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Escalation to Combined Therapy (Mesotherapy + Picosecond Laser) In cases of: Mixed or dermal melasma Recurrent melasma after previous treatments Large pigment area, thick patches or resistant to topicals/peels We integrate: Picosecond laser (e.g., 1,064 nm or 755 nm) one session every 46 weeks (typically 35 sessions) Mesotherapy sessions interspaced between laser sessions or post-laser for healing support

The beam walk test analyzed motor coordination differences and consisted of an overhead wooden beam (5 mm wide, 120 mm length, and 300 mm above table)

Blood 132:20262039 Cattoretti G, Pasqualucci L, Ballon G, Tam W, Nandula SV, Shen Q, Mo TW, Murty VV, Dalla-Favera R (2005) Deregulated BCL6 expression recapitulates the pathogenesis of human diffuse large B cell lymphomas in mice

In fact, a previous study reported that the presence of lactate directly affects energy metabolism by modifying bioenergetics fluxes, including p38 MAPK, AMPK, and mammalian target of rapamycin, a downstream target of AMPK 43