Melasma un upper lip wont go away

For about a year and a half now I have had terrible 'melasma' on my upper lip and a bit on my cheeks.  Prior to this I was tanning in salons.  Once I was diagnosed, I quit tanning and started wearing sunscreen...have not tanned in over a year and a half.  Also, was prescribed Tri-Luma cream from my derm and separately Hydroquinone 4%.  Over the past year I have done the following to get rid of this with no avail.

Stopped tanning/started using SPF 65 sunscreen always and wearing hat when possible
IPL Laser Treatments
Hydroquinone 4%
Tri-Luma Cream
Went OFF birth control
TCA 18% chemical peel
Mild microdermabrasion (Olay over the counter)

Please tell me WHY this will not go away!  It is ALL I see when I look in the mirror and I cant take it anymore.

[Bhupinder Kaur, MD]

Hello,
Melasma is caused by hormonal changes, which stimulate a temporary increase in your body's production of melanin. People with darker complexions are more prone to this condition than people with lighter skin.

Treatment options include treatment with vitamin C and hydrocortisone, peel with carbon dioxide snow and alexandrite and ND-Yag Q-Switched laser treatment preceded by a hydroquinone-based application. Please discuss these options with your dermatologist.

It is very difficult to precisely confirm a diagnosis without examination and investigations and the answer is based on the medical information provided. For exact diagnosis, you are requested to consult your doctor. I sincerely hope that helps. Take care and please do keep me posted on how you are doing.