There is a discrepancy in the attitudes toward melasma between the US, Europe and Asia. Melasma refers to pigment deposition on the cheeks but there is a limit to applying a sweeping definition to varying cases of the disease. Fractional laser has been reported to be effective in melasma in the US and Europe. However, Japanese data do not agree and negative opinions have been voiced in academic conferences. As described above, Japanese women are more susceptible to friction-related inflammation and considerations should be given to different skin care habits for each country. Therefore, it is only natural that treatment modalities and laser output differ by country.
On the other hand, cases of worsened pigmentation or hypo-pigmentation have been reported. Due to such complications, some doctors argue that laser toning is not a safe treatment modality.
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Leading specialists in Japan believe that only a traditional Q-switched laser theory, that is, selective photothermolysis within thermal relaxation time (TRT) constitutes laser therapy for melanin. These doctors dismiss laser toning and academic conferences often discuss the legitimacy of the treatment itself. Therefore, rather than discuss how to improve the techniques of the treatment or how to obtain effects more quickly, it seems more pressing to talk about more fundamental issues such as reducing side effects and bringing lasting effect.
In a away, skepticism over laser toning became prevalent due to inexperienced doctors and nurses who performed high-power laser toning repeatedly causing various complications.
Due to inadequate understanding of laser toning, one may raise the power level thinking that would bring better effects. This often leads to crusting, more severe melasma, and hypopigmentation. Such problems occur in Japan as unlicensed establishments offer aesthetic therapy and nurses often set the power level as well as perform irradiation. These are problems that arise from lack of experience and expertise in aesthetic medicine. Especially, in Japan, when a problem occurs with a certain therapy, patients tend to attribute it to the treatment itself rather than blame the doctors. Doctors do not receive sufficient training in aesthetic procedures. There are weekly seminars and conferences in Korea, however, treatment techniques are often kept secret in Japan.
-To be continued-
