasma treatment
Carefully Planned, Step by Step
Melasma often appears as diffuse pigmentation across both cheeks and may fluctuate with ultraviolet exposure, friction or inflammation. At our clinic in Kobe and Motomachi, we check the mix of redness and spots, the treatment response so far, and plan treatment in stages from oral and topical medication, Mesona J, POTENZA, ADVATx, etc.
OUR APPROACH
Treatment of melasma includes:Prioritize correct identification and sequencing over treatment intensityWe plan care accordingly.
Contents of this page
CONCERNSDiffuse cheek pigmentation
Diffuse cheek pigmentation
may be melasma
You can contact us from the stage of "I want to treat these spots, but I am unsure whether I have melasma".
Symmetrical dullness on both cheeks
Uneven colors with blurred outlines
The pigmentation darkens after rubbing
The pigmentation changes with the season or my general health
The area became darker after previous treatment
Redness and brown pigmentation appear together
I want to distinguish between melasma and normal spots
I want to discuss where to start
Have the skin assessed before pursuing intensive treatment.
melasma, solar lentigines, freckles, and post-inflammatory pigmentation can mix on the same cheek. We first assess melasma activity and redness, then begin with the option least likely to aggravate irritation.
MELASMA OR SPOTSmelasma and spots
melasma and spots
May be mixed
It is difficult to completely separate by appearance alone, and it is judged by distribution, boundaries, redness, course, and treatment history.
solar lentigines
It is a pigmented spot that occurs due to the influence of ultraviolet rays, etc., and the boundary is relatively clear. Partial treatment may be considered after the melasma has stabilized.
freckles
It is a state in which fine pigment spots spread from the nose to the cheeks. Choose the irradiation method carefully if it overlaps with the melasma.
ADM/Pigmentation
Blue and gray ADM, acne and pigmentation after friction are also candidates. Treatment differs according to the condition and pigment depth.
If there is a sudden change, asymmetry, elevation or bleeding, etc. even if there is a color tone visible in the melasma, the doctor will check it including a different skin lesion.
The chart explains that melasma and discrete dark spots have different causes and may coexist on the cheeks. Melasma is associated with chronic inflammation followed by pigmentation and influences such as friction, hormones, and ultraviolet exposure. Solar lentigines and similar spots are associated with photoaging, slower turnover, and accumulated ultraviolet damage. The arrows show each causal sequence; the final caution says appearance alone may not distinguish them and careful assessment is required.
DIAGNOSIS FIRSTBefore choosing a machine,
Before choosing a machine,
We look at the activity of the melasma.
We do not commit to one procedure at the outset. We first assess melasma distribution, redness, dryness, friction, sun exposure, and previous treatment response. We avoid stacking procedures prematurely and proceed to the next stage after reviewing the skin response.
Is the melasma currently unstable?
When redness and dryness are strong, stabilization is a priority.
Are there redness and vascular elements?
Consider treatment that addresses the overall skin condition as well as pigmentation.
Is it mixed with other pigmented spots?
Consider treating melasma separately from localized spots.
STEP-BY-STEP PLANTreatment of melasma
Treatment of melasma
Think in three phases
Treatment is staged according to what the skin needs at each point.
Reduces and stabilizes irritation
Avoid friction, use sun protection and moisturize; consider oral and topical medication
Review daily stimuli and combine oral and topical medication or Mesona J if necessary. The first goal is a more stable skin condition and pigment pattern.
Address redness and inflammation
POTENZA ADVATx Mesona J
Check for overlapping pigmentation, redness and vascular elements to adjust depth and degree of irritation.
Separate and treat mixed spots
Fractional ruby laser treatment and spot treatment
Confirm that melasma is stable and carefully consider treatment for other spots and color unevenness.
TREATMENT OPTIONS
Melasma treatment options
Options are selected according to melasma activity, redness, sensitivity and acceptable downtime.
01 / FOUNDATION
Oral medication, topical treatment, and skin care
Begin with friction-reducing cleansing, moisturization, and sun protection. Depending on the clinical assessment, oral or topical tranexamic acid and vitamin C may be considered; device treatment need not be rushed.
- Potential indications
- Starting treatment; pronounced dryness or irritation; maintenance to reduce recurrence
- Treatment approach
- Continue with regular review of the skin response
02 / GENTLE DELIVERY
Mesona J
Mesona J delivers selected skin-care ingredients without needles. Consider when you want to avoid strong irritation or if you want to condition your skin before and after other Melasma treatments.
- Potential indications
- Dry or sensitive skin; before or after device-based treatment
- Treatment approach
- A course of treatment, alone or combined with other options
03 / MICRONEEDLE RF
POTENZA Melasma Treatment
POTENZA uses microneedles and radiofrequency. The tip, depth and settings are selected according to pigmentation, redness and vascular features, and treatment may be combined with peeling or topical and oral medication.
- Potential indications
- People with melasma who prefer a staged approach guided by skin response
- Treatment approach
- Confirm candidacy and tip selection during consultation; a course of treatment may be proposed
04 / REDNESS CONTROL
ADVATx
ADVATx may be considered when melasma coexists with redness or visible superficial vessels. Its 589 nm and 1319 nm wavelengths may be used in a plan addressing redness and the overall skin condition as well as pigmentation.
- Potential indications
- Melasma accompanied by redness, flushing or visible vessels
- Treatment approach
- A course of treatment with reassessment of redness and tone
05 / MIXED PIGMENT
fractional ruby laser treatment
Fractional ruby laser treatment may be considered cautiously when melasma is stable and other pigmented spots or uneven tone coexist. The method is selected for the target pigment and expected skin response rather than aggressively treating melasma itself.
- Potential indications
- Solar lentigines, freckles, and discoloration mixed with stable melasma
- Treatment approach
- Select the treatment area and settings during consultation
| Skin condition | Potential options | Role of treatment | Stimulation/Downtime |
|---|---|---|---|
| Strong dryness and irritation | Home care, oral or topical medication, Mesona J | Stabilize the skin before further treatment | Usually limited |
| Pigment-based melasma | POTENZA, oral or topical medication | Radiofrequency settings selected for the skin condition | Redness, needle marks, etc. |
| melasma with redness | ADVATx or Mesona J | Address redness and inflammation | Redness, flushing, etc. |
| Mixed with other pigmented spots | fractional ruby laser treatment | Treat separately after stabilization | Depends on irradiation method |
OUR FEATURESWith our Melasma treatment
With our Melasma treatment
What we care about
01
Separate and diagnose melasma, spots, and redness
We assess not only color intensity, but also the boundaries, asymmetry, redness, dryness, and treatment history. When device-based treatment is not appropriate, we will first guide you to stabilize the skin.
02
Do not rely on a single procedure
Oral and topical medication, Mesona J, POTENZA, ADVATx and fractional ruby laser treatment each serve different roles. Order according to skin condition and desired downtime.
03
Long-term management of pigment fluctuation
Melasma may fluctuate with ultraviolet exposure, friction and changes in general health even after treatment. Check each reaction and adjust the treatment interval and home care.
CASES & COLUMNSTreatment of melasma
Treatment of melasma
Clinical cases and related articles
The chart explains that melasma and discrete dark spots have different causes and may coexist on the cheeks. Melasma is associated with chronic inflammation followed by pigmentation and influences such as friction, hormones, and ultraviolet exposure. Solar lentigines and similar spots are associated with photoaging, slower turnover, and accumulated ultraviolet damage. The arrows show each causal sequence; the final caution says appearance alone may not distinguish them and careful assessment is required.
DOCTOR'S COLUMN
How to distinguish between melasma and spots
Fractional ruby laser case. Two comparisons are ordered Before → After. Treatment: five fractional ruby laser toning sessions, with hydroquinone and Skin Brightening Serum 0.25 used at home. The caption reports improvement in pigmented spots, dullness, and skin texture, and explains that combining laser treatment with high-strength retinol and hydroquinone at home contributed to the change. Clinic credit: Minato Motomachi Beauty and Plastic Surgery Clinic / NIE CLINIC.
DOCTOR'S COLUMN
Characteristics of Melasma and How to Assemble Treatment
ADVATx case. Two comparisons are ordered Before → After. Course: five ruby laser sessions and two ADVATx laser sessions. Because melasma and discrete spots coexisted, the ruby laser was used at a lower output to avoid aggravating melasma, followed by ADVATx treatment. The caption reports improvement in darker spots and uneven overall tone. Clinic credit: Minato Motomachi Beauty and Plastic Surgery Clinic / NIE CLINIC.
TREATMENT COLUMN
Treatment of melasma with POTENZA
Fractional ruby laser case. Two comparisons are ordered Before → After. Treatment: five fractional ruby laser toning sessions, with hydroquinone and Skin Brightening Serum 0.25 used at home. The caption reports more even tone, less dullness, lighter fine spots, improvement in fine lines, and greater firmness. Clinic credit: Minato Motomachi Beauty and Plastic Surgery Clinic / NIE CLINIC.
CASE
melasma/spots + redness treatment
ADVATx case 5. Comparison sequence: Before → after two ADVATx sessions → after three fractional ruby laser sessions. Labels identify shine and dullness. Fractional ruby laser and ADVATx were alternated to address sebum-related shine and overall dullness; the caption reports a brighter overall tone and reduced shine. Clinic credit: Minato Motomachi Beauty and Plastic Surgery Clinic / NIE CLINIC.
CASE
Combination treatment for redness, sebum and dullness
Major side effects/risks: redness, swelling, pain, soreness, dryness, needle marks, pinpoint bleeding, scabs, post-inflammatory pigmentation, loss of pigmentation, burns, scarring, deterioration/recurrence of melasma, etc. Changes shown in these cases may also reflect combined oral medication, topical treatment, and skin care. Effects and progress can vary from person to person.
PRICE
Fee for treatment of melasma
Representative treatment fees. Prices shown include tax.
POTENZA melasma treatment course
Full face, 5 sessions165,000 yen
ADVATx (589nm + 1319nm)
Full face including spot treatment, one session¥30,000
Full face including spot treatment, five sessions139,000 yen
Mesona J
Full face and neck, 1 session20,000 yen
Full face and neck, 5 sessions90,000 yen
With ADVATx, 1 session18,000 yen
Fees are based on the official price list as of July 16, 2026. Examination fees, anesthesia, peeling, oral and topical medication, cosmetics, etc. may be required separately. Please check the treatment details and price during consultation.
TREATMENT FLOW
From consultation to post-treatment
Confirmation of facial cleansing and skin condition
Remove makeup, check distribution, boundaries, redness, dryness, friction, sunburn, and treatment history.
Consultation/treatment plan
We will determine the order of treatment based on the activity of the melasma, mixed spots, and desired downtime.
Guidance on procedures and home care
We will guide you through the care, moisturizing, and sun protection to avoid friction according to the skin condition that day.
Progress check/re-adjustment
We review redness, dryness and color changes, then adjust the next treatment, settings, interval and combination.
DOWNTIME & RISKS
Downtime and risks
POTENZA
There may be redness, swelling, pain, pinpoint bleeding, needle marks, roughness, dryness, etc.
ADVATx
Temporary redness, flushing, swelling, dryness, tingling, etc. may occur.
Mesona J, oral and topical medication
Irritation, redness, itching, rashes, changes in physical condition, etc. may occur due to the ingredients used.
Melasma treatment in general
Stimulation may worsen the color tone. Rarely, blisters, burns, pigmentation/depigmentation, scarring, etc. occur.
Please let us know before treatment
Tell us if you are pregnant or breastfeeding, have a history of thrombosis, recent sunburn, dermatitis or infection, take medication, or have reacted strongly to previous laser or RF treatment. Treatment may be postponed or modified, and oral medication may not be suitable.
Japan Dermatological Association and other "Aesthetic Medical Clinical Guidelines" (external source)
FAQTreatment of melasma
Treatment of melasma
Frequently asked questions
How do you distinguish melasma from spots?
Melasma often appears symmetrically across both cheeks, and the boundaries are often unclear. However, it is often mixed with solar lentigines, freckles, and post-inflammatory pigmentation, so we will check the distribution, redness, and treatment history at the consultation.
Can irritation worsen melasma?
Overlapping stimuli such as ultraviolet rays, friction, and inflammation can change color tones. Avoid proceeding prematurely with an intensive procedure, and decide the order of treatment based on care to avoid friction and sun protection.
How many Melasma treatments might I need?
It depends on the skin condition and the treatment you choose. Many options require a course of treatment with the number and interval adjusted according to redness, dryness and pigment changes.
How do you choose between POTENZA and ADVATx?
Candidates change depending on whether pigmentation is the main concern or whether the redness and vascular elements are overlapping. After assessing the skin, we may begin with topical medication, oral medication or Mesona J.
Can I get spot removal even if I have melasma?
If the activity of the melasma is low and other spots are mixed, fractional ruby laser treatment may be considered cautiously. Stabilization of the melasma may be a priority first.
Can I wear makeup during treatment?
It depends on the treatment and the skin condition on the day. After Mesona J or another minimally invasive treatment, makeup may be possible on the same day, but please follow the guidance of a doctor or nurse for treatment using needles or lasers.
COUNSELINGWhether it is a melasma
Whether it is a melasma
For those who don't know
Please contact us from the stage of "I do not know whether the dullness of the cheeks is melasma or spots" or "I feel that it has become darker due to previous treatment". We will guide you in the order that suits your skin condition and lifestyle, including the choice not to rush into intense treatment.