Picosecond lasers have been introduced as a breakthrough technology in the aesthetic and dermatologic fields, touting many reported advantages over other systems. However, many physicians still ask: “Is the picosecond laser really better than the nanosecond laser in real-world applications?” While not everyone may agree, I use a picosecond system called PICOCARE from Wontech, Ltd., Co. (Daejeon, South Korea), and, based on my experience with both a nanosecond laser and a picosecond laser, my answer to this question is “yes”.
Picosecond lasers irradiate the laser energy with a pulse duration that is 10 times shorter than Q-switched (QS) lasers. In theory, picosecond lasers can provide more photomechanical effects to pigments and break them down into finer particles, resulting in better therapeutic results. In addition, less photothermal effects are delivered to the skin, resulting in a short amount of downtime and less damage to surrounding tissues.
When applied clinically, the improved photomechanical effects increase the efficiency of tattoo removal and pigment treatment, even with one-half or one-third of the energy used by QS lasers. And, while ten or more sessions with a QS laser were typically required for treatment of dermal pigmentation, such as nevus of Ota or tattoos, with PICOCARE the number of treatments is reduced, while still achieving observable results.
I am very satisfied with PICOCARE’s performance, but, more importantly, my patients also prefer PICOCARE because the lower energy settings mean less procedural discomfort and pain.
Furthermore, one of the biggest challenges when treating tattoos and pigmentation with QS lasers is scarring and/or post-inflammatory hyperpigmentation (PIH) after treatment. PICOCARE has demonstrated about 30% less scarring and incidence of PIH. And, even if PIH does occur, it disappears in a few weeks, which is another benefit of PICOCARE.
Today, I use PICOCARE not only for tattoo removal and pigmentation, but also for scar treatment, skin rejuvenation and melasma, as well as nail fungus and melanonychia treatment. Patient satisfaction and demand for these indications continue to increase at my clinic.
Instead of a standard handpiece, the HEXA MLA (micro lens array) is used to treat these indications. Consisting of multiple hexagonal focusing lenses, the energy intensity of each fractionated beam converges at the center of the beam, delivering stronger energy to the target.
Delivery of this high-intensity energy via the ultra-short pulse duration initiates a phenomenon called Laser Induced Optical Breakdown (LIOB) in the skin. The plasma generation induces cavitation beyond the simple photomechanical effect.
While preserving the stratum corneum and basal membrane, cavitations are created in the epidermis and/or dermis, a target of scar tissue or skin rejuvenation, to induce a wound healing process. Since this treatment method doesn’t use photothermal effects, the downtime and side effects are greatly decreased, but the therapeutic effect is evident with one to three sessions.
I have observed excellent results when using PICOCARE HEXA MLA on various types of scars, old or new – most specifically atrophic scars, such as acne scars and newer traumatic scars.
Another great advantage of PICOCARE is that I can adjust the spot size from 3 mm to 10 mm depending on the size and section of the scar. In the case of scars with PIH, improvement of both the scar volume and the pigment was highly satisfactory.
In addition, skin rejuvenation using HEXA MLA stimulates new collagen production in the dermis without photothermal effects; thus, uneven skin texture, dull skin tone, enlarged pores, fine lines and wrinkles are all improved, with minimal downtime (a few hours to only a couple of days).
For melasma, I use HEXA MLA in low fluence and the results are very satisfactory. As we all know, melasma is a disease caused by multiple complex factors, such as epidermal barrier function, melanocyte, keratinocyte, dermal environment and vascular factors, so it is difficult to treat with just one energy-based device or pharmaceutical product. Considering these complexities and possible complications, if melasma is treated inadequately, the degree of improvement is not satisfactory.
Even if it is treated successfully, the issue easily returns. And, worse yet, if the melasma is treated too intensely, the pathology can become exacerbated.
HEXA MLA delivers energy without damaging the basal membrane and removes pigments in the epidermis and/or dermis. The laser energy also stimulates neocollagenesis in the dermis, which helps improve the dermal environments.
In other words, the HEXA MLA provides the dual effect of safely and effectively eliminating the pigmentation and improving dermal environments – a cause of melasma.
Understanding the full capabilities of your device or technology is the most important part of any aesthetic or dermatologic treatment, but you must also consider the treatment process, safety and effectiveness when choosing the right device.
In tattoo removal, or the treatment of benign pigmented lesions, picosecond lasers use lower energy than nanosecond lasers and provide remarkable safety and therapeutic effects, even with fewer applications.
While picosecond lasers are still somewhat new to market, in my opinion, the therapeutic safety and efficacy of this technology can be trusted when the desired endpoints are definitively established.
About the Author
Serkan Ozturk, M.D.
Dr. Ozturk is one of the pioneering founders of medical aesthetics at the Mayasante Beauty Center. He also works in the cosmetology and acupuncture units of Medicana International Ankara Hospital, and in the cosmetology unit of Kadıköy Şifa Hospital.