COSMELAN

Pros

• Cosmelan is one of few treatments that's been found to be effective for stubborn melasma. 
• The active ingredients in the chemical peel and at-home cream act on all stages of the melanin production cycle, to both eliminate existing hyperpigmentation and prevent the appearance of new dark spots. 
• It contains a host of anti-aging ingredients that can help with overall skin rejuvenation. 
• Its formula is suitable for all skin types and tones. "Because Cosmelan produces no internal inflammation and doesn't alter the pH of the skin, it produces a safe outcome for melasma and hyperpigmentation patients of all ethnicities and skin types," says Dr. Jason Emer, a dermatologist in West Hollywood, California. 

Cons

• It can be very irritating, so people with sensitive skin should proceed with caution.  
• You’ll need to adjust your skin-care routine before and after Cosmelan treatment, to avoid sensitizing your skin. Cosmelan shouldn’t be used with other lightening agents, glycolic acid, or retinoids. 
• “You’ll also need to avoid the sun during and after treatment, as melasma is exacerbated by sun exposure,” cautions New York City-based dermatologist Dr. Michele Green.

• Average Cost:
• $923

• Range:
• $650 - $1,201

Your cost will depend on your aesthetician or dermatologist’s level of experience and their practice location.

Be wary of Cosmelan products sold on the internet. Cosmelan is a powerful treatment and must be administered by someone who is trained to avoid adverse side effects. There are many counterfeit products available for purchase, and you won't know if a product sold on online is a fake or the real thing. 

"A fake product may do nothing, or it may harm your skin," says Dr. Rebecca Fitzgerald, a dermatologic surgeon in Los Angeles. "Some people should not use Cosmelan, for instance, if they have certain allergies or skin conditions, so self-treating can be a bit like playing with fire."

Both the peel and maintenance cream contain ingredients that suppress the overproduction of melanin, the pigment responsible for your natural skin tone as well as age spots and hyperpigmentation. 

“The Cosmelan peel penetrates deep into the skin, to decrease the natural production of tyrosinase,” the enzyme that catalyzes the production of melanin, says Dr. Sacha Obaid, a plastic surgeon in Southlake, Texas. 

Inhibiting the activation of tyrosinase reduces the amount of melanin synthesized inside the melanocytes, the melanin-producing skin cells, and carried to the superficial layers of the skin. 

Cosmelan 1 and Cosmelan 2 also stimulate cell turnover to help eliminate melanin already accumulated in the visible layers of the skin. 

The active ingredients in Cosmelan 1 include azelaic acid, kojic acid, phytic acid, ascorbic acid, arbutine, and titanium dioxide. 

Cosmelan 2’s active ingredients are titanium dioxide, kojic acid, phytic acid, and ascorbic acid. 

A more aggressive version, Cosmelan MD, contains hydroquinone. “Cosmelan MD is compounded with 8% hydroquinone and Retin-A, and it is much more effective in reducing melasma than the over-the-counter product,” explains Dr. Green. “Cosmelan MD is used only in medical offices, and doctors have found it uniquely capable of removing melasma and post-inflammatory hyperpigmentation (PIH).”

RealSelf Tip: Hydroquinone effectively brightens skin by decreasing the formation of melanin, but it’s a controversial ingredient that has been banned in the European Union, the United Kingdom, Japan, and Australia because of safety concerns. We recommend doing your due diligence to decide if it’s something you want to use.

Related: The Controversy Over Hydroquinone, Explained

Your doctor may advise you to stop using topical retinoids or other skin irritants for a week or more before your Cosmelan peel. It’s also recommended to stop using other acid exfoliants, such as glycolic acid, for a week before your treatment.

On the day of your in-office procedure, your provider will cleanse your skin and then apply the Cosmelan 1 chemical peel mask. The Cosmelan mask will be yellowish-brown where applied, and you’ll go home wearing it. Depending on your skin type and sensitivity level, you’ll leave the mask on for 4–10 hours. 

It’s common to feel some warmth and mild tingling. If the mask begins to flake off toward the end of the treatment, don’t worry; that’s normal. You’ll use a gentle cleanser to remove the mask. 

After 24 hours, you’ll start applying Cosmelan 2 cream once or twice a day, depending on your ability to tolerate the product. Hydra-vital factor K, a moisturizing cream that contains vitamin K, is used to counterbalance any irritation from the products. 

It's important to use both steps of the treatment; otherwise, you'll be shortchanging your skin. "You can use Cosmelan 2 without the mask, but that's like having chocolate milk without the chocolate—you'll be missing the most important part of the recipe!" says Dr. Fitzgerald. "Cosmelan mask contains various levels of hydroquinone, plus a peeling agent. This is what preps your skin to jumpstart the process and give you some fast results."

How long you'll continue to use Cosmelan 2 as an at-home treatment depends on the severity of your pigmentation, says Dr. Green. "Usage is customized from six weeks to six months."

For about a week, you’ll experience side effects like redness, tightness, and peeling before the areas of excess pigmentation and blemishes start to fade. 

Your skin will remain sensitive for the first two weeks—sometimes longer, if you’re prone to irritation. Follow your provider's aftercare instructions and avoid wearing makeup or using any skin products that they don't recommended during this time. 

After three weeks, you’ll return for a follow-up visit. Your provider may apply a second round of the Cosmelan 1 mask or use it to spot treat some areas. 

During your treatment, it’s imperative that you avoid sun exposure. “Strict sun avoidance is necessary to complete the process,” says Dr. Green. 

Even after you've finished your treatment, make a daily habit of daily sun protection to mitigate the appearance of new dark spots. Wear a broad-spectrum sunscreen with an SPF of 30 or higher. "Sun protection is your best friend when it comes to pigmentation control," says Dr. Fitzgerald. "Sunlight and excessive heat will put your pigment-reducing cells back into overdrive and you'll end up where you started."

Your results will continue to improve over time, with full benefits seen around week four or five. 

RealSelf Tip: "When I do a Cosmelan peel (and home care products) on my patients, I also give them a prescription-strength hydrocortisone cream to use. This calms any associated redness, tightness, or dryness. Since adding this into the regimen I haven't had any patients with prolonged redness or irritation." —Dr. Victor Rueckl, a dermatologist in Las Vegas

Cosmelan should not make melasma worse, says Dr. Green, who considers the Cosmelan treatment the best depigmentation treatment to improve melasma. "Laser treatments with Fraxel, IPL, Picosure, as well as other CO2 or fractionated lasers can make melasma worse," she says. "Cosmelan can treat these laser treatment side effects."

That said, if the trauma of the peeling after the mask is too great, this can create post-inflammatory hyperpigmentation, which is a darkening of the skin caused by the trauma and the associated healing process, says Dr. Harold Kaplan, a facial plastic surgeon in Torrance, California. "The good news is that it will go away," he says. "It's a different type of pigment than melasma and does not make melasma worse, but it may look darker temporarily."

You may need two or more peels to see optimal results. These initial treatments are typically done three months apart, and the Cosmelan peel can be repeated on a yearly basis to maintain your results. 

As long as the home care maintenance is continued and sun exposure is strictly avoided, the results from a Cosmelan peel can last for years or be permanent, says Dr. Green. 

However, according to Dr. Fitzgerald, "Most likely you will need a maintenance peel now and then to keep the melasma at bay. Like acne, melasma is not so much cured as controlled. Cosmelan has proven to be a very useful controlling program."