Hyperpigmentation is a broad term used in dermatology that refers to small dark spots to large patches of skin discoloration that are darker than one’s natural skin tone. Hyperpigmentation can be attributed to excess melanin production, which may be related to factors such as sun damage, acne scarring, genetics, underlying medical conditions, hormones, taking certain medications, and more. Melasma is a specific type of hyperpigmentation that is characterized by symmetrical brown or gray-brown patches of skin that are darker than the rest of the surrounding skin. In addition to Cosmelan treatment, Dr. Green uses TCA chemical peels, Mesopeels, Dermamelan, and specially-formulated skincare products to safely and effectively reduce unwanted hyperpigmentation and melasma in patients of all skin types and skin tones.
Dr. Michele Green is an internationally renowned board-certified cosmetic dermatologist with over two and half decades of experience providing some of the world’s most discerning individuals with the best treatments available, including Cosmelan treatment for hyperpigmentation and melasma. Dr. Green takes a holistic approach and embraces a less-is-more philosophy regarding rejuvenation, customizing each patient’s treatment plan to suit their particular needs and goals best. She is consistently identified as one of New York’s best dermatologists by Castle Connolly, New York Magazine, and Super Doctors for her dedication to her patients and expertise. She is one of the only dermatologists in New York City who offers Cosmelan treatment for melasma and hyperpigmentation in patients of all skin tones. Suppose you suffer from dark spots, hyperpigmentation, or melasma. In that case, it’s time to schedule a consultation with Dr. Michele Green at her private dermatology office in New York City’s Upper East Side neighborhood.
Before and after – 3 parts, Cosmelan treatment
What types of hyperpigmentation does the Cosmelan peel treat?
Dr. Michele Green in NYC is an internationally-renowned expert in skincare and treating hyperpigmentation and discoloration on the face and body. Her focus on depigmentation treatment is partly from seeing patients who have been treated with lasers incorrectly, resulting in exacerbated hyperpigmentation. Most cases of melasma and hyperpigmentation are best treated with chemical peels, Cosmelan, Mesopeels, and other appropriate cosmeceuticals and skincare. In addition, dark spots or post-inflammatory hyperpigmentation from acne can be treated effectively with Cosmelan. Below is a list of the main skin conditions that Dr. Green improves with Cosmelan treatment:
- Sun damage
- Acne scarring
- Age spots
- Post-Inflammatory hyperpigmentation (PIH)
- Skin discoloration on chest, neck, and back
- Uneven skin tone
- Dark spots on buttocks
- Dark patches on knees, elbows, feet
- Discoloration from laser treatments such as Fraxel, GentleYag, Erbium, CO2, IPL, and Picosure lasers
What is the Cosmelan peel?
The Cosmelan peel is a professional-grade chemical peel mask that reduces hyperpigmentation and melasma to create a clear, even-toned complexion. Cosmelan is a two-part chemical peel that consists of the in-office application of Cosmelan 1, performed by Dr. Green, and the use of at-home maintenance skincare products, including the Cosmelan 2 depigmenting cream. The Cosmelan 1 mask is worn for several hours, and Dr. Green determines the duration depending on the patient’s skin tone and the severity of the hyperpigmentation. Once the designated amount of time has elapsed, the Cosmelan mask is easily removed at home by the patient with a gentle facial cleanser. A follow-up appointment will be made in four weeks’ time so Dr. Green can assess the progress.
In the meantime, patients adhere to a home care regimen comprising depigmenting and anti-aging skincare products. The Cosmelan 2 cream is a depigmenting cream that contains a blend of brightening ingredients, including kojic acid, azelaic acid, vitamin C, retinoids, and hydroquinone. Dr. Green also recommends using the Hydra-Vital factor K (Vitamin K cream) or Melan Recovery moisturizer and two different types of sunscreen to keep the skin hydrated and protected while undergoing the home care portion of the Cosmelan depigmentation treatment. The ingredients in Cosmelan 2 can be very irritating, particularly if you have sensitive skin. If the cream does cause severe skin irritation, it should be discontinued for several days until it resolves completely. Failure to comply with these instructions can cause increased skin irritation and hyperpigmentation. Since the Cosmelan depigmentation protocol aims to lessen and eliminate hyperpigmentation, it is counter-productive to continue using Cosmelan 2 if you are irritated.
To achieve and maintain the best cosmetic results, it is important that both during and after the Cosmelan peel, patients limit sun exposure and use proper sun protection. Melanocytes, the skin cells responsible for producing melanin (pigment), are triggered by UV exposure. Sun exposure to the treatment area can worsen the appearance of brown spots even after the Cosmelan treatment is complete. Dr. Green recommends a broad-spectrum sunscreen with a minimum SPF of 50, which should be reapplied every ninety minutes. A chemical-based sunscreen should be applied underneath a mineral sunscreen for the best sun protection. Chemical sunscreens contain active ingredients such as avobenzone, and mineral sunscreens contain zinc oxide or titanium dioxide.
Cosmelan before and after
What is Melasma?
Melasma is a common skin condition characterized by brown or gray-brown patches of skin that are darker in color than the rest of the surrounding skin tone. This type of hyperpigmentation commonly occurs on the face, including the upper lip, forehead, bridge of nose, and cheeks, and is often symmetrical on both sides of the face. Melasma can also be present on the body, commonly in areas with frequent sun exposure, such as the forearms, neck, and shoulders. The exact cause of melasma is unknown, but it has been linked to factors such as sun exposure, tanning beds, hormonal changes (i.e., pregnancy and oral contraceptives), certain medications, genetics, and thyroid disease. While men can develop melasma, ninety percent of those affected are women. There is a genetic correlation with melasma, with 50% of affected patients reporting a positive family history of hyperpigmentation disorders. Melasma is more likely to develop in patients with darker Fitzpatrick skin types, especially in patients with type IV or darker skin tones. Melasma is often called chloasma or the “mask of pregnancy,” as it affects 15-50% of pregnant women.
The most common areas of the face for melasma to develop are the following:
- bridge of nose
- In a classic sun-exposed distribution, other extra facial areas involved include the forearms, upper arms, and shoulders.
In the past, a Wood’s lamp examination would be used to diagnose melasma. However, this common clinical diagnosis rarely requires a skin biopsy or Wood’s lamp for diagnosis today. Currently, there is no cure for melasma. Melasma is treatable, and a board-certified dermatologist, such as Dr. Michele Green in NYC, can significantly reduce its appearance. Dr. Green is an internationally renowned board-certified cosmetic dermatologist with a particular interest in improving the appearance of hyperpigmentation and skin discoloration. With over two and a half decades of experience treating some of the world’s most discerning individuals, she is an expert in providing a radiant, healthy complexion that lasts. Melasma is one of the most common conditions treated by Dr. Green, and Cosmelan depigmentation treatment is one of the most popular cosmetic procedures offered at her private dermatology office in NYC’s Upper East Side neighborhood.
What is the pathophysiology of Melasma?
Exposure to ultraviolet light (UV light) is the number one contributing factor in developing melasma. UV radiation triggers the production of the alpha-melanocyte-stimulating hormone, corticotropin, interleukin 1, and endothelia 1, which triggers increased melanin production by melanocytes in the skin.
Cosmelan – 10 weeks before and after
Mesoestetic skincare products
The Mesoestetic company is a world leader in hyperpigmentation treatment. Mesoesthetic has revolutionized the treatment of melasma and other types of skin discoloration by introducing several innovative options for pigment control, including the Cosmelan peel, Mesopeel, Dermamelan, and their specially-formulated skincare products. Their skincare products and in-office treatment options are safe for all skin types and skin tones, including patients with Asian, Hispanic, Mediterranean, and African American skin.
Dermamelan Intimate reduces hyperpigmentation in the intimate area, including the buttocks, groin, and vaginal and anal areas. This depigmentation treatment consists of two parts. Part one is the in-office depigmentation peel performed by Dr. Green in a single clinical session. Part two entails regulating hyperpigmentation with home care, including the daily application of the Dermamelan Intimate depigmenting gel cream.
Mesopeel Periocular is a treatment designed to remove hyperpigmentation around the delicate eye area and improve periocular luminosity. It consists of a series of mesopeels to the eye area, scheduled two weeks apart. The use of special eye creams prescribed by Dr. Green to complement the treatment is advised.
Mesopeels for Face and Body is a gentle chemical peel designed to remove discoloration and varying types of hyperpigmentation on the face and around the axillae (underarms), groin, and buttocks.
These depigmentation treatments are safe and effective options for patients of all skin tones and skin types. When you have depigmentation treatment with board-certified dermatologist Dr. Green, she will provide you with all the pertinent home care and aftercare instructions required to achieve and maintain ideal cosmetic results. Dr. Green will recommend the anti-aging and depigmenting skincare products that are best suited to your particular needs and goals, customizing your treatment plan to you.
How does Cosmelan work?
The Cosmelan treatment involves using a proprietary combination of active ingredients with proven efficacy that interfere with the entire process of melanin production. In addition to removing the accumulation of excess melanin (pigment), the Cosmelan treatment inhibits the formation of new pigment. Cosmelan works via several mechanisms:
- Accelerates epidermal renewal to remove the accumulation of melanin
- Reduces the amount of melanin formation and decreases dark spots
- Blocks the transfer of melanin from the melanocyte to the keratinocyte, thus inhibiting the migration of pigment to epidermal layers of the skin
- Reduces the synthesis of melanin inside melanocytes
The Cosmelan peel consists of 51 active ingredients, including numerous tyrosinase inhibitors, which block melanin production in the skin. The 5 key tyrosinase inhibitors and lightening agents include:
- Kojic Acid
- Azelaic Acid
- Phytic Acid
- Ascorbic acid (Vitamin C)
Cosmelan MD is a prescription formulation, which is only available to physicians, and is compounded with 8 percent hydroquinone for increased skin lightening.
Cosmelan 8 months before and after
What is Cosmelan Depigmentation treatment?
The Cosmelan depigmentation treatment reduces excess melanin and prevents new melanin production in the skin by inhibiting the tyrosinase enzyme. The Cosmelan MD treatment is the highest strength of the depigmentation treatment, contains hydroquinone, and can only be offered by a dermatologist like Dr. Green in NYC. It is important to discontinue all retinoids, glycolic acids, and any other exfoliants one week before your Cosmelan peel. In addition, exfoliating skincare products and Retin-A should be discontinued for one week before the procedure and for the entirety of the home care regimen, which entails using the Cosmelan 2 depigmenting cream daily.
How long does the Cosmelan peel last?
The results from the initial Cosmelan peel must be maintained with the proper home care regimen, including adequate sun protection and the right skincare products. With strict adherence to the aftercare protocol advised by Dr. Green, the results from your Cosmelan depigmentation treatment may be permanent. Limiting sun exposure to the treatment area and properly following the at-home maintenance protocol will help you maintain a clear, healthy, radiant, and even-toned complexion.
Is Dermamelan better than Cosmelan for treating melasma?
Dermamelan and Cosmelan are similar in that they are both chemical peels that are used to address hyperpigmentation, and both have a home care depigmentation protocol. However, these depigmentation treatments are used for two completely different purposes. Cosmelan treatment is specially formulated for melasma and skin discoloration, whereas Dermamelan Intimate is formulated to reduce hyperpigmentation in the intimate areas and inner thighs. Dr. Michele Green is a world-renowned specialist in corrective pigmentation treatment and Cosmelan, Mesopeels, and Dermamelan Intimate treatment. She is one of the only dermatologists in New York City offering Dermamelan Intimate and Cosmelan treatment for patients of all skin tones suffering from hyperpigmentation. When you consult Dr. Green at her private dermatology office in NYC’s Upper East Side neighborhood, she will work with you to create a customized depigmenting and anti-aging treatment plan for rejuvenation.
How to treat melasma
Melasma is a complex skin condition that is caused by the body’s overproduction of melanin. Melasma cannot be treated with plastic surgery or laser treatment. Unfortunately, many patients develop hyperpigmentation as a side effect from other treatments, such as Fraxel laser, Intense Pulsed Light (IPL), or Picosure lasers. Patients are often inappropriately treated with lasers to remove melasma, worsening the melasma and hyperpigmentation. Melasma that has been treated with lasers can be even more difficult to remove as the heat forces the hyperpigmentation to become more entrenched in the deeper layers of the skin. The Cosmelan depigmentation system is the best chemical peel treatment to reduce melasma and prevent its reappearance. Utilizing the proper skin care products and adhering to strict sun avoidance is essential to maintain the results of your Cosmelan peel and prevent the recurrence of your melasma. Dr. Michele Green is a world-renowned specialist in Cosmelan and treating hyperpigmentation disorders and is here to help you brighten your skin and remove melasma.
Does Cosmelan have hydroquinone?
Yes, Cosmelan MD contains eight percent hydroquinone which is compounded with other skin-brightening agents to reduce the overproduction of melanin in the skin. Cosmelan does not contain any trichloroacetic acid (TCA). Cosmelan contains multiple brightening agents in addition to hydroquinone, including kojic acid, vitamin C, retinoids, and azelaic acid. Hydroquinone inhibits the tyrosinase enzyme, which is responsible for causing hyperpigmentation.
Cosmelan before and after
Can Cosmelan make melasma worse?
Cosmelan treatment will not make melasma worse. Dr. Green considers the Cosmelan treatment the best depigmentation treatment to improve facial melasma. Laser treatments with Fraxel, IPL, and Picosure, as well as other CO2, Erbium, or fractional lasers, can worsen melasma. Cosmelan can be used to treat unwanted pigmentation and discoloration, which can be a side effect of laser treatments. To attain the best cosmetic results from your Cosmelan depigmentation treatment, it is important to adhere to the home care instructions provided by Dr. Green, including wearing sunblock daily and limiting sun exposure to the treatment area.
Can I do the Cosmelan peel at home?
No. Cosmelan MD is not an at-home chemical peel and must be applied by a board-certified dermatologist or other medical professional. However, the Cosmelan treatment involves a home care regimen of brightening skincare products. It is important to note that these skincare products are not the same as Cosmelan MD, which has hydroquinone, retinoids, and other active ingredients. Following the application of Cosmelan 1, the results and maintenance treatment need to be monitored by Dr. Green, who is experienced in treating facial pigmentation and melasma.
How to use Cosmelan 1
Cosmelan 1 is the first part of the Cosmelan depigmentation pigment plan and will need to be applied by a dermatologist like Dr. Green to treat your melasma. At the time of your depigmentation treatment, Dr. Green will advise you on the length of time you are required to leave on the initial Cosmelan mask. Depending on your skin type and skin tone, the length of time can vary from 2 to 10 hours. The Cosmelan 1 peel will then be removed by the patient at home with a gentle skin cleanser.
How to use Cosmelan 2 cream
Cosmelan 2 is a topical depigmenting cream for home care maintenance after the Cosmelan 1 peel is performed in Dr. Green’s office. Cosmelan 2 can be used once or twice daily, depending on how much irritation is associated with the product’s use. Cosmelan 2 prevents the appearance of new dark spots and treats existing dark spots on the face. The active ingredients in Cosmelan 2 may be irritating with daily use, and frequency should be adjusted based on tolerance. If skin irritation occurs, Dr. Green advises discontinuing Cosmelan 2 for several days until it resolves. Failure to comply with these home care instructions can cause increased skin irritation and worsened hyperpigmentation. Since the Cosmelan depigmentation protocol aims to reduce hyperpigmentation, it is counter-productive to continue using Cosmelan 2 with skin irritation. Dr. Green will monitor your home care regimen and adjust as necessary to guarantee optimal results.
45-54 year old male, Cosmelan – 2 months before and after
Do I wash off Cosmelan 2?
You do not wash off Cosmelan 2 after applying it to the skin, as it must be allowed to penetrate the skin. If Cosmelan 2 is too irritating, you should discontinue it for several days and apply moisturizer as directed by Dr. Green. Some patients are only able to tolerate Cosmelan 2 three times a week. Overuse of Cosmelan 2, with irritation, can cause unnecessary hyperpigmentation and the reverse of the desired skin-lightening effect of Cosmelan.
Does Cosmelan 2 cause peeling?
Yes, Cosmelan 2 can cause peeling when applied to the skin. However, if there is peeling caused by Cosmelan 2, discontinue use until the peeling is resolved. Applying the moisturizers Dr. Green recommends, such as the Melan Recovery or Hydra-Vital Factor K, will also help minimize any dryness and irritation caused by Cosmelan 2. Using Cosmelan 2, while peeling and irritated, is counterproductive and can worsen your pigmentation.
Can you use Cosmelan 2 without Cosmelan 1?
In general, you should not use Cosmelan 2 without Cosmelan 1. Cosmelan 2 is meant to be the maintenance cream after treatment with Cosmelan 1. If you choose to use Cosmelan 2 for melasma without first undergoing the Cosmelan 1 peel, you may not get the results you are looking for. There are, however, some special indications where Dr. Green may prescribe Cosmelan 2 without performing an initial Cosmelan peel treatment.
Where can I buy Cosmelan?
The Cosmelan MD line of depigmenting and anti-aging skincare products is available through the office of Dr. Michele Green in New York. Only current patients can purchase these depigmentation products since they contain active ingredients like hydroquinone and need to be supervised under the care of an experienced board-certified dermatologist to monitor their use and prevent unwanted side effects.
How often can you do a Cosmelan peel?
The Cosmelan peel can be repeated if required. Suppose certain areas are re-pigmented due to sun exposure or are difficult to treat due to significantly entrenched hyperpigmentation initially. In these cases, the Cosmelan peel can be repeated. Cosmelan treatment can be re-applied to the entire face or smaller dark spots. The decision to repeat the Cosmelan peel will be discussed in consultation with Dr. Green. Remember that limiting sun exposure to the treatment area and properly using sunscreen will help prevent the recurrence of melasma and the need to repeat the Cosmelan peel.
Cosmelan – 1 session, 3 months before and after
How much is the Cosmelan peel?
The cost of Cosmelan treatment depends on the geographic location of the office where you’re treated, your provider’s experience level, and the treatment area’s scope. The Cosmelan depigmentation treatment involves applying a Cosmelan 1 peel, which Dr. Michele Green performs in her private dermatology office. There is also an array of depigmenting and anti-aging skincare products that are recommended for home care. Dr. Green customizes the home care protocol depending on the patient’s specific needs and personal aesthetic goals. The total cost of the Cosmelan treatment will also include the price of the additional skincare products required to maintain results and enhance the depigmentation process. The price for the Cosmelan peel also depends on the area being treated body. For example, treating just the face will be less expensive than treating the neck and chest areas. During your initial rejuvenation consultation with Dr. Green, the areas of concern will be identified, and the total cost of your Cosmelan treatment will be determined.
Does the Cosmelan peel work?
Yes! Cosmelan peel is an extremely safe and effective treatment for melasma and hyperpigmentation. Cosmelan peels are the best way to treat melasma, sunspots, dark spots, and other hyperpigmentation disorders from sun exposure in patients of all skin types and skin tones.
Lasers and the treatment of melasma
In general, laser treatments such as the Fraxel laser, Picosure, and IPL often worsen the appearance of melasma and make it more difficult to remove in the future. Patients are often inappropriately treated with lasers to remove melasma, worsening the melasma and hyperpigmentation. Melasma that has been treated with lasers can be even more difficult to remove as the heat forces the hyperpigmentation to become more entrenched in the deeper layers of the skin. Dr. Green prefers the Cosmelan depigmentation treatment for safely and effectively removing melasma.
How to protect melasma from the sun
- Strict sun avoidance
- Wide-brimmed hat
- Year-round, life-long sun protection
- Daily sunscreen with a broad spectrum SPF 50 or higher with re-application every 90 minutes
- Makeup/BB Cream to help protect facial skin from the sun
- Sun umbrellas
- Discontinue hormonal or oral contraceptives whenever possible
Is the Cosmelan peel worth it?
The Cosmelan peel is one of the most effective treatment options for hyperpigmentation and melasma. This depigmentation treatment reduces unwanted hyperpigmentation by up to 95%. With few potential side effects, minimal downtime, and consistently stunning cosmetic results, most patients agree that Cosmelan is worth it. During and after the Cosmelan depigmentation treatment, it is crucial to utilize proper sun protection, including two types of sunblock and protective clothing like a hat, to maintain the best cosmetic results. Hyperpigmentation and melasma can return after treatment if there is sun exposure to the treatment area. Dr. Green recommends layering a mineral sunblock over a chemical sunblock to guarantee maximum sun protection and always reapply every ninety minutes.
Is the Cosmelan peel safe?
When you have your Cosmelan peel with a board-certified dermatologist, such as Dr. Michele Green in NYC, and adhere to the home care instructions as dictated, it is a safe and effective treatment option for reducing hyperpigmentation and melasma.
Is Cosmelan peel permanent?
The rejuvenating effects of Cosmelan can be long-lasting to permanent with the right maintenance care. Melanocytes, the skin cells that produce melanin, are activated by UV exposure, so limiting sun exposure and using the right sun protection following your Cosmelan peel is important.
Is Cosmelan effective?
The Cosmelan peel is one of the most effective treatment options for melasma and one of the most popular cosmetic procedures offered at Dr. Green’s private dermatology office in Manhattan’s Upper East Side neighborhood. The Cosmelan depigmentation treatment can reduce unwanted hyperpigmentation and melasma by up to 95%.
Is Cosmelan a deep peel?
Cosmelan is a medium-depth chemical peel designed specifically to treat hyperpigmentation and melasma. There are three major classifications of chemical peels: light/ superficial, medium, and deep.
How to apply Cosmelan
Dr. Michele Green applies Cosmelan 1 at her private dermatology office in Manhattan’s Upper East Side neighborhood. Cosmelan 2 is used during the home care portion of the Cosmelan depigmentation treatment. Patients can begin using Cosmelan 2 the day after their Cosmelan 1 treatment. A small amount (pea-sized) of Cosmelan 2 should be applied only to the areas affected by hyperpigmentation and melasma. It is recommended to use Cosmelan 2 as often as it can be tolerated and to discontinue it when skin irritation occurs in the treatment area. Signs of skin irritation can include redness, peeling, stinging, swelling, and tenderness. Using Cosmelan 2 while the skin is irritated may potentially exacerbate the hyperpigmentation, worsening its appearance and prolonging treatment. Patients can safely resume the use of Cosmelan 2 once skin irritation resolves. Cosmelan 2 may be used daily or several times a week, depending on one’s tolerance. Cosmelan 2 does not need to be washed off after applying.
Does Cosmelan have hydroquinone?
When you have your Cosmelan peel with a board-certified dermatologist, such as Dr. Michele Green in NYC, both Cosmelan 1 and 2 contain hydroquinone. Cosmelan MD is the highest available strength of the depigmenting peel and is only accessible through a dermatologist. Cosmelan peels that are offered outside of a dermatologist’s office do not contain hydroquinone. Cosmelan 2 MD contains hydroquinone and retina. Cosmelan 1 MD contains kojic acid, azelaic acid, phytic acid, ascorbic acid, titanium dioxide, hydroquinone, and retina.
Can I do the Cosmelan peel at home?
The Cosmelan 1 treatment is a specialized chemical peel for reducing hyperpigmentation and melasma that requires application by a dermatologist, such as board-certified dermatologist Dr. Michele Green. The Cosmelan 1 mask, however, is just the first step. The second part of the Cosmelan depigmentation treatment entails using a home care regimen. Dr. Green provides several skincare products, including the Cosmelan 2 cream and Hydra-Vital Factor K moisturizer from Mesoestetic. After the Cosmelan 1 treatment, patients should use these skincare products for four weeks before returning to Dr. Green’s dermatology office for a follow-up appointment.
How to get started with Cosmelan to treat hyperpigmentation and melasma
Hyperpigmentation and melasma can be stubborn skin conditions to treat, and using the wrong approach can worsen their appearance. The Cosmelan treatment by Mesoestetic is a medical-grade chemical peel that diminishes hyperpigmentation and melasma to create a clear, radiant, even-toned complexion. This depigmentation treatment can reduce unwanted hyperpigmentation by up to 95%. With few potential side effects, minimal downtime, and consistently stunning cosmetic results, the Cosmelan treatment is one of the most popular cosmetic procedures offered at Dr. Green’s private dermatology office. She is one of the only dermatologists in New York City who provides Cosmelan treatment for melasma and hyperpigmentation in patients of all skin tones.
Dr. Michele Green is an internationally renowned board-certified dermatologist with over two and a half decades of experience providing some of the world’s most discerning individuals with the best non-invasive cosmetic treatments available, including Cosmelan for hyperpigmentation and melasma. She is consistently voted one of the best dermatologists in New York City by Castle Connolly, Super Doctors, the New York Times, and New York Magazine for her dedication to her patients and expertise. When you consult with Dr. Green, she will work with you to create a customized rejuvenation treatment plan that best suits your specific skin concerns and aesthetic goals. If you’re ready to achieve a clear, radiant, beautiful complexion that lasts, contact us online today or call 212-535-3088 to book a consultation with Dr. Green.