What Melasma Actually Is
A condition where the wrong device or setting doesn’t just fail to help, it can actively worsen the pigmentation you’re trying to treat.
Melasma is a chronic pigmentation condition that produces brown or gray-brown patches, usually on the cheeks, forehead, upper lip, and nose. It develops from sun exposure, hormonal changes, and genetic predisposition, and affects women far more often than men, particularly those with medium to deep skin tones. Pregnancy and hormonal medications are common triggers, which is why melasma is sometimes called the “mask of pregnancy.”
Our melasma treatment in San Jose requires more caution than most pigmentation concerns, because aggressive treatment or the wrong device can trigger new inflammation that darkens the skin further. Getting the approach right matters more here than with almost any other condition we treat.
Details
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Benefits of a Properly Matched Approach
Reduces pigmentation without triggering a worsening flare
Device and settings matched to your specific skin tone
Combines in-office treatment with a maintenance plan
Addresses recurrence risk, not just visible patches
Builds gradually, avoiding aggressive, high-risk shortcuts
Types of Melasma
Epidermal (surface-level pigment)
Dermal (deeper pigment, harder to treat)
Mixed (both layers involved)
Pregnancy-related ("mask of pregnancy")
Recurring, following prior treatment
Areas It Treats
Cheeks and forehead
Upper lip and nose
Chin
Why Treatment Choice Isn’t Just a Formality Here
Our melasma treatment in San Jose is approached differently. Aggressive laser settings, or a wavelength poorly matched to your skin tone, can trigger post-inflammatory hyperpigmentation, meaning the treatment itself darkens skin further. This risk rises in deeper skin tones, where the margin for error is smaller.
This is why being independent and brand-agnostic matters medically, not just as a business detail. A practice locked into one device or manufacturer contract has to make that device work for every patient, including those it isn’t suited for. Your provider selects an approach based on what’s safe for your actual skin, not which device happens to be under contract.
The Factors Behind Melasma
Melasma rarely stems from a single cause. Most patients have a combination of these factors contributing to their pigmentation.
Matched to Your Skin and Never a Fixed Protocol
Our melasma treatment in San Jose combines multiple approaches, chosen based on your skin tone and melasma type.
What to Expect
The Provider Behind the Plan
Sandra K. Ewers, MS, PA-C, founded Entre Nous Aesthetics and has trained other providers on behalf of Cynosure and Allergan, with more than 10,000 laser procedures performed. That depth of experience shapes how she approaches melasma, favoring conservative, skin-tone-matched settings over aggressive protocols that risk worsening pigmentation.
Let’s Talk About What You Actually Want
Every treatment plan starts with a conversation, not a script. Tell us a little about your goals, and we’ll take it from there.
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Frequently Asked Questions
Yes, if the device or settings aren’t properly matched to your skin tone. Aggressive treatments can trigger post-inflammatory hyperpigmentation, darkening the skin further. This risk is higher in deeper skin tones, which is why careful candidacy assessment matters more here than for most pigmentation concerns.
Melasma is chronic, driven by ongoing triggers like sun exposure, hormones, and genetics, not a onetime issue that treatments permanently resolve. Without continued sun protection and maintenance, previously treated pigment often returns.
Some melasma treatments in San Jose aren’t recommended during pregnancy, since certain treatment ingredients and light-based therapies aren’t well studied for their safety in that context. Melasma often improves after pregnancy as hormones stabilize. Your provider can discuss safe skincare and sun protection in the meantime.
Because melasma responds unpredictably to aggressive treatment, especially in darker skin tones, a device poorly matched to your skin risks making pigmentation worse. A provider tied to a single device can’t always adjust for this.
Results build gradually over weeks to months, since faster, more aggressive approaches carry more risk. Most patients see continued improvement over a series of sessions combined with strict sun protection, with expectations set based on your specific type and skin tone.
Sun and visible light exposure, hormonal changes, heat from saunas or exercise, and inflammation from harsh skincare or aggressive treatments can all trigger flares. Most patients have several factors contributing at once, which is why a comprehensive plan addresses more than visible pigment alone.
In San Jose, we select an approach based on your specific skin tone and melasma type, not a single device we’re contracted to use on every patient. As an independently owned, clinician-led practice, we prioritize getting this right, since the wrong approach here can genuinely cause harm.
Be Our Guest
Contact us to set up a virtual consultation or an in-office visit. You can also use our interactive eConsultation tool to tell us your concerns and get a personalized treatment plan in the comfort of your own home.