Who is Dr. Simon Ourian?

Dr. Simon Ourian is the founder and medical director of Epione Beverly Hills, a cosmetic dermatology practice he established in 1998. He has close to 30 years of practice and developed the Coolaser® and Neustem® technologies used at Epione.

Are the answers in this section written by Dr. Ourian?

Yes. Each question is asked to him directly and answered out loud. The answers are recorded and transcribed, then edited for length and structure only. Nothing is added that he did not say, and he reads every article before it publishes.

How often is new content published in this section?

Five new questions are answered each month. Questions are drawn from what patients ask most often in consultation and from what is being answered incorrectly in public.

Are the statistics in these articles from published studies?

No. Figures attributed to Dr. Ourian are observations from his own patient population and are labelled that way. Where a figure comes from published literature, the source is cited. Numbers do not appear without one of those two frames.

Can I get a treatment recommendation from this section?

No. These articles explain how treatments behave in general and what Dr. Ourian looks for. Determining what any individual patient needs requires an in-person examination of the skin.

Why does this section not list prices?

Epione does not publish a fixed price menu. Treatment plans are built per patient based on skin type, the concern being addressed, and the technologies appropriate to both, so a published number would be inaccurate for most people reading it.

Why does melasma come back?

And why sun spots, treated the same week with the same laser, do not.

Roughly 30 to 40 percent of melasma patients see some recurrence within a year. Sun spots treated in the same session rarely come back at all. The difference is not the laser and it is not the patient. A sun spot is a finished deposit of pigment. Melasma is an active process, and treatment suppresses it rather than ending it.

What is actually different about the two

Attribute	Melasma	Sun spots (solar lentigines)
What it is	Melanocytes that are switched on and staying on	Pigment already deposited from past UV exposure
Depth	Epidermal, dermal, or mixed	Epidermal
Driver	Estrogen and progesterone, heat, visible light, UV	Cumulative UV exposure
Vascular involvement	Increased dermal vascularity and mast cell activity	None
What treatment does	Suppresses an ongoing process	Removes a completed deposit
After clearance	The driver is still present	The deposit is gone

Clearing a sun spot ends the problem because the pigment was the whole problem. Clearing melasma does not, because the cells that produced the pigment remain receptive to the same triggers they responded to before. Heat, visible light, and hormonal shifts do not stop being present because the skin looks clear.

How often it comes back

In Dr. Ourian's own patients, recurrence within a year runs at roughly 30 to 40 percent. That figure is a practice observation across his own population rather than a published rate, and it sits below what much of the literature reports, which reflects a protocol built around suppression and maintenance rather than clearance alone.

The remaining 60 to 70 percent are not permanently cured. They are maintained.

What tells him a case will be stubborn before he treats it

The finding is visible in the first minute of the consultation, and it is about color rather than pattern.

"In the first minute of consultation, I look for a deep, grayish dermal hue. That tells me it will fight us."

A brown, well-defined patch sitting high in the skin behaves differently from a diffuse gray one. The gray cast indicates pigment that has dropped into the dermis, where it is held by melanophages rather than sitting in the epidermis where it can be lifted. Dermal and mixed-type melasma is the type that returns, and it is identifiable before any device is chosen.

The same mechanism governs how pigment behaves in deeper skin types, where the inflammatory response after treatment matters more than the resurfacing itself.

What he stopped doing

"Ten years ago, we hit melasma with heavy peels, which just woke up the pigment later."

The logic behind aggressive peeling was reasonable on its face. Remove the layer holding the pigment and the pigment goes with it. What that reasoning misses is that melanocytes in melasma are already primed to respond to injury. A heavy peel is an inflammatory event, and inflammation is one of the triggers that switches those cells on. The result was clearance for a period, then a return that was frequently worse than the starting point.

Where the standard approach still gets it wrong

Two errors, and they are opposite versions of the same mistake.

The first is treating hydroquinone as a permanent solution rather than a limited-duration suppressant. The second is applying too much heat, which reproduces the peel problem with a different device.

Both come from treating melasma as pigment to be destroyed rather than as a process to be quieted. The more force applied, the more reliably the process is provoked.

What patients arrive already believing

"Patients think it's a tattoo we can erase forever."

That belief shapes how a patient hears the entire treatment plan. Someone expecting removal experiences maintenance as failure. Someone expecting maintenance experiences the identical clinical result as success. The expectation is set before the first session or it is not set at all.

What he tells a patient who wants it gone permanently

"I tell them straight out: it's semi-permanent. We clear it, but you maintain it."

Maintenance is three specific things, and none of them are optional for the patients who hold their result.

Maintenance	What it does
Daily SPF, including indoors and in winter	Blocks UV and, with the right formulation, visible light, which triggers melasma independently of UV
Retinol	Keeps epidermal turnover elevated so pigment clears as it forms rather than accumulating
Avoiding saunas, steam, and direct heat	Heat activates melasma with no light exposure at all, which is why it recurs in patients who are diligent about sun

The third is the one patients discount, and it is frequently the reason a well-managed case returns.

Maintenance is built into the plan from the first session of melasma treatment at Epione.

Frequently asked questions

Can melasma be cured permanently?

No. Melasma is semi-permanent. Treatment clears the visible pigment, but the melanocytes producing it remain responsive to hormonal shifts, heat, and light. Patients who hold their result do so through maintenance rather than because the condition was eliminated.

What percentage of melasma comes back after treatment?

In Dr. Ourian's practice, roughly 30 to 40 percent of patients see some recurrence within a year. This is his observation across his own patient population, not a published rate.

Why does melasma come back when sun spots do not?

A sun spot is pigment already deposited from past sun exposure, so removing it ends the problem. Melasma is produced by melanocytes that are currently active. Treatment clears the pigment but does not switch those cells off, so production can resume.

Can melasma come back without any sun exposure?

Yes. Heat alone will activate melasma. Saunas, steam rooms, hot yoga, and prolonged direct heat trigger it independently of UV, which is why patients who are careful about sun still see recurrence.

What is dermal melasma and why is it harder to treat?

Dermal melasma is pigment that has dropped below the epidermis into the deeper layer, where it is held by cells called melanophages. It appears as a diffuse gray cast rather than a defined brown patch, and it responds more slowly because the pigment sits below the level most treatments reach.

Can chemical peels make melasma worse?

They can. Melanocytes in melasma respond to inflammation, and an aggressive peel is an inflammatory event. Dr. Ourian stopped using heavy peels for melasma for this reason, having observed pigment returning after treatment and in some cases returning worse.

Is hydroquinone a permanent solution for melasma?

No. Hydroquinone suppresses pigment production while it is being used and is intended for limited-duration courses. Treating it as a permanent fix is one of the two most common errors Dr. Ourian identifies in the standard approach.