Hyperpigmentation and Melasma Treatment in London: Peels, Cosmelan, Laser and Medical Skincare

Reviewed by Dr Salinda Johnson MD FSCD

Dark marks are not one disease. Sun spots, post-inflammatory marks after acne, and melasma behave differently and fail differently. That is why a single “brightening facial” rarely holds.

This is the pathway we use at The London Cosmetic Clinic when patients come in for hyperpigmentation treatment.

Name the mark before you treat it

• Solar lentigines — discreet sun spots, often on cheeks and hands
• Post-inflammatory hyperpigmentation (PIH) — stamps left after spots, picks, burns or the wrong peel
• Melasma — hormonally influenced patches, often symmetric on the face, worse with heat and UV
• Freckling and mixed patterns — very common in London patients who holiday hard and commute

If the diagnosis is wrong, the device is wrong.

Why melasma is a long game

Melasma is a chronic tendency, not a stain you laser off once. Heat, visible light, UV, pregnancy and some hormones refill it. Aggressive laser on unprepared melasma is a well-known way to darken the patch.

First-line care is almost always medical: strict daily SPF (yes, in London, all year — this is not a seasonal “winter skincare” essay), pigment-suppressing topicals, and time.

Medical-grade topicals

We use and prescribe in clinic rather than sending you into a 20-step routine. Depending on the case that may include retinoids, hydroquinone-containing or alternative pigment inhibitors, anti-inflammatories and barrier repair.

Obagi and ZO Skin Health programmes are tools, not religions. They only work if the diagnosis fits and you can follow the irritating phase without improvising extra acids at home.

Peels and PRX

PRX and selected chemical peels can lift dullness and some PIH with little peeling compared with old-fashioned frost peels. They are not a melasma cure. Depth, skin type and what you put on the skin afterwards decide whether you fade or rebound.

Cosmelan

Cosmelan is an intensive depigmentation programme: an in-clinic mask, a visible peeling and redness phase, then months of maintenance. It can be transformative for the right mixed pigmentation and a disaster if you cannot stay out of direct sun or will not do the home cream.

Ask us plainly about social downtime before you book a mask.

When laser helps — and when it harms

Vbeam is a vascular laser. It is useful when redness and vessels sit with pigment, and in some scar-related colour. It is not an automatic “zap the brown patch” tool.

Pigment lasers have a role in discrete sun spots on carefully typed skin. They are used cautiously, or not at all, on active melasma and on many deeper skin tones until the skin is prepared.

Skin of colour

PIH risk is higher. Test spots, slower protocols and sun discipline matter more than the brand name on the peel. A Harley Street setting does not make an aggressive protocol safe; the protocol does.

A realistic 3–6 month plan

Month 1: diagnose, photograph, start barrier + SPF + pigment suppression. Pause the acids you bought online. Months 2–3: add peel, Cosmelan or laser only if the skin is stable. Months 4–6: maintain. Most relapses are sun, heat and abandoned topicals — not a “failed peel”.

Microneedling such as SkinPen may enter later for texture, not as a first attack on unstable melasma.

FAQs