Beverly Hills Dermatology
Melasma Treatment in Beverly Hills
A chronic, hormonally influenced pigment disorder that can be controlled but not cured — managed with a disciplined protocol rather than a single procedure.
- Verified Reviews
- 792
- Overall Rating
- 4.77★
- Bedside Manner
- 4.84★
- Years in Practice
- 20+
Overview
Melasma presents as symmetric brown to gray-brown patches across the forehead, cheeks, upper lip, and chin. It is driven by three interacting factors: hormonal stimulation (estrogen and progesterone, including pregnancy and oral contraceptives), ultraviolet and visible light exposure, and genetic predisposition. That is why melasma is far more common in women, more common in Fitzpatrick skin types III through V, and why it so often appears or worsens after pregnancy or a sunny holiday.
Mechanistically, melanocytes in affected skin are hyperactive rather than more numerous. They respond excessively to light and hormonal signaling by producing and transferring more melanin to surrounding keratinocytes. In epidermal melasma the pigment sits in the upper layers and responds relatively well to treatment. In dermal and mixed melasma, pigment has also reached the dermis, where it is far more resistant — which is why Dr. Zaks assesses pigment depth before discussing expected outcomes.
Effective treatment therefore works on three fronts at once: suppressing melanocyte activity, removing pigment already deposited in the epidermis, and eliminating the triggers that continually re-stimulate the process. Removing pigment without suppressing the trigger produces a few good months and then relapse — which is what most patients have already experienced elsewhere before they arrive.
Sun protection is the foundation of any melasma plan, not an afterthought. Melasma is triggered by ultraviolet, visible light, and heat; ordinary chemical sunscreens do not block these well. Dr. Zaks recommends a mineral sunscreen with zinc oxide or iron oxides at SPF 30+, reapplied during the day, along with hats and shade. Results are best maintained when photoprotection is kept up consistently.
Dr. Zaks personally performs every injectable, laser, and procedural treatment at his Beverly Hills practice. Patients are never seen by rotating physician assistants, nurse injectors, or aestheticians for these procedures.
Treatment Options
Cosmelan® Depigmentation System
A professional depigmenting protocol (Mesoestetic) applied in office and continued with a structured home regimen over three to six months. It is Dr. Zaks' most reliable option for moderate to severe melasma, working primarily by suppressing tyrosinase activity rather than by wounding the skin — an important advantage in the darker skin types where melasma is most common.
Prescription Topical Therapy
Hydroquinone, tretinoin, and mild corticosteroid combinations, and non-hydroquinone alternatives such as azelaic acid, cysteamine, and kojic acid for maintenance. These are cycled deliberately — continuous high-potency hydroquinone is not a long-term plan.
Salicylic Acid Chemical Peels
At this practice, chemical peels for melasma are limited to salicylic acid peels and the Cosmelan® protocol. Salicylic acid is lipophilic, superficial, and predictable, which makes it appropriate for pigment-prone skin. Peels are used in a series and always alongside topical suppression, never on their own.
Maintenance and Trigger Control
Mineral sunscreen with zinc oxide or iron oxides at SPF 30+ daily, review of hormonal contraception with your gynecologist where relevant, heat avoidance, and gentle pigment-safe skincare. Maintenance is indefinite because the underlying tendency is permanent.
The Treatment Experience
Diagnosis and pigment-depth assessment
Dr. Zaks confirms the diagnosis — melasma is frequently confused with post-inflammatory hyperpigmentation, lentigines, and drug-induced pigmentation — and assesses whether pigment is epidermal, dermal, or mixed, since that determines what is realistically achievable.
Trigger review
Hormonal contraception, pregnancy history, medications, occupational and recreational sun exposure, heat exposure, and prior treatments that may have inflamed the skin are all reviewed, because unaddressed triggers defeat any protocol.
Protocol design and initiation
A staged plan is built: suppression first, then controlled pigment clearance with Cosmelan® or salicylic acid peels as appropriate, at a pace matched to your skin type. Dr. Zaks performs in-office applications and peels himself.
Review, taper and long-term maintenance
Progress is reviewed at follow-up visits, typically around four to eight weeks, active agents are cycled or tapered, and you transition to a maintenance regimen designed to hold the result through Southern California summers.
Important Notes
- Chemical peels for melasma at this practice are limited to salicylic acid peels and the Cosmelan® protocol. Aggressive or deeper peels are avoided in pigment-prone skin because they can trigger rebound hyperpigmentation.
- Darker skin types require caution with lasers. In Fitzpatrick types IV through VI, laser and light-based treatment of melasma can worsen pigmentation and cause post-inflammatory hyperpigmentation, so Dr. Zaks prioritizes topical suppression and depigmentation protocols and approaches any device-based treatment conservatively, if at all.
- Melasma is chronic. Treatment controls it; nothing cures it. Expect maintenance rather than a finish line.
- Hydroquinone and tretinoin are not used during pregnancy or breastfeeding. Safe alternatives, primarily rigorous photoprotection and azelaic acid, are used until after delivery and nursing.
- Inflammation is a trigger. Waxing, harsh scrubs, over-exfoliation, and irritating actives can all darken melasma.
Frequently Asked Questions
Is Cosmelan safe during pregnancy or breastfeeding?
Dr. Zaks does not start Cosmelan® or prescription hydroquinone and tretinoin regimens during pregnancy or breastfeeding. Melasma that appears in pregnancy often lightens on its own in the months after delivery, so the approach during that period is strict photoprotection with mineral sunscreen at SPF 30+ and, where needed, azelaic acid, which is generally considered acceptable in pregnancy. Active depigmentation is deferred until you are no longer pregnant or nursing.
Does insurance cover melasma treatment in Beverly Hills?
Generally no. Melasma is considered a cosmetic condition by most carriers, so topical protocols, Cosmelan®, and peels are self-pay. The office visit to diagnose pigmentation — particularly to rule out other causes — may be billable to PPO insurance or Medicare. Call (310) 552-3376 and the office will tell you exactly what is and is not covered before you commit.
Can melasma be cured permanently?
No. Melasma can be substantially lightened and then held stable, but the melanocyte hyperreactivity that causes it does not go away. Patients who understand this from the start do far better, because they maintain photoprotection and periodic topical therapy instead of stopping the moment their skin looks clear.
How long before I see results?
Most patients see meaningful lightening within four to eight weeks of starting a supervised protocol. Deeper or mixed melasma takes three to six months of consistency, and some dermal pigment never fully clears. Progress is judged at follow-up rather than by day-to-day inspection.
Can lasers treat my melasma?
Lasers are not the first-line answer for melasma, and in darker skin types they can make it worse. Heat and inflammation are melasma triggers, so device-based treatment risks rebound hyperpigmentation. Dr. Zaks leads with suppression and depigmentation, and considers any light-based approach only cautiously, in selected lighter-skinned patients whose pigment is stable and whose triggers are controlled.
Will stopping my birth control clear my melasma?
It may help, but rarely on its own and not quickly — pigment can persist for months or years after the hormonal trigger is removed. Any change to contraception is a decision for you and your gynecologist; Dr. Zaks will explain how large a factor it appears to be in your particular case.
Does Dr. Zaks perform the in-office treatments himself?
Yes. Dr. Zaks personally performs every peel, Cosmelan® application, and procedural treatment at his Beverly Hills practice. Patients are not passed to aestheticians for pigment treatment, where technique and judgment change the outcome.
Patient Reviews
“I have been going to Dr. Zaks for over 4 years. His outstanding skill, great bedside manner, warm personality, and artistry with Botox make me come back again and again!”
“I had Rosacea on my face for over 10 years. Dr. Zaks quickly reduced this embarrassing condition. Nobody else could help me. He's the best Dermatologist in LA hands down!”
“Dr. Zaks did not rush and he gave me 100% attention. He did not try to sell me product or convince me to try aggressive procedures which I appreciated.”
“Doctor took the time to explain the technical aspects of my condition, the treatment options and the expectations.”
About Dr. Boris Zaks, MD
Dr. Boris Zaks personally performs every procedure at Superior Beverly Hills Dermatology — never rotating assistants. He has practiced dermatology in Beverly Hills for more than twenty years.
- Board Certified — American Board of Dermatology (since 2002)
- Medical Degree — UCLA School of Medicine
- Chief Resident — Charles Drew University of Medicine & Science
- B.S. Biology — UCLA, Summa Cum Laude (age 19)
- Medical Board of California Expert Reviewer since 2009
- Super Doctors® 2023, 2024, 2025, 2026 & 2027 (Southern California)
- "Rock Star Dermatologist" — Glamour Magazine
Schedule Your Consultation
435 N. Roxbury Drive, Suite 408, Beverly Hills, CA 90210 · Monday–Friday · (310) 552-3376
Paid parking on-site, or free 2-hour parking at 461 N. Bedford Drive Garage, 1 block away
Areas Served
Patients seek melasma treatment at Dr. Zaks’s Beverly Hills office from throughout greater Los Angeles: West Hollywood, Bel Air, Brentwood, Malibu, Pacific Palisades, Santa Monica, Westwood, Century City, Culver City, Marina del Rey, Studio City, Sherman Oaks, Encino, Calabasas, Burbank, Glendale, Pasadena, Manhattan Beach, Hermosa Beach, Torrance, Long Beach, Newport Beach, and Irvine.