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and dermal melasma. In case of dermal melasma is possible to associate collagen biostimulation technics invasive (PDO THREADS, calcium hydroxyapatite, Poly-L-lactic acid (Sculptra) and non-invasive (microneedling, deep and medium peelings) associated to melan reduxx program. Melasma resistant in most of case with hormonal causes and melasma resistant to hydroquinone must be evaluated in relation to good professional practice. on first case is important to evaluate the estrogen in hormonal exames and perform the hormonal modulation with nutraceuticals as melatonin, chrysin and others. and in the second case trying to work with topical cysteamine (epidermal melasma) and topical and oral cosmetics formulations (nutraceutical) with elevated antioxidant proposal. It is important to mention that hormonal fluctuations, excessive solar radiation, photosensitizing medications can lead to increased skin pigmentation. And each case should be discussed with the aesthetic health professional to evaluate the best strategies that minimize the rebound effect of pigmentation on melasma [14,17]. The melan reduxx program can be carried out for 3 until 5 months throughout the year with annual maintenance or as needed. However topical and oral cosmetics should be kept under continuous use; since these are nutraceuticals that aim to modulate antioxidant stress due to external factors (UV radiation among others), inflammation as well as excessive vascularization of the skin and the hormonal factors present (estrogen modulation due to different causes with herbal medicines). The melan reduxx program can be performed in men and women who have melasma both epidermal and dermal melasma. Melan Reduxx Program - Professional procedure The melan reduxx program involves the application of chemical and photoactiveated peels and application of low level light professional therapy using amber LED (25 J/cm2) and infrared laser light (5 J/cm2) associated on irradiation procedure (total dose= 30 J/cm2). The application of both wavelengths at same time is useful modulating mainly the inflammatory response [34]. Not forgetting the benefits of amber LED light on decrease of vascularization and degradation of melanin. On melan redux procedure firstly to open skin we can use tools as microneedling and chemical peels. This first step (FASE 1) increase the permeation of the photoactivated peels thought skin on FASE 2. On the second step (FASE 2) the photoactivated peel, commercial professional cosmetic called melan reduxx peel (Priscila Menezes company – Araras- Brazil) was applied on skin and immediately after; started the light irradiation procedure, using laser and LED, at skin. The melan reduxx Peel cosmetic (photoactivated peel) presents on its composition a blend of AHAs (mandelic acid, lactic, glycolic acid) and BHAs (salicylic acid) at low concentrations, photoactives (chromophores) as hypericin (0.5-1%), methylene blue (0.05-1%) and curcumin (0.5-1.5%), that absorbs amber, red and blue light respectively, associated with tranexamic acid (2-8%) and others 2020 Vol.6 No.3:10 principal actives that acts on depigmenting skin as arbutin, alpha arbutin, kojic acid, resveratrol, vitamin c, dipalmitate, kojic acid, niacinamide, Hexylresorcinol, belides, ferulic acid, phytic acid, prodizia and others. After irradiation procedure the photoactivated peel was removed from skin and a third cosmetic product, in the form of a mask, was added at skin. This mask contains a blend of actives and cosmetic retinol. This mask must remain on the skin until 8 hours on skin. All these products are used in the professional procedure on clinical [14-17]. Oral and topical home care cosmetic products For topical cosmetic proposals of the melan redux program on home care melasma management; we development commercial cosmetics products (Priscila Menezes company – Araras- Brazil) and them can be described as nutri skin Advanced cream (anti-aging cream), melan clean cream (depigmenting cream), Irradiance eyes cream (depigmenting cream of eyes) and hidra balance Advanced cream (High moisturizing and inert cream). The melasma cosmetic kit (Priscila Menezes company – Araras - Brazil) proposed here contains the follow creams: nutri skin advanced, melan clean and hidra balance advanced. the application of products must be done in the follow sequence; 1) on morning must be applied on skin firstly nutri skin advanced cream on face and after one sunscreen and 2) at night must be applied on skin firstly the melan clean cream on all face. the topical commercial formulations contains the principal cosmetic actives as mentioned before, that acts on melanogenesis pathways control as well as on aging process, on hydration and restoring the skin barrier (protection of skin) [15,17]. one another nocturnal formulation containing acid can be prescribed to be added after melan clean cream only over spots. This formulation can be similar to kligman formulation containing retinoic acid, hydrocortisone and actives as kojic acid, mandelic acid and arbutin in the place of hydroquinone. The oral cosmetic substances used on melan reduxx program can be described as : Picnogenol (50-100 mg), hydroxytyrosol (100- 300 mg), polypodium leucotomos (100-200 mg), resveratrol (20- 100 mg), panax ginseng (50-200 mg), nicotinamide (50-200 mg), vitamin C (50-200 mg), curcumin (50-250 mg), green tea (50-200 mg), zinc chelate (10-50 mg), chrysin (100-500 mg), bioperine (5-10 mg) among others. Also melatonin (medical prescription: 3-10 mg) and oral tranexamic acid for patients without thrombo problems (medical prescription 250 mg) can be prescribed by doctors [3,16,17]. Both topical and oral cosmetic products on The melan reduxx program has intention to controlling skin pigmentation by different strategies and modulating the inflammatory process avoiding the rebound effect due to hyperpigmentation pos inflammatory so common on melasma treatment. Discussion In Figure 1 light application on skin using laser and LEDs systems on different wavelengths was performed on melasma patient. 4 This article is available from: http://aesthetic-reconstructive-surgery.imedpub.com Journal of Aesthetic & Reconstructive Surgery ISSN 2472-1905PDF Image | Photodynamic Cosmetic Therapy on Melasma Management
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