Pigmentation Playbook: BBL, MOXI, Secret PRO CO2 or Peels
Which Is Right for Your Skin?
Founder & Clinical Director, Harley Street Injectables
I'd estimate that about a third of the patients who come to see me at the clinic are here because of some form of pigmentation. And almost all of them say the same thing: "I've tried everything and nothing's really worked." When I dig a little deeper, it usually turns out they've been given one treatment (often the wrong one for their particular type of pigmentation) and told to hope for the best. That's not how this works.
The reality is that pigmentation isn't one problem. It's a whole family of problems that happen to look vaguely similar on the surface but behave very differently underneath. Sun spots, melasma, post-acne marks: they each have different causes, sit at different depths, and respond to completely different treatments. Get the match wrong, and you can genuinely make things worse.
I wrote this guide because I got tired of seeing patients arrive confused and let down by the oversimplified information out there. So here's what I actually tell my patients when they sit down across from me: a walk-through of the four main treatment pathways we use for pigmentation (BBL Hero, MOXI, the Secret PRO CO2 laser by Cutera, and chemical peels including Cosmelan), when each one makes sense, and when it doesn't.
First Things First: What Type of Pigmentation Are You Dealing With?
This is where so many clinics skip straight to the sales pitch. Before I even think about which device to use, I need to understand what's driving the pigmentation. It changes everything about the treatment plan.
Sun Damage and Photodamage
Probably the most straightforward type to treat, thankfully. Years of UV exposure cause melanocytes (the cells that produce pigment) to go into overdrive in certain spots. The result: freckles, sun spots, that mottled look you might notice on your chest or hands. The good news is that sun damage usually sits fairly shallow in the skin, so it tends to respond well to light-based treatments.
Melasma
Melasma is the one that keeps me up at night, clinically speaking. It shows up as larger, often symmetrical patches of brown or greyish discolouration, typically across the cheeks, forehead, and upper lip. Hormones are usually the culprit: pregnancy, the pill, HRT. Heat and UV make it worse. And here's the frustrating part: aggressive laser treatments can trigger a rebound flare that leaves patients worse off than before. The British Association of Dermatologists estimates melasma affects up to one in three women of childbearing age. Incredibly common, incredibly mismanaged.
Source: British Association of Dermatologists (BAD), Patient Information Leaflet on Melasma, 2023.
Post-Inflammatory Hyperpigmentation (PIH)
PIH is what happens when your skin overreacts to an injury. A breakout clears up, but leaves a dark shadow behind. A burn heals, but the mark lingers for months. I see this constantly in patients with Fitzpatrick skin types III through VI, where the melanin response tends to be more pronounced. Research published in the Journal of Clinical and Aesthetic Dermatology confirms that PIH disproportionately affects people with skin of colour, which makes careful treatment selection non-negotiable.
Source: Davis EC, Callender VD. "Postinflammatory Hyperpigmentation." Journal of Clinical and Aesthetic Dermatology, 2010; 3(7): 20-31.
Mixed Pigmentation
Here's where it gets complicated. Loads of patients walk in with more than one thing going on. Melasma underneath, sun spots on top. PIH from old acne mixed with general photodamage. You can't throw a single treatment at that and expect it to sort itself out. This is why we keep such a wide range of technologies at the clinic.
When BBL Hero Is the First Choice
For straightforward sun damage and photodamage, BBL Hero is usually where I start. It's our workhorse for sun spots, redness, and that dull, uneven look that years of sun exposure creates.
How It Works
BBL delivers pulses of broadband light that get absorbed preferentially by melanin and haemoglobin. The pigmented cells heat up, break apart, and your body clears them naturally over the following week or two. What I find particularly impressive about BBL is the research behind it. A Stanford University study published in the Journal of Investigative Dermatology showed that regular BBL treatments actually changed gene expression patterns in the skin, pushing cells towards younger, healthier behaviour. That's not marketing spin; it's peer-reviewed science.
Source: Chang ALS et al. "Rejuvenation of Gene Expression Pattern of Aged Human Skin by Broadband Light Treatment." Journal of Investigative Dermatology, 2013; 133(2): 394-402.
What It Feels Like and What Happens After
Patients usually describe BBL as a warm, snapping sensation. Not exactly relaxing, but very tolerable. In the days that follow, your pigmented spots will go darker (patients sometimes panic at this stage, but I promise it's a good sign). Over the next week or two, those darkened spots crust gently and flake off. Most people are back at work the same day, though I'd suggest scheduling around anything where you need to look camera-perfect.
Who It Works Best For
BBL Hero is most effective for Fitzpatrick skin types I through III. If you've got fair to light-olive skin and your main complaint is sun spots or a generally blotchy tone, this is likely going to be your primary treatment. For darker skin tones, I'm much more cautious with BBL because the device can struggle to distinguish between the unwanted pigment and your skin's natural melanin. It's not necessarily off the table, but I'll often recommend a different starting point.
Where MOXI Fits (and Why I Often Pair It with BBL)
I think of MOXI as the "pre-juvenation" laser. It's gentler than most fractional lasers and brilliant for mild pigmentation, early textural changes, and that general "I just want my skin to glow" request I hear so often from patients in their late twenties and thirties.
How It Works
MOXI creates thousands of microscopic treatment zones in the skin, stimulating the body to push out old, damaged cells and replace them with new ones. Because it's non-ablative, it doesn't remove the surface layer; it works within the tissue to accelerate cell turnover and improve tone and texture from the inside out.
The BBL + MOXI Combination
This is honestly one of my favourite protocols. We do BBL followed by MOXI in the same session. BBL goes after the pigment specifically, then MOXI resurfaces and rejuvenates the surrounding skin. It's the difference between spot-cleaning a carpet and deep-cleaning the whole thing. Patients regularly tell me their skin looks "lit from within" after a course of these.
Who It Works Best For
MOXI is safe across a wider range of skin tones, including Fitzpatrick types I through V, which makes it a great option for patients who aren't ideal BBL candidates. Recovery is about two to four days of sandpapery texture, then you peel through to visibly fresher, brighter skin.
Secret PRO CO2: For When Other Treatments Haven't Been Enough
Some pigmentation is stubborn. Really stubborn. When patients have tried light-based treatments without getting where they want to be, or when the pigmentation sits deeper than BBL or MOXI can comfortably reach, that's when I bring in the Secret PRO CO2 laser by Cutera.
How It Works
Secret PRO uses a high-intensity CO2 laser to create thousands of precise micro-channels in the skin. These controlled micro-injuries trigger a powerful healing cascade: your body clears out old, pigmented tissue and replaces it with fresh collagen and healthy new cells. What makes it different from older CO2 lasers is its dual-mode approach, offering both ablative and non-ablative settings. That means I can dial the treatment up or down depending on what your skin needs, going aggressive on stubborn photodamage or gentler on sensitive areas, all in the same session.
The Trade-Off
I'm always upfront about this: CO2 resurfacing involves real downtime. We're talking three to seven days of redness, swelling, and some crusting depending on intensity. You won't want to be on a video call for a few days. But the regenerative results can be genuinely transformative. Published data in the Journal of Cosmetic Dermatology shows that fractional CO2 laser resurfacing produces significant improvement in photodamaged skin, with measurable increases in collagen density and more even pigment distribution.
Source: Tierney EP et al. "Fractional CO2 Laser Resurfacing." Journal of Cosmetic Dermatology, 2011.
Chemical Peels (Including Cosmelan) for Melasma and Mixed Pigment
I know what you're thinking: "Peels? Aren't those a bit... old-fashioned?" I hear it all the time. But chemical peels are one of the most effective weapons we have for melasma and mixed pigmentation, precisely because they work differently from lasers.
Why Peels Still Matter
Lasers target pigment that's already been deposited. Peels go after the production line. They inhibit tyrosinase, the enzyme driving melanin synthesis, which means they're not just clearing what's there but actively slowing the process that creates new pigmentation. For melasma, where the whole problem is overactive melanin production, this makes peels absolutely essential.
The Cosmelan Protocol
Cosmelan deserves its own mention because it's in a league of its own for stubborn melasma. It's a medical-grade depigmentation system: we apply a professional mask in clinic, you leave it on for a set number of hours at home, and then you follow a strict home-care routine with Cosmelan 2 cream for several months afterwards.
I won't sugarcoat it. Week one is rough. Peeling, tightness, redness. Your skin looks worse before it looks better, and that takes some nerve. I've had patients text me photos on day four looking slightly alarmed. But I've also had those same patients come back at their follow-up with the clearest skin they've had in years. The protocol works, but only if you see it through and stay religious about SPF afterwards.
Who Peels Work Best For
Cosmelan and chemical peels are my first recommendation for melasma and for patients with Fitzpatrick skin types IV through VI, where laser-based treatments carry a higher risk of making things worse. They're also what I reach for when dealing with mixed pigmentation presentations, because we need to tackle the melanin factory, not just the melanin it's already produced.
How I Actually Decide: The Thinking Behind Your Treatment Plan
People often ask me if there's a formula for this. Sort of. It's not a rigid algorithm, but there are a handful of factors that steer every decision I make.
Your Skin Type Comes First
The Fitzpatrick classification system, first developed in 1975 by Harvard dermatologist Thomas Fitzpatrick and still the global standard today, underpins everything. BBL works best for types I to III. MOXI is safer up to type V. Peels work across the full spectrum. Secret PRO CO2 suits most skin types, though darker complexions sometimes need a preparatory protocol to stabilise pigmentation first. Getting this wrong isn't just ineffective; it can actively cause harm.
Source: Fitzpatrick TB. "The Validity and Practicality of Sun-Reactive Skin Types I Through VI." Archives of Dermatology, 1988; 124(6): 869-871.
What Kind of Pigmentation and How Deep
Sun damage sits shallow and responds to light. Melasma sits deeper and needs melanin suppression. PIH needs gentle handling. Mixed pigmentation needs a sequenced, multi-treatment plan. I can't emphasise enough how much the type of pigmentation determines the treatment.
Your Life, Your Schedule
I'll always ask how much downtime you can realistically handle. There's no point recommending Secret PRO CO2 if you've got back-to-back meetings for the next week. I'd rather we build a plan around MOXI and BBL that you'll actually stick with than prescribe the "perfect" treatment you'll postpone indefinitely. I also want to know your treatment history, because what's been tried before shapes what we do next.
Quick Reference: Matching Treatment to Concern
The SPF Conversation (Yes, Every Single Time)
My patients are probably sick of hearing me say this, but I'll say it again: no treatment in the world will give you lasting results if you're not wearing SPF 50 every day. Every. Single. Day. Grey skies, office days, January. The British Association of Dermatologists recommends daily broad-spectrum SPF as the foundation of any hyperpigmentation management plan, and they're absolutely right.
Source: British Association of Dermatologists, "Sunscreen and Sun Safety" guidelines, updated 2024.
Beyond sunscreen, I'll typically build a skincare routine that includes vitamin C, a retinoid, and something like niacinamide or tranexamic acid for ongoing brightening. And I schedule maintenance sessions, usually once or twice a year, because pigmentation is a condition you manage long-term rather than fix once and forget about.
Why We Don't Just Pick One Device and Call It a Day
Browse most clinic websites and you'll find a page dedicated to one device that makes it sound like the answer to everything. I find that approach a bit reductive. Pigmentation is rarely one-dimensional, and the patients who get the best outcomes are almost always the ones on a plan that combines technologies. Maybe BBL Hero for the visible spots, then MOXI for the overall quality, with Cosmelan if there's a melasma component. That's why we've invested in the range of technology we have. I never want to be in a position where I'm shoehorning a patient into the only device we own.
Frequently Asked Questions
These are the questions that come up in virtually every pigmentation consultation I do.
Q: How many sessions will I need before I see a difference?
A: It depends on what we're treating. Lots of patients see a noticeable shift after a single BBL session, but I generally recommend three to five spaced about four to six weeks apart for the best outcome. Cosmelan for melasma tends to show significant clearing within four to eight weeks, though the home-care protocol runs for several months. I'll give you a realistic timeline at your consultation.
Q: I have darker skin. Are pigmentation treatments safe for me?
A: Yes, absolutely. But the treatment choice matters enormously. I'm far more cautious with light-based treatments on Fitzpatrick skin types IV to VI, and I'll typically lean towards Cosmelan, carefully calibrated MOXI, or Secret PRO CO2 with a preparatory protocol. What I won't do is apply a blanket approach and hope for the best. Melanin-rich skin needs a practitioner who understands its specific behaviour.
Q: How painful are these treatments?
A: Honestly, they're all very manageable. BBL feels like a warm snap. MOXI has a prickling, heated sensation that numbing cream takes the edge off nicely. Secret PRO CO2 is the most intense of the group, so we always apply topical anaesthetic beforehand and adjust the laser settings to keep you comfortable. Peels can sting a bit during application. Nobody has ever asked me to stop mid-treatment, if that reassures you.
Q: What's the downtime really like?
A: BBL: minimal. Darkened spots for a week or two that flake off on their own. Most people go straight back to work. MOXI: two to four days of rough, gritty skin texture. Secret PRO CO2: budget three to seven days of redness, swelling, and some crusting depending on how aggressively we treat. Cosmelan: the first week is intense with significant peeling and tightness. I always help patients plan treatments around their diaries so the downtime falls at a convenient time.
Q: I've had pigmentation treatment before and it came back. Why?
A: This is so common it almost deserves its own article. Usually it's one of three things: the treatment wasn't suited to the type of pigmentation (aggressive lasers on melasma are a classic culprit for rebound darkening), the post-treatment SPF routine wasn't strict enough, or the underlying trigger was never addressed. When I see patients in this situation, the first thing I do is figure out what went wrong last time so we don't repeat it.
Q: Can I do pigmentation treatment alongside fillers, Botox, or skin tightening?
A: Very much so, and we do it all the time. Pigmentation treatment slots into a broader plan alongside injectables, Thermage FLX for skin tightening, and more. The trick is getting the sequence and spacing right, and that's something I'll map out for you so everything works together rather than against each other.
Q: Do I really need a consultation, or can I just book a treatment?
A: You need the consultation. I know that sounds like a sales pitch, but I genuinely cannot tell you which treatment is right without seeing your skin in person. I need to assess the type, depth, and distribution of your pigmentation, check your skin tone under proper lighting, and go through your history. A consultation at the clinic is thorough, honest, and completely pressure-free.
Q: What about during pregnancy or breastfeeding?
A: We don't perform lasers, BBL, or peels during pregnancy or while you're breastfeeding. But I can absolutely help you with a pregnancy-safe skincare and SPF plan to keep pigmentation from getting worse in the meantime, and we'll have a treatment plan ready to go for when you're done nursing.
Ready to Get Started?
Look, I know pigmentation can feel really demoralising, especially if you've already spent time and money on treatments that didn't deliver. My hope is that this gives you a clearer picture of how a thoughtful, personalised approach works. We're CQC-registered, medically directed, and we've been treating pigmentation across all skin types for over a decade. If you're ready to take the next step, I'd love to see you for a consultation. Let's figure out what your skin actually needs.
This article is for informational purposes only and does not constitute medical advice. Individual results vary, and all treatments should be preceded by a professional consultation. Harley Street Injectables is registered with the Care Quality Commission (CQC). All treatments are performed or supervised by qualified medical professionals.
