In twenty-seven years of practicing medicine, I have helped a great many patients feel more like themselves again. But there is one condition that has challenged me both professionally and personally: melasma and hyperpigmentation.
I know this struggle because I live with it.
As a woman of color with Fitzpatrick skin type IV, I understand the frustration of looking in the mirror and seeing dark patches that appear without warning and refuse to fade, no matter how disciplined you are. My own pigmentation became more noticeable during a period of hormonal change — a reminder that physicians are not exempt from the conditions we treat.
For years I looked for approaches that were both effective and appropriate for skin like mine. What I want to share here is what I have learned, and how we approach this condition at Skincredible.
What Melasma Actually Is
Melasma is a chronic pigmentary condition that produces brown or gray-brown patches on the face — most often across the cheeks, forehead, nose, upper lip, and chin. It affects millions of people worldwide and is considerably more common in women.
Melasma is not dangerous. It is not contagious, and it is not a sign of a serious underlying illness. But it can have a real effect on confidence and emotional well-being. Patients tell me they avoid photographs, wear heavy makeup every day, or have simply given up because nothing has worked.
I understand that feeling, because I have had it.
Why Melasma Happens
Melasma is more complex than sun damage. Several factors contribute, and most patients have more than one:
- Hormonal changes, including pregnancy and menopause
- Oral contraceptives and hormone therapy
- Ultraviolet exposure, including on cloudy days and through car windows
- Visible light, including blue light from screens and overhead lighting
- Heat exposure, independent of sun — cooking, saunas, hot climates
- Genetics and family history
- Skin inflammation or irritation, including from aggressive skincare
- Certain medications
Even brief exposure can re-stimulate the pigment-producing cells in the skin, which is why melasma so often returns after it has improved. Daily broad-spectrum sun protection is non-negotiable — but sunscreen alone is rarely enough.
Why Treating Skin of Color Requires a Different Approach
Patients with Fitzpatrick skin types IV, V, and VI have skin that contains more melanin. That same melanin makes the skin more reactive to inflammation or injury, which means any procedure carries a higher risk of post-inflammatory hyperpigmentation — darkening that occurs after the treatment itself.
This is not a reason to avoid treatment. It is a reason to be deliberate about it. Device selection, energy settings, treatment intervals, and pre- and post-treatment skin preparation all matter more in richly pigmented skin than they do in lighter skin. Conservative settings and a slower pace usually produce better long-term results than aggressive treatment.
This is one of the reasons I spent a great deal of time researching technology before bringing any of it into our practice.
The Technology We Use
At Skincredible we use the Picofy platform by InMode, a picosecond laser system that delivers energy in extremely short pulses — measured in trillionths of a second. In the United States, Picofy is FDA-cleared for tattoo removal and for the treatment of benign pigmented lesions, acne scars, and wrinkles.
Picosecond technology is of interest in pigmentary conditions because the very short pulse duration allows pigment to be targeted with comparatively less heat delivered to surrounding tissue. In skin of color, limiting unnecessary heat matters.
Melasma specifically is not among Picofy’s cleared indications. When laser treatment is used as part of a melasma plan, that is an off-label application — a clinical decision made by a physician based on published evidence and individual assessment, not a marketing claim. I discuss this openly with every patient before we begin, because you deserve to know exactly what is and is not established about any treatment I recommend.
Laser is also never the whole plan. In melasma, it is one tool among several, and for some patients it is not the right tool at all.
How We Build a Treatment Plan
No two cases of melasma are the same, and the most durable results usually come from combining approaches:
- Medical-grade topical therapy, including pigment-suppressing agents
- Rigorous, daily photoprotection — including tinted mineral sunscreen for visible-light coverage
- Review of medications and hormonal contributors, where appropriate
- Careful device-based treatment when the skin is well prepared and the timing is right
- Test-spot treatment before treating the full face in higher Fitzpatrick types
- A long-term maintenance plan, because recurrence is expected without one
I want to be direct about expectations. Melasma is a chronic, relapsing condition. There is no single treatment that eliminates it permanently, and any provider who promises you otherwise is not being honest with you. Our goal is meaningful, steady improvement achieved safely — and a plan you can sustain. You can read more about how we approach melasma and hyperpigmentation as a service.
Results vary from patient to patient. Every treatment carries risk, including redness, swelling, temporary darkening, and, less commonly, lightening or darkening of the skin that persists. We discuss all of this before you consent to anything.
Why This Matters Here in Wichita
Patients in our community have often had to travel to larger cities to access newer aesthetic technology, particularly patients with richer skin tones who want a provider comfortable treating skin like theirs.
We wanted to change that. Our aim at Skincredible is straightforward: physician-led aesthetic medicine, delivered here, with the same clinical standards I hold myself to in every other area of my practice.
What I Promise My Patients
When you sit in my treatment chair, I am not looking at another appointment. I am often looking at someone experiencing exactly what I have experienced.
I understand the emotional weight of melasma. I understand the disappointment of treatments that did not deliver. And I understand how much it means when your skin begins to settle and your confidence comes back.
So every plan we build is individualized. No unnecessary procedures. No promises I cannot support. Just careful medicine, appropriate technology, and honest conversation about what is realistic for your skin.
Ready to Start?
If you are dealing with melasma, post-inflammatory hyperpigmentation, or stubborn dark spots, we would be glad to help you understand your options.
Schedule a consultation with Dr. Samrah Mansoor at Skincredible Wichita, and we will build a plan around your skin type, your history, and your goals.
Healthy skin is not about perfection. It is about confidence — and everyone deserves to feel at home in their own skin.
Individual results vary. Candidacy for any treatment can only be determined during an in-person consultation and examination. Picofy by InMode is FDA-cleared for tattoo removal and for the treatment of benign pigmented lesions, acne scars, and wrinkles; use in the management of melasma is off-label. All treatments carry risk, which will be reviewed with you before you provide informed consent.