Disclaimer: Read more to understand the pros and cons of Cosmelan vs pico lasers in the management of melasma pigmentation. We offer Cosmelan, Dermamelan, Picosure, Picoway, & a whole lot more for melasma, so take it as you will, this is a guide based upon facts, not marketing BS.
What is the Cosmelan peel?
The Cosmelan Peel is the most highly marketed melasma peel in the history of chemical peels. Though it is over rated (primarily because of aestheticians & beauty therapists), it does have its merits as it is one of the better melasma peels on the market. Cosmelan consist of the following active ingredients-
- Kojic acid. Very old ingredient, but useful.
- Octadecenedioic acid. A weak pigment inhibitor that is naturally found.
- Vitamin C. A powerful antioxidant.
- Tyrosine complex. Fluffy stuff.
- Niacinamide. A useful anti-inflammatory but a weak pigment corrector.
- Salicylic acid. A variant of mashed up Aspirin, acts as an exfoliant.
- Nonapeptide 1. Made up name.
- Liquorice extract. Fluffy botanical that is used in most natural skin care products.
How good is it?
As previously mentioned, the Cosmelan (& Dermamelan) peel system has one of the highest hit rates for reducing melasma pigmentation. As a ‘fire & forget’ system (blindly treated for all melasma types without pre-selection or proper diagnosis), the ‘hit’ rate is around 60-65%. Add medical therapy & it sits around 70-75%. The failure rate is due to –
- Failure to pre-select suitable patients (covers everything from exogenous radiation sources to vascular involvement)
- Failure to understand the depth of pigment (dermal vs superficial melasma pigment).
What is the downside about Cosmelan?
Downtime. Cosmelan recovery ranges from a mild peel to look like-sh*t for two weeks…& everything in-between. Granted, it is one of the fastest ways to sort melasma pigmentation. Most patients (we call our clients patients; as melasma is a medical condition) will have significant skin irritation during the peeling period & commonly 1-6 weeks after.
Should I give Cosmelan a go?
Sure. If you have a spare 1-2 weeks of your life you want to give up, give Cosmelan a go. But seriously, it is still one of the FASTEST ways to temporarily clear up melasma for up to 3 to 4 months.
Just remember to ask your skin specialist / professional how to deal with non-responders, rebound melasma past the phase 2 (home care Cosmelan kit) & ask them a game plan moving forward. Just be ready for the ‘you can repeat the Cosmelan peel every year.’
Yes, you can repeat the Cosmelan every year, but seriously only 10% of our patients do, given the marked downtime.
What does the peel involve?
A pre-peel prep 2 weeks before the Cosmelan Peel, followed by a mask application in clinic, followed by a wash off period at home. Skin recovery ranges from 10 to 14 days.
This is then followed by the Cosmelan® 2 home maintenance skin care for a defined period of time, usually 4+ months.
What about pico lasers for melasma?
The two main lasers for melasma are Picoway or Picosure Pro. Both are good lasers, however we favor the latter. Pico, used in correct settings (they matter), has a hit rate of around 85%, hence it is better than Cosmelan in most but not all cases of melasma.
For low contrast melasma, Cosmelan has the edge over pico laser, however for mixed depth melasma, mixed pigment (sun spots, post inflammation, age spots), pico has the edge.
The downside of pico lasers is that they work much slower than chemical peels, including the Cosmelan or Dermamelan peel. Results can be seen in one session (off label hero settings by a dermatologist), however in most cases, optimal results are seen around 10 to 12 weeks after the first session. As a guide, 4 sessions spaced 2-3 weeks apart are recommended to shift melasma pigment.
What is the upside of pico laser for melasma?
Unlike Cosmelan peels, pico has ZERO recovery. That’s right, no downtime. The whole session takes 2.5 minutes to perform (once every 2-3 weeks) & just like that pigment fades away. Pico works by blowing up pigment into smaller bits. These fragments are then exfoliated or absorbed by your skin’s immune system.
Post-pico you can go about your normal activities- exercise, swimming, socials etc…
As for the hit rate of pico vs Cosmelan peels? Pico, in the correct settings will give better results – 80-85% for pico vs 60-65% for Cosmelan peel.
Speed of results- Cosmelan vs Pico, which is better?
Cosmelan, Dermamelan & the Vi Peel provide faster results as compared to pico lasers, even if ‘hero’ settings on the Picosure Pro are used. Lasers work by-
- Shattering pigment that requires your immune system to clear up pigment; much like a tattoo.
- Reducing the pigment transfer & production from melanocytes.
Both these factors are biologically controlled. Peels on the other hand, primarily work by exfoliation (phase 1 of the Cosmelan peeling process). Accelerate exfoliation enables skin to turn over within a week or two. This means faster results compared to pico lasers.
Comfort levels, chemical peels vs lasers
Chemical peels means exfoliation of skin, this means longer recovery times that are associated with some form of discomfort- think itchy, peeling, red, inflamed skin. In contrast, pico lasers have zero discomfort & no healing times.
Why is the Cosmelan & Pico laser short sighted in their approach to melasma?
Here’s the skinny; both Cosmelan & pico (both Picosure Pro & Picoway) are marketing exercises in melasma management. That is right, both peels & lasers only address the pigment side of things. Both modalities do not address the true science of melasma management. The Cosmelan kit itself runs out of talent at month three, whilst pico on the other hand (depending on the package you engage in), will stop between 3 to 6 months after the initial session. What about ongoing management? Not a long term management plan in sight from both companies.
| Solution type | Speed of results | Longevity of results | Addresses long term remission |
| Pico laser | Weeks to months | 6+ months | No |
| Cosmelan Peel | Fast, | 4 months + | No |
Melasma as we know is chronic, much like diabetes, hypertension, thyroid disease & other medical conditions. Coming up with a game plan is paramount for long term remission & this is where medical management comes into play.
What is the long term plan that pico laser & Cosmelan don’t address?
It gets complicated, but I will try to explain it as best I can in simple terms. The aim of long term remission has to be individualized to the patient. Briefly it entails-
- Identification of radiation sources. This is unique to each melasma patient. Sources include UVB, UVA, visible light & IR sources. By far, this is the hardest part of melasma management & takes the longest time to decipher .
- Understanding the involvement of cellular senescence & cross talking between cells. It’s more complex than just pigment kick-up in melasma. If you have a spare 100 hours of time, search Pubmed to understand, but here is the super-short summary in one paragraph. Melasma is a complex interplay of talking between aging cells like the melanocyte (pigment cell), mast cells (stuff that release histamine, the substance that gives you welts), keratinocytes (skin cells), endothelial cells (that line blood vessels), fibroblasts (the legend that makes collagen) & more. Remission is achieved by balancing out the above & addressing the tensile strength of skin, in addition to reversing photoaging.
- Addressing vascular issues. As above. Vascular modifiers, namely medical therapy, are advocated over fluffy skin care. VEGF-1 & plasminogen factors are addressed.
- Addressing hormonal issues. Again hard. No one is going to advocate taking out the ovaries over pigmentation issues, but the changes in menopause can make melasma harder to control in this age group. Additionally, keeping your thyroid in balance can help.
Why look beyond pigmentation & consider skin quality?
Skin quality goes beyond pigmentation. Dermatologists will always strive for glass skin, a Korean term to describe homogenous skin pigmentation (no red splotches, no pigment), with minimal pore size, absence of fine lines, zero sun damage & a brilliant light reflex. For optimal skin quality, these ‘imperfections’ (I hate that word, because it is normal to have these skin quality issues, especially in mature skin), can be addressed with lasers.
Peels are great for addressing pigmentation only (apart from high strength peels, read more in the context of melasma). Pico lasers address pigmentation, as well as textural issues- fine lines, enlarged pores & skin luminosity. Lasers provide an improvement of skin quality beyond what chemical peels can offer.
Hence, as a dermatologist, my aim is to provide patients the best possible outcomes, hence in most cases I am biased towards lasers & injectables over chemical peels, again acknowledging that if you are in a hurry to treat pigment only, then Cosmelan is an excellent choice.
Where does the Vi Precision Plus Chemical peel come in?
Our clinic has all the peel types, from vitamin A, AHA, BHA, enzyme, Cosmelan, Dermamelan, through to epic phenol, TCA, Jessner & more. There is one peel however, that stands out from the rest (at least for melasma). That is the Vi Precision Peel. We get this formulation from the United States, then modify it according to your skin type.
The Vi Peel works much like Cosmelan however it has the following advantages-
- Much less downtime (3 days of mild shedding compared to 10 plus days).
- Lower costs, typically 35 to 50% cheaper than the Cosmelan.
Is the Vi Precision peel as effective as the Cosmelan? Truthfully, not quite, but it’s close. 80% close. The upside is that timed correctly, the Vi Precision Plus won’t take your work or social life away for 2 weeks. We typically start the peel on a Tuesday or Wednesday, you have delayed peeling that starts on a Friday to the weekend, then you can go about your weekly work activities on the Monday.
Davin’s Opinion.
| Who is Davin?
Dr Davin Lim is a procedural dermatologist who works in Sydney. He has over 25 years’ experience in clinical dermatology (he’s old) & has experience in all types of chemical peels, including Cosmelan, Dermamelan & more. He has over 8 years’ experience in pico lasing, adopting the generation one Picosure since 2016. Davin has also authored several journal articles & research papers on melasma & pigmentation treatments. |
Hopefully this article will give you some insight into the management of melasma. As a dermatologist I have been there in the ‘old days’ or chemical peels, namely high strength Jessner or Jessner-TCA peels. Did we get good results? Hell yeah, results are not hard with medium to deep peels as we remove the majority of pigment in one sitting, along with the entire upper layers of skin. The problem lies with the rebound we had with these old -fashioned peels. Inevitably melasma came back with a vengeance. We then figured out that a softer approach was required, hence entering the fluffy peel era.
The Fluff era of peels for melasma
The ’fluffy peel era consisted of a combination of AHA peels (think glycolic or lactic acid peepells), or fluffier still enzyme peels, mandelic acid peels, whilst higher strength retinoic acid peels had some merit. The upside? At least rebound melasma was not so much of a problem with fluff. The main issue was that it really didn’t shift much pigment & if they did it was marginal and short lived.
Of all the fluffy peels for melasma, the step up program of AHA peels, in particular glycolic acid, gave the best results, with zero downtime. The usual program consisted of peels every 10 to 14 days, from 20, 35, 50 to 70%. AHA peels only address one element of melasma, pigment in the upper layers of skin. They did zilch for pigment production in the deeper layers; unlike Cosmelan, Dermamelan or Vi Precision Plus.
Do I still endorse ‘fluffy peels’? Yes, as they still work for non-melasma pigment, namely sun damage in lighter skin types.
Enter the novel peels
This era heralded the secret squirrel novel peels. Why secret squirrel? It is because the formulations are tightly guarded, which distracts from the notion of advancing medical science at the expense of commercialisation of melasma peels. These peels serve one purpose, that is to line the pockets of companies that create them. Granted they (Cosmelan – Dermamelan – Vi Precision peels) are largely effective, the tightly held intellectual properties (formulations) have kept them out of the medical literature.
The Marketing of Melasma
Both Cosmelan & pico lasers do not offer a long term solution to melasma management, granted both are exercises in marketing. Mesoaesthetics want to sell as many Cosmelan peel kits to beauticians as possible, whilst Candela & Cynosure want to market their ¼ million dollar lasers as the latest & greatest melasma treatments. Though both peels & lasers can offer a good initial clearance of melasma pigment, both do not offer a long term solution, or come up with a melasma prevention game plan; apart from getting more peels or lasers.
Think of melasma management as a marathon & not a sprint. Pacing well designed treatment programs with a long term goal is paramount for both results & remission.
Final word
Chemical peels are still one of my favorite procedures. Though I have this love-hate relationship with Cosmelan, we still acknowledge this treatment modality as one of the fastest ways to treat melasma, however one should have a strategic game plan post peel. Whichever way you choose ensure that your provider –
- Can provide peel alternatives to just Cosmelan (melasma treatment should be customized).This includes alternatives such as the Vi Precision Plus peel, which has less downtime than Cosmelan peels.
- Combine peels with medical management of melasma, this include vascular modification, addressing cellular senescence & hormonal factors that may contribute to melasma pigmentation,
- Gives you the option of no downtime procedures, this includes novel pico lasers or modified thulium laser resurfacing.
