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Melasma, or facial pigmentation, is a complex condition caused by a combination of sensitive skin, hormones, and sun exposure. Melanin, the primary determinant of skin and hair color, is what causes the pigmentation in your skin. If your body produces too much melanin in a given area, the result are brown patches, dark spots, and resulting hyperpigmentation. Melasma is much more common in women than men and can be triggered by birth control pills, pregnancy, hormone therapy, heat, stress, thyroid disease, and sun exposure. The most common areas on the face for the presentation of melasma are the forehead, cheeks, chin, and the skin above the lips. Melasma has often been called the “mask of pregnancy,” although the hormonal changes of pregnancy are not the only cause of this hyperpigmentation and the resulting facial discoloration and dark spots. Dr. Michele Green is a board certified, cosmetic dermatologist in NYC, who specializes in using Cosmelan to treat facial hyperpigmentation and melasma in patients from New York and around the world. For over two decades, she has successfully used Cosmelan depigmentation peels to treat thousands of patients with recalcitrant melasma, facial and body hyperpigmentation, in patients of all skin types. If you are suffering from hyperpigmentation and melasma, Dr. Green is here to help.

Hyperpigmentation is a broader term which describes many skin conditions which leaves your skin discolored or dark from a myriad of factors. Hyperpigmentation can be the result of sun damage, sun spots, acne scarring, post-inflammatory hyperpigmentation, eczema or sensitive skin healing which heal with dark spots. Many patients develop hyperpigmentation as a side effect from other treatments, such Fraxel laser, IPL, or Picosure lasers. All too often, patients will attempt to have laser treatments to remove melasma and the result is a worsening of the melasma and hyperpigmentation. This type of hyperpigmentation, as a result of laser treatment, is more difficult to remove as the hyperpigmentation becomes more entrenched in the deeper layers of the skin. However, Dr. Green has successfully treated this type of post-inflammatory pigmentation with specially designed depigmentation treatments in her private, New York City dermatology office.

Dr. Michele Green specializes in treating patients whose melasma and pigmentation were worsened by ablative and non-ablative laser treatments, such as IPL, Erbrium, Fraxel, Picosure lasers. Many patients suffer from hyperpigmentation and although the Cosmelan depigmentation system was initially developed to treat melasma, Dr. Green has expanded its use to incorporate the treatment of acne scars, post-inflammatory hyperpigmentation (PIH) from lasers, sun spots, and sun damage and discoloration on the face, chest, and body. Hyperpigmentation, whatever the cause, needs to be properly evaluated and treated. Once the correct depigmentation treatment is established by Dr. Green, proper sun avoidance, skin care, sunscreens, cleansers, and life style changes need to be put in place to avoid the reappearance of these brown patches and hyperpigmentation.

Dr. Green is a world renowned specialist in Cosmelan and disorders of pigmentation and is here to help you brighten your skin and remove discoloration and hyperpigmentation. She is one of the only dermatologists in New York City who treats patients, with al skin tones, who are suffering from melasma or hyperpigmentation with Cosmelan peels. Cosmelan depigmentation system is an outstanding skin lightening treatment and one that Dr. Green utilizes daily in her boutique private NYC dermatology office. Cosmelan can be used on all skin types and is safe and effective for removing melasma and pigmentation on your face and body. If you are suffering from dark spots, hyperpigmentation, or melasma, it’s time to schedule a consultation with Dr. Michele Green in New York.

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Before and after – 3 parts, Cosmelan treatment

What types of hyperpigmentation does Cosmelan treat?

Dr. Michele Green, in NYC, is an expert in skincare and treating hyperpigmentation on the face and other areas of discoloration on the body. Her focus on depigmentation treatment comes in part from seeing patients who were treated with Fraxel, IPL, Picosure, and other lasers incorrectly with resulting 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. The following list are the main conditions which Cosmelan treats:

  • Melasma
  • Sun spots
  • Sun damage
  • Acne scarring
  • Age spots
  • Post-Inflammatory hyperpigmentation (PIH)
  • Skin discoloration on chest, neck, and back
  • Blemishes
  • Uneven skin tone
  • Dark spots on buttocks
  • Dark patches on knees, elbows, feet
  • Discoloration from laser treatments such as Fraxel, NdYag, Erbium, CO2, IPL, and Picosure lasers

What is a cosmelan peel?

The Cosmelan® peel is a professional-grade mask that is applied by board certified dermatologist Dr. Michele S. Green in her practice on the Upper East Side. The mask is left in place for a number of hours (depending on the degree of pigmentation and skin type). The cream is easily removed at home by the patient, with a neutral gentle facial cleanser, several hours later. Cosmelan® will produce an initial “peeling” of the skin, which will leave the skin smooth and dramatically decrease the signs of facial pigmentation. Cosmelan® is a simple and safe treatment with minimal down time. The patient returns three weeks later for a touch-up of Cosmelan® in order to treat any residual pigmentation.

A series of creams including kojic acid, azelaic acid, hydroquinone, hydra-vital factor K (Vitamin K cream), and sunscreen are used at home after the Cosmelan mask is removed to maintain the effects of the procedure and keep the skin clear and pigment-free. Strict sun avoidance, and a sunscreen of SPF 50 or higher, which contains titanium dioxide, must be utilized. Dr. Green recommends layering two different sunscreens to her melasma patients. She recommends using a chemical based sunscreen, such as one that contains oxybenzone and one that contains a physical block, such as zinc oxide or titanium dioxide. Sunscreen use is paramount throughout the procedure and afterwards, in order to avoid melasma, brown spots, and the recurrence of your hyperpigmentation.

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Cosmelan before and after

What is the Cosmelan Depigmentation Treatment?

The Cosmelan depigmentation treatment consists of a two part chemical peel system, of Cosmelan 1, applied approximately three weeks apart in the office of Dr. Michele Green. This depigmentation treatment is an in office procedure which Dr. Green applies to your skin, in her NYC office. The cosmelan depigmentation chemical peel is combined with home treatment to revive the dark spots, maintain healthy looking skin, and prevent recurrence of the depigmentation.

At home, patients are instructed to use Cosmelan 2 depigmenting cream is used daily or twice a day, depending on the patient’s ability to tolerate the product. It is is important to note that Cosmelan 2 is both hydroquinone and retinoid based. As such, Cosmelan 2 can be very irritating. It is essential to use Cosmelan 2 daily. However, if the cream causes irritation, it is essential to discontinue Cosmelan 2 for several days, until the irritation completely resolves. Failure to comply with these instructions can cause increased irritation to your skin and increased hyperpigmentation. Since the goal of the Cosmelan depigmentation protocol is to lessen and eliminate hyperpigmentation, it is counter-productive to continue using Cosmelan 2 if you are irritated.

To counter balance any irritation from the products, Dr. Green recommends Hydra-vital factor K, Melan Recovery, or MGSKINLABs Recovery Cream to allow your skin to heal and give you the best cosmetic results. Sun avoidance and the re-application of sunscreen, every 90 minutes, as photoprotection is vitally important. Daily compliance with the home maintenance products and sun avoidance is essential to remove the pigmentation both immediately and long term.


Melasma is one of the most common skin disorders that patients consult Dr. Michele Green to treat at her Upper East Side New York private dermatology office. Melasma is also called chloasma, or the “mask of pregnancy,” when it occurs in pregnant patients. Ninety percent of patients who suffer from melasma are women, due to both a genetic and hormonal propensity. Studies have showed that there is a four-fold increase in thyroid disease i patients who have melasma. There is also an increased presence of melanoyctic and lentiginous nevi in patients with melasma. Melasma is more likely to develop in patients with darker skin types, especially in patients with type IV or darker skin tone. Women are affected nine times more than men with melasma and it is uncommon to develop melasma before puberty, most commonly affecting women during their reproductive years. There is a genetic correlation with melasma, with 50% of patients reporting a positive family history of this type of disorders of hyperpigmentation. Medications, such as certain chemotherapies and cosmetics can also cause a phototoxic reaction and trigger melasma.

The classic presentation distribution of melasma are dark or discolored patches on the face, typically darker than your normal skin color. These dark patches may be symmetrical, affecting both sides of the face. Other areas of the body, such as the neck, chest, and forearms can be similarly affected with this type of hyperpigmentation. The most common areas of the face for melasma to develop are the:

  • cheeks
  • forehead
  • bridge of nose
  • chin
  • Other extra facial areas involved include the forearms, upper arms, and shoulders, in a classic sun-exposed distribution.

In the past, a Wood’s lamp examination would be used to diagnose and confirm melasma. However, this common clinical diagnosis rarely requires a skin biopsy or Wood’s lamp for diagnosis today.

What is the pathophysiology of Melasma?

Exposure to ultraviolet light (UV light) is the number one most important factor involved in developing melasma. UV radiation triggers the production of alpha-melanocyte-stimulating hormone, corticotropin, interleukin 1, and endothelia 1, which triggers an increased amount of melanin productions by melanocytes in the skin.

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Cosmelan – 10 weeks before and after

Mesoestetic products

Mesoesthetic products have revolutionized the treatment of melasma and depigmentation with their  Cosmelan treatments, Mesopeels, and other products to treat facial and body hyperpigmenation. Cosmelan treatment can be used for all skin types, especially for patients with type IV or darker skin. Cosmelan is uniquely made to treat patients with AsianHispanic, Mediterranean, and African American skin. These skincare products were designed to treat hyperpigmentation and dark spots for all skin types. Home maintenance creams are a crucial part of treating hyperpigmentation and melasma with the mesoestetic line of products.

Mesoesthetic products have expanded dramatically over the past few years, to improve skin texture, luminosity, and successfully achieve pigment control. In addition to the Cosmelan depigmenting creams and peels, other specially formulated peels for the treatment of hyperpigmentation have been developed, including:

Dermamelan Intimate:  used to treat vaginal and anal discoloration and hyperpigmentation

Mesopeel Periocular:  to remove hyperpigmentation around the delicate eye area and improve periocular luminosity

Mesopeels for Body:  designed to remove discoloration and varying types of hyperpigmentation around the axillae (underarms), groin, and buttocks.

These depigmentation treatments complement the existing line of chemical peels and treatments for patients with all skin tones. Proper skin care, including cleansers and treatment products are reviewed with you during your consultation with Dr. Green, to provide you with the best treatment outcomes in rejuvenating your skin.

What is Cosmelan MD?

Cosmelan MD is distinct from general Cosmelan, and is a medical grade treatment for melasma and hyperpigmentation. Cosmelan MD is only available from a dermatologists’s office, like Dr. Michele Green in New York. Cosmelan MD contain both retinoids and hydroquinones as active agents in this unique pigment control cream and chemical peel depigmentation system.

How does Cosmelan work?

Cosmelan is a proprietary combination of active ingredients of proven efficacy that acts on the entire process of pigment formation to remove the accumulation of melanin and inhibit the formation of new pigment. Cosmelan works by several mechanisms:

  • Accelerates epidermal renewal to remove the accumulation of melanin.
  • Reduces the amount of melanin formation and decreases the dark spots.
  • Blocks the transfer of melanin from the melanocyte to the keratinocyte, inhibiting the migration of pigment to epidermal layers of the skin.
  • Reduces the synthesis of melanin inside melanocytes.

Cosmelan complex consists of 51 active ingredients, including numerous Tyrosinase inhibitors, which block the production of melanin in the skin. The 5 key Tyrosinase inhibitors and lightening agents include:

  • Kojic Acid
  • Azelaic Acid
  • Arbutine
  • Phytic Acid
  • Licorice
  • Ascorbic acid

Cosmelan is a prescription formulation, which is only available to physicians, and is compounded with 8 percent hydroquinone for increased skin lightening.

Cosmelan 12 months before and after

Depigmentation Peel

The Cosmelan depigmentation gel decreases the melanin production in the skin, by inhibiting the tyrosinase enzyme, and helping to effect beautiful, clear skin. It is important to discontinue all retinoids, glycolic acids, and any other exfoliants, for one week before your Cosmelan peel. In addition, the use of these exfoliating products, as well as Retin-A should be discontinued for one week before the procedure and during the Cosmelan 2 maintenance treatment.

How long does the Cosmelan peel last?

The Cosmelan peel needs to be incorporated with the home maintenance treatment to have the best cosmetic results. The results from the Cosmelan chemical peel will be permanent as long as strict sun avoidance is maintained, along with the maintenance cream.

Is Dermamelan (Fortified Method) better than Cosmelan for treating melasma?

Dermamelan contains a stronger amount of salicylic acid, in addition to Azelaic acid, Aubutin, Kocic Acid, Licorice Extract, and Phytic Acid. Some cases of melasma may require Dermamelan treatment but this will be decided on an individual basis, depending on skin type, skin tone, cosmetic history, and medical history.

How to treat melasma?

Melasma is a complex pigmentation condition, which is caused by the body’s overproduction of melanin in the skin. Melasma cannot be treated with plastic surgery or laser treatment. The Cosmelan depigmentation system is the best chemical peel treatment to reduce melasma and prevent its relapse. Proper skin care and sun avoidance is essential to maintain the results of your Cosmelan peel and prevent the recurrence of your melasma.

Does Cosmelan contain hydroquinone?

Yes, Cosmelan contains an 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 agents in addition to hydroquinone, which inhibit the tyrosinase enzyme, which is responsible for causing hyperpigmentation.

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Cosmelan before and after

Can Cosmelan make melasma worse?

Cosmelan will not make melasma worse. Dr. Green considers the Cosmelan treatment the best depigmentation treatment to improve facial melasma. Laser treatments with Fraxel, IPL, Picosure, as well as other CO2, Erbium, or fractional lasers, can make melasma worse. Cosmelan can be used to treat the unwanted pigmentation and discoloration, which can be side effects from laser treatments.

Can I do the Cosmelan peel at home?

No. Cosmelan MD is not a home peel. Cosmelan does have other skin care products and chemical peels for home use. However, these products are not the same as the Cosmelan MD which has hydroquinone, retinoids, and other active ingredients. Only a board certified cosmetic dermatologist, like Dr. Green, can apply the Cosmelan peel in her medical office. 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 is the professional treatment which Dr. Green will apply on your face to treat your melasma. At the time of your depigmentation treatment, Dr. Green will advise you as to the length of time which you are required to leave on your Cosmelan peel. Depending on your skin type and skin tone, the length of time can vary from 4 hours up to 10 hours. The Cosmelan 1 peel will be removed by the patient at home with a gentle skin cleanser.

How to use Cosmelan 2 maintenance cream?

Cosmelan 2 is a topical anti-spot pigmentation cream for home maintenance use after the Cosmelan 1 peel is performed in Dr. Green’s office. Cosmelan 2 can be used once a day or twice daily, depending on how much irritation is associated with the product use. Cosmelan 2 prevents the appearance of new dark spots and treats existing dark spots on the face. If Cosmelan 2 cream causes too much irritation, Dr. Green advises to discontinue its use for several days until the irritation is resolved, and continue moisturizing until you can initiate treatment with Cosmelan 2 again. Cosmelan 2 is a critical part to the success of the Cosmelan depigmentation system and regulating the production of melanin in the melanocytes, and successfully treating your facial melasma.

Does Cosmelan 2 cause peeling?

Yes, Cosmelan 2 can cause peeling when applied to the skin. However, if there is any peeling caused by the product, it is a sign to discontinue the Cosmelan 2 until the peeling is resolved. and apply the proper moisturizers which Dr. Green will advise. Using Cosmelan 2, while peeling and irritated, is counterproductive and can worsen your pigmentation.

Where can I buy Cosmelan?

Cosmelan MD line of products is available through the office of Dr. Michele Green in New York. Only current patients have access to purchase this depigmentation line of products, since they need to be under the care of a board certified physician to monitor their use and prevent unwanted side effects.

How often can you do a Cosmelan peel?

The Cosmelan peel can be performed again, if required. If certain areas have re-pigmented due to sun exposure, or area are difficult to treat due to entrenched pigmentation, the Cosmelan peel can be repeated for the entire face or spot areas. The decision to repeat the Cosmelan peel will be discussed in consultation with Dr. Green.  Proper sun avoidance and sunscreen will help prevent the recurrence of melasma and the need to repeat the Cosmelan peel.

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Cosmelan – 1 session, 3 months before and after

How long does the Cosmelan peel last?

Melasma and other disorders of pigmentation are exacerbated by the sun. If you practice complete sun avoidance, the clear skin from your Cosmelan peel should be maintained.

How much is the Cosmelan peel?

Cosmelan peel is a set of two chemical peels, performed in the office of Dr. Michele Green. The price for Cosmelan peel depends on the number of area of the body performed. Treating just the face will be less expensive than patients who need to treat the neck and chest as well.

Does the Cosmelan peel work?

Yes! Cosmelan peel is extremely safe and effective! Cosmelan peels are the best way to treat melasma, sunspots, dark spots, and other disorders of hyperpigmentation from sun exposure in all skin tones.

Lasers and the treatment of melasma

In general, laser treatments such as Fraxel laser, Picosure, and IPL often worsen melasma and make it more difficult to effectively remove and treat melasma in the future.

How to protect my skin with 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 contraceptive whenever possible

How do I get started with Cosmelan to treat my melasma and hyperpigmentation?

Dr. Michele S. Green is one of the only dermatologists in New York to offer Cosmelan treatment. Originally developed in Spain, Cosmelan® is both safe and effective on all skin types. The mask treatment has been proven to be more effective than laser treatments on all skin types, included darker skin tones, such as Asian, Hispanic, and African American skin.

Dr. Michele Green has treated thousands of cases of melasma and hyperpigmentation, and she will customize a treatment protocol for you. Your treatment can consist of skin lightening creams from the MGSKINLABs, Inc line of products, retinoids, Vitamin C serums, Cosmelan, Mesopeels for body pigmentation, Mesopeel periocular peels for dark under eye circles, Fraxel laser, Clear + Brilliant® laser, among other treatment modalities.

If you are suffering from hyperpigmentation or melasma, Dr. Green is here to help. Dr. Michele Green is consistently voted as one of the best dermatologists in NYC by Castle Connolly, Super Doctors, and New York Magazine. An expert in pigmentation, chemical peels, Botox injections, Juvederm, Thermage skin tightening, and other non-invasive procedures, Dr. Green will help you achieve the brightest skin possible. If you’re ready to bring out the best in your skin, contact us online today or call 212-535-3088 to learn more about why Dr. Green has the best treatment for melasma in New York City.

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