Summary
Pigmented lesions are a type of skin problem caused by abnormal pigment deposition due to congenital genetic defects, acquired environmental factors, or skin aging.
Pigmented lesions present with diverse clinical manifestations, including freckles, lentigines, nevi, and café-au-lait spots.
So, how should treatment parameters be set when using Pico lasers to treat different types of pigmented lesions? What precautions should be taken? This article will introduce detailed guidelines for using Pico Laser to treat four common types of pigmented lesions.
Pico Laser Treatment Theory
Pico laser refer to lasers with output pulse widths in the picosecond range, also known as sub-nanosecond lasers, primarily including wavelengths of 755nm, 532nm, 730nm, and 1064nm. Due to their extremely short pulse widths, pico lasers can achieve extremely high peak power instantaneously, thereby generating a photoacoustic effect on the target chromophore, pulverizing tattoo dye particles or melanin particles into smaller fragments (compared to Q-switched lasers), making them easier for macrophages and other pigment-loving cells to clear, resulting in a milder inflammatory response. Therefore, picosecond lasers are more effective and have fewer adverse reactions than Q-switched lasers in treating tattoos and most pigmented lesions.
According to the “Expert Consensus on the Clinical Application of Picosecond Lasers,” picosecond lasers can be used to treat various pigmented lesions of the epidermis and dermis. It has ideal efficacy for freckles, solar lentigines, and nevus of Ota; it is effective for café-au-lait spots and freckle-like nevi, but still has a certain recurrence rate; its efficacy for pigmented hairy epidermal nevi and Riehl’s melanosis is uncertain, but it can be used as one of the treatment options.
Freckle Treatment Guide
1. Theoretical Analysis
Freckles are the most common epidermal pigmentation disorder in clinical practice, and 532nm is considered one of the commonly used wavelengths for freckle treatment. In observations of 755nm/532nm picosecond laser treatment for freckles, the 755nm Pico laser showed higher lesion clearance and satisfaction rates.
Studies on the treatment of facial/non-facial freckles with 730nm picosecond lasers showed higher freckle clearance rates in patients with skin type II-III, with 74% of patients achieving more than 50% improvement in lesions. Simultaneously, related histopathological studies also indicated that the 730nm picosecond laser has excellent selectivity for pigment and minimal damage to the dermal-epidermal junction, thus shortening healing time and reducing the risk of adverse events.
Therefore, different wavelengths of picosecond lasers have shown good performance in the treatment of freckles. Compared to nanosecond lasers, picosecond lasers do not have a significant advantage in freckle clearance rates, but their lower side effects and additional cosmetic effects (such as improved skin texture and pores for a better overall aesthetic effect) make them widely used in the treatment and improvement of freckles.
2. Treatment Parameters
The endpoint reaction is an immediate whitening reaction at the freckled area.
- 755nm alexandrite picosecond laser (Picosure, Cynosure, USA): Energy density 4.07 J/cm², spot diameter 2.5 mm.
- 730nm picosecond laser (Picoway, Syneron, USA): Energy density 1.4~1.7 J/m², spot diameter 3 mm, one scan, minimizing overlap.
- 532nm picosecond laser (Picoway, Syneron, USA): Treatment parameters are determined based on skin type, clinical presentation, and endpoint reaction; pulse width 240~400 ps, one scan.
Nevus of Ota Treatment Guide
1. Analyze Nevus of Ota
Studies have shown that a retrospective study of 1064nm Pico laser treatment for nevus of Ota revealed significant improvement in skin lesions after three treatments, with only one patient experiencing hyperpigmentation. Other studies using 755nm Pico lasers for nevus of Ota had an average total treatment time of 10 months, with some rashes disappearing completely after one to two treatments. Therefore, while nanosecond lasers have consistently shown satisfactory results in treating nevus of Ota, picosecond lasers offer shorter treatment cycles and fewer treatment sessions, significantly improving the patient experience.
Both the 755nm alexandrite Pico laser and the 1064nm Nd:YAG Pico laser are recommended for the treatment of nevus of Ota.
Clinical research and practice have demonstrated that Q-switched laser treatment for nevus of Ota is more effective in children than in adults, requiring fewer treatment sessions to achieve the desired success rate. Therefore, it is recommended to begin laser treatment for childhood nevus of Ota as early as possible to benefit the child.
2. Treatment Details
The endpoint reaction of 755nm alexandrite picosecond laser treatment is immediate mild grayish-white lesions, without purpura.
- 755nm alexandrite PICO laser (PicoSure, Cynosure, USA): Treatment of Ota’s nevus in adults and children. Pulse width 750ps, spot diameter 2-4mm, energy density 1.59-6.37J/cm², one scan, full spot coverage of the lesion with minimal overlap, treatment interval 3 months, 3 or more treatments required.
- 755nm alexandrite pico laser (PicoSure, Cynosure, USA): Treatment of Ota’s nevus in children (<12 years old). Pulse width 750ps, spot diameter 3.5-4mm, energy density 1.96-2.08J/cm², treatment interval 3-4 months, 3 or more treatments required.
- 1064nm Nd:YAG picosecond laser (PicoWay, Syneron, USA): pulse width 450ps, spot diameter 3~4mm, energy density 1.8~4.3J/cm2, the treatment endpoint reaction is immediate mild gray-white spots and mild purpura, treatment interval 3~12 months, more than 3 treatments.
Café-au-lait Spot Treatment Guide
1. Treatment Introduction
According to the “Guidelines for the Diagnosis and Treatment of Common Diseases Related to Laser Cosmetic Treatments,” personalized treatment options for café au lait spots can be explored based on the patient’s age and skin tone, combined with the size, shape, and location of the lesions. These options include Q-switched lasers, PICO lasers, intense pulsed light (IPL), and fractional lasers. The overall effective rate ranges from 20% to 74.4%.
High-energy nanosecond lasers (wavelengths 532, 694, and 755 nm) and picosecond lasers (wavelengths 532 and 755 nm) are considered as the first-line treatment options for café au lait spots.
Large-spot, low-energy 1064 nm Pico lasers are increasingly becoming an important treatment option for café au lait spots in infants and children, regular café au lait spots, and refractory café au lait spots due to their advantages such as almost no downtime, no pain, and low likelihood of post-inflammatory hyperpigmentation.
Different patients may have significantly different responses and effects to lasers. It is recommended to conduct trial treatments with different lasers on a small local area before treating large lesions to determine the optimal laser and energy level for each individual.
2. Parameter Recommendations
- 755nm Pico laser (Picosure, Cynosure, USA): Spot diameter 2mm, energy density 5.56~6.37J/cm2, frequency 2~5Hz, one scan, no overlap, treatment endpoint is immediate whitening of the skin, treatment interval 3 months, 3 or more treatments required.
- 532nm Nd:YAG picosecond laser (Picoway, Syneron, USA): Spot diameter 4~5mm, energy density 0.8~1.6J/cm2, frequency 2Hz, treatment endpoint is immediate grayish-white discoloration of the skin, one scan, no overlap, treatment interval 3 months, 1 or more treatments required.
Melasma Treatment Guide
1. Analysis of Melasma Treatment
Melasma is the most common type of yellowish-brown pigmentation on the face of Asian women. Due to its complex pathogenesis, even with a variety of treatment options, melasma still has a certain recurrence rate and adverse reaction rate after laser treatment.
Melasma is divided into active and stable phases. Active phase: Recent expansion of lesion area, darkening of color, redness of lesions, redness after scratching, and fading on glass slides. Stable phase: No recent expansion of lesion area, no darkening of color, no redness after scratching, and no fading on glass slides.
During the active phase, high-energy laser/microcurrent treatments and high-concentration chemical peels should be avoided. Gentle treatment plans should be chosen, combined with systemic drug therapy and adjuvant therapies. During the stable phase, treatment should also be gradual to avoid irritating melanocytes, aggravating the inflammatory response, and damaging the skin barrier.
For Pico laser treatment of melasma, the parameters should be set with gentle intensity, the initial energy should not be too high, the treatment interval should not be too short, and the treatment endpoint is a mild flushing reaction. Melasma remains one of the most difficult-to-cure pigmentary skin diseases worldwide. Phototherapy is generally not recommended as a first-line treatment for melasma, and single, repeated phototherapy treatments carry the risk of hyperpigmentation, hypopigmentation, or depigmentation.
Therefore, it is essential to select different laser/phototherapy techniques and treatment parameters based on individual patient differences, and to selectively combine other treatment methods to achieve satisfactory results and reduce the recurrence of melasma.
2. Clinical Treatment Parameters
- 755nm Pico laser in fractional mode (PicoSure, Cynosure, USA): wavelength 755nm, frequency 10Hz, spot diameter 6~8mm, energy density 0.4~0.7J/cm2, treatment interval 1.5 months, 4 treatments.
- 755nm Pico laser in ZOOM mode (PicoSure, Cynosure, USA): (1) Spot diameter 4.4~5.1mm, energy density 0.88~1.18J/cm2, 3 scans, total 1000 pulses, 1 treatment per month, 4 treatments in total, the endpoint reaction is slight redness of the skin. (2) Frequency 10Hz, spot diameter 6~8mm, energy density 0.40~0.71J/cm2, the endpoint reaction is slight redness and warmth of the skin, treatment interval 1.5 months, 4 treatments.
- 1064nm in fractional mode Pico laser (Picoway, Syneron, USA): Frequency 4Hz, spot diameter 6mm, energy 1.3~1.5mJ, coverage 4%, 2~3 scans, endpoint reaction is slight redness of the lesion, total 4 treatments.
- ZOOM mode 1064nm Pico laser (Picoway, Syneron, USA): Wavelength 1064nm, spot diameter 7mm, frequency 8Hz, energy density 0.6~0.8J/cm². Treatment starts with low energy, observing the patient’s skin reaction and adjusting the energy level as needed. 2~3 flat scans, endpoint reaction is no reaction or slight redness of the skin.
Buy High-Quality Pico laser
Pico lasers are not only used for tattoo removal but also effectively treat most pigmented lesions. The biggest characteristic of Pico lasers is their short pulse width (pulse duration), resulting in a short contact time with the skin and rapid energy delivery, giving them a strong explosive effect. Simultaneously, because the laser pulse remains on the skin for a short time, patient pain is minimal.
Currently, many counterfeit Pico lasers are appearing on the market, with some manufacturers passing off superior Q-switched lasers as Pico lasers. The standard for a genuine Pico laser is a pulse width of less than 550 ps.
Liton Laser sells genuine Pico lasers with a pulse width of 350 ps, belonging to the picosecond laser class. These are commonly used to treat various pigmented lesions (melasma, freckles, etc.) and are available with 532nm, 755nm, and 1064nm handpieces. Custom-made 585nm and 650nm handpieces are also available for removing all colors of tattoos and eyebrow tattoos.
If you need to purchase a high-quality, genuine Pico laser, please feel free to contact Liton Laser. We sell the best Pico laser.
Frequently Asked Questions
Q1: What skin issues can Pico laser be used on?
Pico laser has many indications and can effectively remove most tattoos and eyebrow tattoos. It also has good treatment results for pigmented lesions (chloasma, freckles, etc.).
Q2: Why did the melasma get worse after laser treatment?
1. Incorrect laser selection. Not all lasers are effective against melasma; choosing the wrong one can actually worsen the condition:
Intense pulsed light (IPL), while gentle, has limited effectiveness on deep melasma, and blindly using it may cause pigmentation to spread. Traditional Q-switched lasers have too concentrated energy, easily irritating the skin; those with sensitive skin or a weak skin barrier have a high probability of post-inflammatory hyperpigmentation.
Doctors now recommend a “large spot size, low energy, multiple treatments” approach, such as PICO lasers (especially Super Pico). Its shorter pulse width precisely breaks down pigment while causing less damage to the skin, and it also stimulates collagen regeneration, addressing both pigmentation and skin barrier repair. Furthermore, combination treatments (such as laser + chemical peels) are more stable than single-laser treatments, improving pigmentation problems from different angles.
2. No sun protection was used after the laser treatment.
Many people think everything is fine after laser treatment, but they neglect sun protection, leading to pigmentation rebound, and then blame the laser for being ineffective.
Therefore, sun protection should be taken into account after all laser treatments.
Q3: Besides Pico laser, which other lasers can be used to treat pigmented lesions?
For laser treatment of pigmented lesions (melasma, freckles, etc.), many excellent lasers are available. Besides the commonly used Pico laser, Liton Laser recommends an even better machine: the thulium-erbium dual-wavelength laser (1927nm, 1550nm).
The 1927nm thulium laser improves epidermal pigmentation issues, while the 1550nm erbium laser targets the dermis, heating and removing pigment cells from the dermis.
The combined use of thulium-erbium dual lasers is very effective in treating melasma because the pigment in melasma is dispersed, located not only in the epidermis but also in the dermis. The thulium-erbium laser has two wavelengths, 1927nm and 1550nm, which target the epidermis and dermis respectively, providing a perfect treatment for melasma.
Conclusion
Because pico laser have an extremely short pulse width-induced photoacoustic-mechanical ablation effect, they release less heat energy when breaking down melanin, resulting in less impact on surrounding tissues. Therefore, they require fewer treatment sessions and have shorter treatment cycles for dermal pigmented lesions, with a relatively shorter downtime. For epidermal/mixed pigmented lesions, they have similar effects to nanosecond lasers, but with better treatment results and a more comfortable treatment experience.
If you need to learn more about Pico laser treatment for other lesions, systematically study relevant knowledge of skin diagnosis and treatment, or require professional Pico laser training to enhance your clinical practice skills, please feel free to contact Liton Laser. We will recommend Professor Hong (a professional medical aesthetic equipment training physician) to you.
