612 PROCEDURE GUIDE

Deep Melasma Protocol — Step-by-Step Clinical Application Guide for Practitioners

Cosmelan Forte · 7-Agent Combo Peel TCA-Based · Frost Monitoring · 4–6 Hr Contact Fitzpatrick II–IV (Caution V)

⚠ TCA-BASED PROTOCOL — ADVANCED PRACTITIONERS ONLY

prodermic 612 contains Trichloroacetic Acid (TCA). This is a medium-depth chemical peel that requires frost endpoint monitoring. It should only be performed by experienced dermatologists or trained aesthetic professionals with prior TCA peel experience. Improper application can result in scarring, post-inflammatory hyperpigmentation, or burns.

Product Overview

prodermic® 612

Deep Melasma Protocol · Cosmelan Forte

Type	7-Agent Combo Peel (Highest agent count)
Total Active	High concentration
Size	30ml jar
Yield	~7 sessions per jar
Fitzpatrick	II–IV (caution V, avoid VI)
Peel Depth	Superficial to Medium
Aggression	HIGH

Active Composition

TCA

Arbutin

Niacinamide

Kojic Acid

Vitamin C

+ Glycolic Acid & Lactic Acid base for multi-depth surface resurfacing

Mechanism of Action

Agent	Mechanism
TCA	Controlled medium-depth peeling — trichloroacetic acid causes controlled coagulation necrosis of epidermis to access deep pigment deposits. The primary penetration driver of this protocol.
Arbutin	Hydroquinone glycoside (natural origin) — potent tyrosinase inhibitor that blocks melanin synthesis without the side effects associated with hydroquinone.
Niacinamide	Blocks melanosome transfer — prevents pigment from moving from melanocytes to surrounding keratinocytes. Also supports barrier repair.
Kojic Acid	Chelates copper required for tyrosinase enzymatic activity, providing a second independent pathway of pigment suppression.
Vitamin C	Antioxidant defense, collagen synthesis support, and mild tyrosinase inhibition for additional pigment control.
Glycolic & Lactic Acid	Multi-depth AHA surface resurfacing — glycolic provides rapid superficial exfoliation while lactic acid supports hydrating desquamation and ceramide production.

Clinical Indications

$Refractory Melasma$

Refractory Melasma

Dermal Pigmentation

Advanced Cases

Patient Selection & Pre-Procedure

Ideal Patient Profile

Treatment-resistant melasma that has not responded to standard AHA protocols
Patients seeking a Cosmelan/Dermamelan alternative with comparable clinical outcomes
Patients who are ready for a more aggressive intervention after milder peels have plateaued
Dermal or mixed-type pigmentation requiring deeper penetration than superficial peels can achieve
Fitzpatrick skin types II–IV (use with caution on type V — AVOID type VI)
Patients who understand and accept the 5–10 day downtime commitment

⚠ FITZPATRICK VI — ABSOLUTE CONTRAINDICATION

Do NOT use prodermic 612 on Fitzpatrick VI skin. The TCA component carries a high risk of post-inflammatory hyperpigmentation (PIH) and dyschromia in deeply pigmented skin. There is no safe way to titrate this risk in type VI patients.
For Fitzpatrick V patients: proceed with extreme caution, conservative application, and reduced contact time. Consider a test area first and wait 4 weeks to assess for PIH before proceeding with full treatment.

Contraindications

DO NOT TREAT IF

Active skin infections or inflammation in the treatment area
Compromised skin barrier (eczema, dermatitis flare, rosacea flare)
Pregnancy or breastfeeding
Oral isotretinoin use within the last 6 months
Topical retinoids use within 72 hours of session
Open wounds, cuts, or abrasions in the treatment area
Fitzpatrick VI skin (absolute contraindication)
History of keloid or hypertrophic scarring
History of post-inflammatory hyperpigmentation after previous chemical peels
Active herpes simplex — TCA can trigger viral reactivation (consider antiviral prophylaxis for patients with HSV history)
Known allergy to TCA or any of the active ingredients
Recent laser or IPL treatment within 4 weeks

Pre-Procedure Patient Preparation

Comprehensive Skin Assessment: Evaluate Fitzpatrick type, melasma pattern (epidermal vs. dermal vs. mixed — use Wood’s lamp), prior peel history, and any history of PIH. Determine suitability carefully.
HSV Prophylaxis: For patients with a history of herpes simplex, prescribe antiviral prophylaxis (e.g., valacyclovir) starting 2 days before the procedure and continuing for 5 days after.
Sun Exposure: Advise the patient to avoid all direct sun exposure for at least 2 weeks prior. Strict SPF 50+ use is mandatory in the lead-up.
Discontinue: Stop topical retinoids 72 hours before. Stop all AHAs/BHAs 48 hours before. Stop any other chemical exfoliants.
Informed Consent: Discuss expected outcomes, the frost monitoring process, significant downtime (5–10 days of peeling), the self-neutralizing nature (patient washes off at home), TCA-specific risks (PIH, scarring if misused), and the need for strict post-care compliance.
Photography: Take standardized baseline photographs under consistent lighting. Include close-ups of pigmented areas.

Step-by-Step Procedure

KEY: SELF-NEUTRALIZING FORMULA WITH FROST ENDPOINT

prodermic 612 is a self-neutralizing peel with TCA. It is applied in-clinic with frost endpoint monitoring. Once the frost develops and stabilizes, the peel begins self-neutralizing. The patient leaves with the peel on and washes it off at home after 4–6 hours. No in-clinic neutralization agent is required.

Cleanse & Degrease (Thorough)

Cleanse the treatment area with a gentle, non-residue cleanser. Remove all makeup, sunscreen, and surface impurities. Then thoroughly degrease the skin using a pre-peel degreasing solution (acetone or alcohol prep) applied with gauze. Wipe across the entire treatment area in systematic strokes.

Critical for TCA: uneven degreasing leads to uneven acid penetration, causing patchy frosting and unpredictable peel depth. Degrease contact: 2–3 minutes. Wipe clean. Allow skin to dry completely before proceeding.

Patch Test (First Session — Mandatory)

For the patient's first session, perform a mandatory patch test. Apply a small amount of prodermic 612 to the post-auricular area (behind the ear) or a small area of the jawline. Wait 10 minutes and observe carefully for signs of excessive irritation, burning, blistering, or allergic reaction.

TCA patch testing is more critical than with AHA peels. Observe for frost development on the test area — if Level II frost appears on a small test patch within 2 minutes, the patient may be highly reactive. Proceed with extreme caution or consider a lower-strength protocol.

Apply prodermic 612 — Thin, Even Layer

Using a fan brush, apply a thin, even layer of prodermic 612 across the treatment area. Work systematically:

Forehead: Apply in horizontal strokes from center outward, even pressure
Cheeks: Apply from the nose outward toward the ears — most common melasma zone
Nose bridge: Light application only
Chin: Apply in upward strokes

Use approximately 3–4ml per full-face application. AVOID the periorbital area (around eyes), nasolabial folds, and lip vermilion — TCA pooling in these thin-skinned areas can cause burns. Uniformity is critical: uneven application = uneven frost = unpredictable results.

Frost Endpoint Monitoring (CRITICAL)

After application, closely monitor the treatment area for frosting. Frosting is the visible whitening of skin that indicates protein coagulation and marks the effective peel depth. Frost typically develops 2–5 minutes after application.

⚠ FROST MONITORING — CRITICAL CLINICAL STEP

Frost level determines peel depth. You must monitor the frost development continuously and know when to stop. The frost endpoint is the most important safety variable in this protocol.

Level I

Erythema with streaky white frost — Superficial depth. Pink-red skin with scattered white streaks. This is the initial frost and indicates superficial protein coagulation. Expected within 2–3 minutes.

Level II

White coat with pink showing through — Medium depth. Even white film over the treated area with underlying pink still visible. This is the TARGET endpoint for prodermic 612. Expected within 3–5 minutes.

◼ STOP

Do NOT attempt Level III (solid white frost). Level III indicates deep dermal penetration and carries a high risk of scarring, prolonged erythema, and PIH. If any area reaches solid white frost, note it and monitor closely during the observation phase.

Post-Frost Observation (5–10 Minutes)

Once Level II frost has developed and stabilized across the treatment area, observe the patient in-clinic for 5–10 minutes. During this time, the frost will gradually subside and the peel begins its self-neutralizing process. Monitor for:

Frost stabilization then gradual fade: Normal — this is the expected response
Continued frost deepening: Monitor closely; if progressing to solid white, be prepared for extended post-care
Severe burning, swelling, or blister formation: Remove product immediately with saline-soaked gauze

The self-neutralizing process begins after frost development. Reassure the patient that the intense sensation will diminish progressively. Document the frost level achieved in the patient record.

Discharge with At-Home Instructions

Once the observation period is complete, the frost has begun to subside, and the patient shows no adverse reactions:

Leave the peel on: The patient leaves with the peel still on the skin
Contact time: Instruct the patient to leave it on for 4–6 hours (based on session number — see Progressive Protocol)
Wash off at home: After the prescribed contact time, rinse thoroughly with lukewarm water until all residue is completely removed
Apply a thick, bland recovery moisturizer or barrier cream immediately after washing
No other actives, serums, or makeup for the rest of the day

Provide written or WhatsApp post-care instructions before the patient leaves. Emphasize: NO picking, NO sun exposure, and strict SPF 50+ compliance starting Day 1. Schedule the next session in 21–28 days.

Early Removal & Adverse Reactions

INSTRUCT PATIENT TO WASH OFF IMMEDIATELY IF

Severe burning or pain that does not subside or is escalating after the first hour
Excessive redness, edema, or swelling beyond what was observed in-clinic
Hives, welts, or signs of allergic reaction
Blistering or skin breakdown (rare but possible with TCA)
Inability to tolerate the sensation — patient safety and comfort come first

Emergency Removal Steps (At Home)

Rinse the treatment area thoroughly with cool water (not cold — avoid thermal shock) until all product is removed
Continue rinsing until all tingling and burning has completely stopped
Apply a thick, bland barrier cream or petrolatum-based ointment (no actives)
Apply a cool compress for comfort if needed
Contact the clinic immediately to report the reaction — send photographs
Do not apply any other products until instructed by the practitioner
Document the reaction thoroughly — reduce contact time, application density, or consider stepping down to a milder protocol (e.g., 580) for the next session

PATIENT COMMUNICATION

Ensure the patient has the clinic’s WhatsApp/phone number before leaving
Advise them to send photos at 1 hour, 4 hours, and 24 hours post-application
Intense tightness and darkening are normal with TCA — reassure the patient but emphasize: when in doubt, wash it off
The patient should NOT be alarmed by the skin turning significantly darker over Days 1–2 — this is the expected TCA response before peeling begins

Post-Procedure Care Instructions

Provide these instructions to the patient (verbal + printed/WhatsApp). Compliance is critical with TCA peels — non-compliance significantly increases the risk of PIH and complications.

Day 0 (Day of Procedure)

Leave the peel on for 4–6 hours as instructed (based on session number)
Wash off thoroughly with lukewarm water
Apply a thick recovery moisturizer or barrier cream immediately after
No other actives, no makeup for the rest of the day
Sleep on a clean pillowcase — expect some product transfer

Days 1–2 (Tightness & Darkening Phase)

Skin will feel extremely tight, dry, and will appear significantly darker — the skin may take on a leathery, bronzed appearance. This is expected with TCA
Cleanse with a gentle, soap-free cleanser once daily (avoid rubbing)
Apply a thick, bland moisturizer or barrier cream 4–6 times daily — keep the skin heavily moisturized
Apply SPF 50+ broad-spectrum sunscreen every 2 hours if going outdoors — UV exposure during this phase can cause permanent PIH
Absolutely no direct sun exposure, saunas, steam rooms, hot showers, or strenuous exercise
Do NOT pick, pull, scratch, or scrub under any circumstances

Days 3–5 (Heavy Peeling Begins)

Heavy peeling and shedding will begin — this is significantly more intense than with AHA peels
Do NOT pick, pull, or force peeling skin off — premature removal risks scarring and PIH
Continue thick moisturizer 4–6 times daily + SPF 50+
Large sheets of skin may come off — this is normal for TCA at this depth
The skin underneath will appear pink and raw — this is expected

Days 5–8 (Active Peeling Continues)

Peeling continues, gradually diminishing
Continue moisturizer + SPF 50+ regimen
New skin will be sensitive and pink — protect it from all irritants
Avoid all actives, exfoliants, retinoids, and fragranced products

Days 8–10 (Recovery Phase)

Peeling should be mostly complete by Day 8–10
Continue moisturizer + SPF 50+
May resume very light mineral makeup once peeling is complete
Continue avoiding harsh actives (retinoids, AHAs, BHAs) until Day 14
Fresh skin will appear significantly lighter and more even

Days 10–28 (Between Sessions)

Maintain strict sun protection (SPF 50+, physical avoidance, hats)
Can resume normal skincare routine from Day 14 onwards
Consider maintenance with brightening serums (niacinamide, vitamin C) between sessions
Next session at Day 21–28 — do not schedule earlier

Expected Peeling Timeline

Day 0

Application

Applied in-clinic with frost monitoring, wash off at home after 4–6 hrs

Day 1–2

Darkening

Intense tightness, skin darkens, leathery texture

Day 3–5

Heavy Peeling

Significant peeling begins, large sheets of skin shedding

Day 5–8

Active Peeling

Peeling continues, pink new skin emerging

Day 8–10

Peeling Subsides

Fresh, lighter skin visible

Day 21–28

Next Session

Repeat protocol if needed

Treatment Program

Parameter	Recommendation
Total Sessions	3–4 sessions (assess at each session)
Session Interval	21–28 days between sessions (3–4 weeks)
Contact Time	4–6 hours (self-neutralizing with frost monitoring)
Downtime	5–10 days significant peeling per session
Full Program Duration	3–4 months (3–4 sessions at 21–28 day intervals)
Product per Session	Approximately 3–4ml (full face)
Yield per Jar	~7 full-face sessions from one 30ml jar
Maintenance	1 session every 6–8 weeks, or step down to 580 protocol

Progressive Protocol Guide

This protocol uses a progressive intensity approach. Increase application density and contact time gradually across sessions based on patient tolerance and frost response:

Session	Contact Time	Approach
Session 1	4 hours	Conservative application, monitor frost closely, document frost level and patient response. This is the calibration session.
Session 2	4–5 hours	Increase application density if Session 1 was well tolerated with no PIH. 3–4 weeks after Session 1.
Session 3	5–6 hours	Full application if prior sessions tolerated. Assess cumulative clinical improvement. 3–4 weeks after Session 2.
Session 4 (if needed)	6 hours	Maximum application and contact time. Only if substantial melasma remains. Do not exceed 6 hours.

Expected Outcomes

After Session 1: Significant peeling over 5–7 days. Initial lightening of superficial pigment. Skin texture noticeably smoother. This session calibrates the patient’s response.
After Session 2: Deeper pigment deposits begin to lighten. Visible improvement in melasma patches. More even skin tone emerging.
After Session 3–4: Substantial melasma reduction. Significantly more even complexion. Dermal pigment visibly diminished. Results comparable to traditional cosmelan/dermamelan protocols.

Set realistic expectations: Melasma is a chronic condition. While prodermic 612 can produce dramatic improvement, patients should understand that maintenance treatments and strict sun protection are essential for sustaining results. Melasma can recur with hormonal changes and UV exposure.

Full Ingredient List

Glycolic Acid, Lactic Acid, Trichloroacetic Acid (TCA), Arbutin, Kojic Acid, Hyaluronic Acid, Niacinamide, Vitamin C (Ascorbic Acid)