Treating Melasma with the Aerolase Neo Elite: Dr. Chauncey Barbulescu Explains Her Protocol

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Dr. Chauncey Barbulescu, a board-certified dermatologist practicing in Tampa, Florida, discusses her approach to treating melasma with the Aerolase Neo Elite, recorded live at the AAD Annual Meeting 2026 in Denver, Colorado.

Melasma is a chronic, relapsing condition driven by multiple factors: hormonal influences, basement membrane disruption, vascular changes, and UV triggering. Because pigment in melasma sits deeper in the dermis rather than the epidermis, Dr. Barbulescu explains why the 1064 nm Nd:YAG wavelength and 650-microsecond pulse duration of the Aerolase Neo Elite make it well suited to reach that depth while limiting surrounding tissue heat, a key factor in avoiding rebound hyperpigmentation.

Dr. Barbulescu outlines her full clinical protocol:

• Pre-treatment: Patients are evaluated at a medical consultation before laser treatment is booked. Pre-treatment typically includes a topical lightening agent and a retinoid, when tolerated, to calm melanocyte activity and prepare the skin surface.
• Laser settings: Low fluence with multiple passes over each area of hyperpigmentation, rather than higher energy in fewer passes, to minimize heat-related inflammation.
• Treatment cadence: Sessions every two to four weeks until the patient reaches their goal, followed by maintenance treatments approximately every six months.
• Patient comfort: Dr. Barbulescu notes that patients tolerate the Neo Elite without topical numbing, describing the sensation as a warm snap rather than a painful pulse.
• Adjunct care: Sun protection and continued prescription topical therapy remain essential alongside laser maintenance.

Dr. Barbulescu also addresses why melasma has historically been considered a controversial condition to treat with laser therapy, and why the Neo Elite's low-heat, non-ablative profile changes that calculus for her practice.

Presented by Chauncey Barbulescu, MD, FAAD

Board-certified dermatologist practicing at Academic Alliance in Dermatology in Tampa, Florida. She earned her medical degree from the University of Central Florida College of Medicine and completed her residency at the University of Colorado School of Medicine. Dr. Barbulescu's clinical focus includes skin of color, alopecia, and cosmetic and surgical dermatology, treating both adult and pediatric patients. She is a member of the American Academy of Dermatology, the American Hair Research Society, the Skin of Color Society, and the Women's Dermatology Society.