Is Laser Treatment Necessary for Melasma? A Doctor Explains if Oral Medication and Topical Treatments Alone Can Improve It
両頬にぼんやり広がる薄茶色のシミ、それは肝斑かもしれません。肝斑は一般的なシミと原因も治し方も違い、強いレーザーでかえって濃くなることもあります。肝斑とシミの見分け方、悪化させる原因、トラネキサム酸の内服やハイドロキノン外用によるレーザーを使わない治し方まで、わかりやすくまとめました。
目次
July 31, 2026
Is Laser Treatment Unnecessary for Melasma? A Doctor Explains if it Can Be Improved with Oral and Topical Treatments Alone
combines oral, topical, and injectable therapies.
Many people have questions and anxieties about melasma treatment, such as "I was told melasma can only be cured with lasers," "I was recommended laser treatment but I'm hesitant because of the high cost," or "Does laser treatment really work for melasma?"
In fact, laser treatment is not essential for melasma. Many individuals have seen significant improvement without lasers by combining oral tranexamic acid, topical hydroquinone, and thorough sun protection. Furthermore, improper laser irradiation can even worsen melasma.
In this article, a doctor from Mona Aoyama Clinic explains why melasma can be improved without lasers, the specific methods of oral and topical treatments, and the flow of treatment at our clinic.
- Online prescription of tranexamic acid and hydroquinone available nationwide
- Whitening and antioxidant treatments like placenta injections are available in-person (Tokyo, Aoyama)
- Same-day prescription and shipping (for payments made by 4 PM)
Why the Misconception "Melasma = Laser" Spread
It is true that laser treatment is effective for freckles and general hyperpigmentation. However, melasma has an entirely different cause than common age spots (senile lentigo). Melasma is a condition where melanocytes (melanin-producing cells) become hypersensitive due to hormonal fluctuations. Applying strong energy or heat stimulation can further activate melanocytes, leading to excessive melanin production. This is the reactive hyperpigmentation that occurs when melasma "worsens with lasers."
The image of "melasma requiring lasers" has largely been spread through the marketing efforts of clinics that own laser equipment. While oral and topical treatments may seem less glamorous, they are a very rational approach that directly targets the underlying mechanism.
💡 Low-output toning lasers can be effective for melasma in some cases, but high-output standard spot lasers carry a risk of worsening melasma. If you are considering laser treatment, always get a diagnosis for "whether it's melasma" first.
Reasons Why Melasma Can Be Improved Without Lasers
The essence of melasma is a state of overly activated melanocytes. There are three main approaches to calming this activity:
| Approach | Method | Role |
|---|---|---|
| ① Suppress melanin production from within | Oral tranexamic acid | Inhibits plasmin activity and fundamentally suppresses melanocyte activation |
| ② Suppress melanin-producing enzymes externally | Topical hydroquinone | Directly inhibits tyrosinase (melanin synthesis enzyme). Also lightens existing pigmentation. |
| ③ Eliminate exacerbating factors | Daily sunscreen, avoid friction | UV radiation and friction are the biggest exacerbating factors that stimulate melanocytes. Thoroughly block these. |
By combining these three, you can achieve the same goal as laser treatment, "reducing melanin," with lower risk. In particular, oral tranexamic acid is a medication with insurance coverage for melasma and has a long history of clinical success.
Our Clinic's Melasma Treatment — A Combination of Online and In-Person Care
| Treatment Method | Effect | Availability | Estimated Cost |
|---|---|---|---|
| Oral Tranexamic Acid (250mg x 3 times/day) | ◎ Fundamental suppression of melasma. Clear improvement in 3–6 months. | ✅ Online Prescription | Provided at time of prescription |
| Topical Hydroquinone (4–8%) | ◎ Directly inhibits melanin production. Effect in 4–8 weeks. | ✅ Online Prescription | Provided at time of prescription |
| Oral Vitamin C | ○ Antioxidant, auxiliary melanin suppression | ✅ Online Prescription | Provided at time of prescription |
| Placenta Injections | ○ Antioxidant, whitening, skin metabolism promotion. As an auxiliary treatment for melasma. | ✅ In-person treatment (Aoyama) | Provided at time of prescription |
| Sunscreen (SPF50+・PA++++) | ◎ Blocks the biggest exacerbating factor. Maximizes treatment efficacy. | ✅ Over-the-counter products are fine | — |
✅ Starting with oral and topical treatments online and then adding in-person treatments as needed is the most accessible and easiest way to begin. Many people experience sufficient improvement with oral medication alone.
Reasons Why Placenta Injections Are Effective for Melasma
Placenta injections (injectable drugs with placental extract as the active ingredient) have recognized effects in whitening, antioxidant action, and promoting skin metabolism. In relation to melasma, the following effects are expected:
- Antioxidant effect: Removes active oxygen, reduces oxidative stress on melanocytes, leading to suppression of melanin production.
- Whitening effect: Tyrosinase activity inhibition has been reported, which may subsidiarily suppress melanin production.
- Promotes skin metabolism: Normalizes cell turnover and promotes the expulsion of accumulated melanin.
- Influences hormone balance: Since hormonal fluctuations are an exacerbating factor for melasma, it may contribute to stabilizing hormone balance.
While the effect of placenta injections alone for melasma treatment is auxiliary, a synergistic effect can be expected when combined with oral tranexamic acid and topical hydroquinone. Our clinic offers this as an in-person treatment (Tokyo, Aoyama).
Treatment Progression — Recommended Steps
- First, diagnosis — Confirm whether it's melasma or a different type of spot. Melasma is characterized by bilateral, symmetrical brownish discoloration on both cheeks. We can make a preliminary assessment if you send photos during an online consultation.
- Start using sunscreen daily (you can do this right away). Use sunscreen with SPF50+ and PA++++ or higher every day. Wash your face gently by enveloping it in foam. Avoid friction.
- Begin oral tranexamic acid + topical hydroquinone. Prescribed through online consultation. Take oral medication three times a day after meals. Apply a thin layer of hydroquinone before bed.
- Check effects after 1-2 months. "Feeling slightly lighter" is the first sign. Many people see clear improvement in 3-4 months.
- If you want to further enhance the effect, add placenta injections. Add placenta injections through in-person treatment (Tokyo, Aoyama). Aim for a synergistic effect by combining it with oral and topical treatments.
- Continue maintenance after improvement. Melasma is prone to recurrence due to UV exposure and hormonal fluctuations. Continuing low-dose tranexamic acid and thorough sun protection are key to maintenance.
Is "Lasers Cure It Faster" True?
Appropriate low-output toning lasers (those designed for melasma) can indeed have a quicker effect than oral medication alone. However, considering the following points, starting with oral and topical treatments is suitable for many people:
| Comparison Item | Laser (Toning) | Oral + Topical (Our Clinic) |
|---|---|---|
| Speed of Effect | ◎ Can feel changes in a few sessions | ○ Takes 1-3 months |
| Cost | ¥10,000-¥30,000 per session x 5-10 sessions = Approx. ¥100,000-¥300,000 | Can continue for ¥X,XXX per month | Risk of Worsening | △ Risk of worsening if settings or clinic selection are incorrect | ◎ Almost none |
| Effort of Clinic Visits | Requires 1-2 visits per month | ◎ Completed online |
| Maintenance | Prone to recurrence once laser treatment stops | ◎ Easy to maintain by continuing oral medication |
Considering the balance of cost, risk, and convenience, it is reasonable to first try oral and topical treatments for 3-6 months, and then consider lasers if improvement is insufficient.
Frequently Asked Questions
Yes, it can. Post-laser reactive hyperpigmentation often calms down with a combination of oral tranexamic acid, topical hydroquinone, and sun protection. Please consult us online first.
Hydroquinone can cause irritation depending on its concentration and how it's used. For sensitive skin, we recommend starting with a low concentration (4%) and observing your skin's reaction by applying a small amount for a short period. If irritation is strong, please consult us to adjust the prescribed amount and frequency.
Both can have a certain effect individually. However, combining them allows for simultaneous suppression of melanin production from "inside" and "outside," so the combination is considered more effective and leads to faster improvement.
For whitening and promoting skin metabolism, we recommend starting with 2-4 injections per month for 3 months. Combining with oral and topical treatments will likely enhance the effects. Please consult us during your in-person consultation for more details.
Tranexamic acid is generally to be avoided during pregnancy. Hydroquinone is also recommended to be avoided during pregnancy. If you are pregnant or breastfeeding, prioritize thorough sun protection and gentle moisturizing care. Please consult us online after childbirth or when breastfeeding ends.
Related Columns
What's the Difference Between Melasma and Other Spots? How to Distinguish and Treat Them — Can Oral Tranexamic Acid Improve It? Does Oral Tranexamic Acid Cure Melasma? A Doctor Explains Its Effects, How to Take It, and Duration
Clinic Hours and Access
| Clinic Name | Mona Aoyama Clinic |
| Consultation Format | Online Consultation (Nationwide) / In-Person Consultation (Tokyo, Aoyama) |
| Location | D Building 3F, 1-10-3 Minami Aoyama, Minato-ku, Tokyo 107-0062 |
| Nearest Station | 5-minute walk from Tokyo Metro "Aoyama-itchome Station" |
| Online Consultation | Available 24 hours / Same-day shipping (for payments made by 4 PM) |
Consult Mona Aoyama Clinic for Melasma Treatment
You can start without lasers. Begin by consulting online for a tranexamic acid prescription.
