I have several issues with my skin advice needed please

[debsnbax]

I have been looking into Dermarolling for aging and sagging facial skin, it was all sounding very promising until I read that it could make melasma worse..  Can I treat both problems at the same time??? Can I treat one problem at a time?? My Melasma has really spread over the years, it is under my eyes, totally and frames my face, I have sagging round the jawline, mouth and eyes. Any help or advice on the Dermarolling and product suitable to treat my issues would be greatly appreciated

[SarahVaughter]

Dermarolling can both improve Melasma and make it worse, this is individual. Melasma is caused by uneven production/distribution of skin pigment melanin. Melanin pigment is normally present in the skin and more is produced upon sun exposure. Melanin is our natural UV filter. The darker the skin the more we are protected from UV damage. However, if melanin is unequally distributed /produced in the skin you get hyperpigmentation.  It is not known why the skin unevenly overproduces melanin in melasma and that is why you cannot address the cause, only the consequences. It is often connected to excessive sun exposure in the past and melasma suffers must protect themselves from the sun as much as they can.

BTW, melanin is also present in the iris of the eyes. Blue eyes have a layer of melanin in the back layer of the iris. Brown eyes have a layer of melanin in the back and also in the front layer of the iris and they are better protected from the UV. Albinism is the disorder of having no or almost no melanin.
In some unfortunate individuals (common in melasma suffers) skin sometimes produces more melanin as a reaction to other stimuli than the sun. The stimuli can be hormonal, mechanical - having massage, being exposed to very hot or very cold temperatures, being exposed to strong wind, having any kind of skin procedure (acid peel, laser treatment, dermarolling, applying irritating skin products etc.).

The same procedure can help or worsen melasma, depending on how you individually react to it. Acid peel can diminish melasma or the irritation from the peel will trigger more melanin production. It is the same with other methods.  Any kind of irritation of the skin can potentially trigger melanin production in melasma suffers. 
There is no other way to know how you will react than trying it repeatedly on a small test patch.

Many melasma suffers use a dermaroller to enhance penetration of hydroquinone cream (hydroquinone prevents melanin formation and you should try it) with great results but we also have a forum posting from a person saying she thinks her melasma got darker after rolling.

What I suggest is that you buy a dermastamp (not a dermaroller) and do targeted treatment of your wrinkles (if you have wrinkles around your eyes and lips). The size guide for various skin conditions is here:

https://http://dermaroller.owndoc.com/dermaroller-instructions.pdf

First do a test patch with the dermastamp, if everything OK, stamp the wrinkles around your eyes and lips for several months. If everything OK, you can slowly start with dermarolling your entire face.

It is the same with our skin products.  Both Tretinoin and vit. C (ascorbic acid) helped melasma in medical studies (you can find the link to the studies on our forum) but they are irritating to the skin and thus they can potentially also make melasma worse.

Hydroquinone (we do not sell it) has its issues as well. You can try a 0.5 mm regular dermaroller (up to three times a week) to enhance the penetration of a Hydroquinone cream. The best protocol is 3 month on, 1 month off and so on.

In 2011, there has been a study about enhancing the penetration of skin depigmenting products by dermaneedling with successful results:

Skin Needling to Enhance Depigmenting Serum Penetration in the Treatment of Melasma G. Fabbrocini, 1 ,* V. De Vita, 1 N. Fardella, 1 F. Pastore, 1 M. C. Annunziata, 1 M. C. Mauriello, 1 A. Monfrecola, 1 and N. Cameli. Copyright © 2011 G. Fabbrocini et al.

Abstract

Melasma is a common hypermelanotic disorder affecting the facial area which has a considerable psychological impact on the patient. Managing melasma is a difficult challenge that requires long-term treatment with a number of topical agents, such as rucinol and sophora-alpha. Aims. We aim to compare the combined treatment of skin needling and depigmenting serum with that using depigmenting serum alone in the treatment of melasma, in order to evaluate the use of microneedles as a means to enhance the drug's transdermal penetration. Methods. Twenty patients were treated with combined skin needling and depigmenting serum on one side of the face and with depigmenting serum alone on the other side. The outcome was evaluated periodically for up to two months using the Melasma Area Severity Index score and the Spectrocolorimeter X-Rite 968. Results. The side with combined treatment (skin needling + depigmenting serum) presented a statistically significant reduction in MASI score and luminosity index (L) levels compared to the side treated with depigmenting serum alone, and clinical symptoms were significantly improved. Conclusions. Our study suggests the potential use of combining skin needling with rucinol and sophora-alpha compounds to achieve better results in melasma treatment compared to rucinol and sophora-alpha alone.


You may also be interested to read this:

Successful treatment of hydroquinone-resistant melasma using topical methimazole

https://http://onlinelibrary.wiley.com/doi/10.1111/j.1529-8019.2012.01540.x/pdf