Online store

Melasma Treatment in Bergen – Why IPL Can Make It Worse

If you have melasma and are considering laser or IPL treatment, there’s one thing you should understand before booking an appointment: the wrong technology can make the spots darker, not lighter. Melasma is the one pigmentary condition where the choice of machine and protocol truly determines the outcome. This article explains why—and what the research says actually works.

By Rebecca Bergetun, Nurse - Cosmetic Nurse •

A recognizable pattern in clinical practice

A woman in her 30s comes in for a consultation. She has symmetrical, brownish patches on her cheeks and upper lip—the classic melasma pattern. She has undergone two rounds of IPL treatment at another clinic. It improved slightly during the first week. Then the patches returned. Worse than before. More widespread than before.

This is not an exception. It is a recognizable pattern in clinical practice, and research explains why it happens.

“The most common scenario we see with patients who come to us for melasma is that they’ve already tried IPL or another laser treatment that actually made it worse. It’s a challenging situation to start from a worse point than they were in before.”

— Rebecca Bergetun, cosmetic nurse at TBL Medical

What is melasma?

Melasma is a chronic pigmentary condition that causes symmetrical, brownish patches, most commonly on the cheeks, forehead, upper lip, and chin. It is triggered by a combination of factors:

  • Hormonal changes (pregnancy, birth control pills, hormone therapy)
  • UV radiation—both UVB and UVA, as well as visible light
  • Genetic predisposition
  • Heat. Yes, heat alone can trigger melasma

This last point is key to understanding why certain treatments make the condition worse.

Unlike ordinary sunspots or age spots, where the pigment cells are dormant and standard laser treatment works well, the pigment cells in melasma are overactive. They react to the slightest stimulus by producing more pigment. It is this biological mechanism that makes melasma so difficult to treat—and that makes the choice of technology so critical.

Why IPL Often Worsens Melasma

IPL (Intense Pulsed Light) is an effective treatment for many conditions— sunspots, broken capillaries, and general skin rejuvenation. That is why many clinics offer it. The problem arises when it is used to treat melasma.

IPL is not a laser, but broad-spectrum light that delivers significant heat across a wide range of wavelengths. For a patient with stable pigmentation, this works well: the pigment cell is destroyed, the body clears away the melanin, and the spot disappears.

For a patient with melasma, the reaction is the opposite. The overactive pigment cell perceives the heat as a threat and responds by producing more pigment, not less. The result is called rebound hyperpigmentation, and it can be difficult to reverse.

This is not an isolated clinical observation. There is a consensus in the medical literature. Research on melasma is extensive, and recent evidence points in a clear direction. A randomized controlled trial published in Frontiers in Medicine in 2023 (Liang et al.) compared the picosecond Nd:YAG 1064 nm laser, the picosecond alexandrite 755 nm laser, and 2% hydroquinone cream in 60 patients with melasma. Pico Nd:YAG produced the greatest reduction in MASI scores after three monthly treatments and was significantly more effective than both the alexandrite laser and hydroquinone. A 2026 meta-analysis published in Cureus, including 52 studies, confirms that it is precisely the 1064 nm wavelength with low fluence that produces a statistically significant effect—regardless of whether it is delivered as Q-switched or picosecond.

With regard to IPL specifically: Although IPL is effective for other pigmentary conditions, there is broad clinical consensus that it should not be the first-line treatment for melasma. The widespread thermal stress caused by IPL can stimulate the overactive pigment cells and trigger rebound hyperpigmentation—the opposite of the desired effect

Many clinics that offer IPL also state on their websites that it should not be used on melasma—but this information is often buried deep within the site, while the homepage promises “removal of pigmentation spots” in general. Few people mention this distinction before treatment.

What the research recommends

What stands out in the research is the low-fluence picosecond laser operating at a wavelength of 1064 nm. Three characteristics make this combination well-suited for melasma:

  • The 1064 nm wavelength penetrates deep enough into the skin to target the melanin, but safely passes by blood vessels and superficial structures
  • Picosecond pulses are extremely short (450 picoseconds—trillionths of a second). The energy is converted into a mechanical pressure wave that shatters the pigment rather than heating it
  • Low fluence (energy density) means minimal heat transfer to surrounding tissue—which is essential for avoiding stimulation of the overactive pigment cells

The results of the studies are consistent: a significant reduction in mMASI scores (the medical measure of melasma severity) after four monthly treatments, with minimal side effects. A 2023 study published in Lasers in Surgery and Medicine showed that independent dermatologists could identify the “after” image in 80% of cases based solely on the reduction in visible pigment.

Realistic expectations

Melasma is not a condition you can simply “get rid of.” It is a chronic pigmentary condition that can be managed and kept under control, but often requires ongoing maintenance. A realistic treatment plan consists of:

  • Accurate medical diagnosis — not all brown spots are melasma, and treatment depends on the type
  • The right laser technology and protocol — low-fluence pico-laser, not IPL
  • Daily sun protection, even indoors and in the winter — mineral-based SPF is recommended
  • Consistent topical home treatment between clinic visits
  • Maintenance as needed — especially before and after the summer season

“What I usually tell my patients is that we’re not looking for a cure. We’re looking for control. With the right treatment and daily sun protection, it’s entirely possible to keep melasma under control over time—but it requires consistent follow-through.”

— Rebecca Bergetun, cosmetic nurse at TBL Medical

From practitioner to patient and back again

Rebecca has also experienced melasma herself—and has been helping patients with melasma for over 15 years. She developed it after her second pregnancy, when she started taking birth control pills—one of the classic triggers. That was one of the things that motivated her to delve deeper into pigment treatments.

Rebecca Bergetun, cosmetic nurse at TBL Medical.

“When I first noticed the spots, I thought they were just sunspots that would go away. They didn’t. I did some research, tried different products, and discovered just how much misinformation is out there—even among professionals. That’s one of the reasons I’m so committed to ensuring our patients get the right diagnosis first, and a treatment plan they actually understand.”

“I know what it feels like to look in the mirror and not recognize yourself. And I know how much it means to understand what you’re dealing with—that it’s a condition, not something you’ve done wrong. That conversation is more important than people realize.”

— Rebecca Bergetun

What TBL Medical uses

TBL Medical has deliberately selected a range of lasers that covers the entire spectrum of pigment treatment, including the most challenging cases: melasma and complex hyperpigmentation. Two platforms are key:

  • Candela PicoWay — 1064 nm picosecond Nd:YAG, the platform on which the majority of melasma studies have been conducted
  • Fotona StarWalker PicoPro — 1064 nm picosecond, with optional add-ons such as YellowLase 585 nm. Research indicates growing interest in addressing the vascular component of melasma—blood vessels that may contribute to pigment formation, particularly in recurrent or treatment-resistant cases. Its use is evaluated on a case-by-case basis and as an adjunct therapy

This is medical-grade pico equipment selected specifically because it is the first-line treatment recommended by research for melasma. To the best of our knowledge, TBL Medical is the only clinic in Bergen offering this specific treatment regimen for pigmentation.

Questions to ask before treatment — no matter where you go

These are the questions a patient should have answered before their first treatment, regardless of the clinic:

  • Which laser is used to treat melasma—and at what wavelength? If the answer is IPL or Alexandrite alone, there is reason to consider alternatives
  • Is a low-fluence protocol being used? The practitioner should be able to explain this
  • How many patients with melasma has the clinic treated? Experience with the condition is at least as important as the equipment
  • What is the plan for maintenance and home care? If no one mentions sun protection and topical products, that’s a red flag
  • What does the clinic do if the condition worsens? A reputable clinic has an answer to this

Pre-treatment consultation

Proper treatment starts with an accurate diagnosis. Not all brown spots are melasma—they could also be sunspots, age spots, post-inflammatory hyperpigmentation, or other conditions, and each requires a different approach.

Book a consultation with one of our cosmetic nurses at TBL Medical, located at Marken 32 in Bergen. We’ll give you a thorough evaluation, and if we don’t think laser treatment is right for you, we’ll let you know.

Sources

This article has been reviewed by the medical director at TBL Medical Bergen and is intended for informational purposes only; it does not replace an individual medical evaluation. Please schedule a consultation to have your specific situation evaluated.