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Real effects, risks and side effects you need to know to avoid failure with pico lasers

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Seiko Ko
Dr. Seiko Ko

KO CLINIC

Plastic surgeon Japan Plastic Surgery Society Japan Laser Medical Association (Councilor) Japan Cosmetic Surgery Society Japan Society of Aesthetic Dermatology Japanese Breast Oncoplastic Surgery Society Japanese Society of Anti-Aging Medicine

Medical institution with Dr. Huang Holy Amber

KO CLINIC KO CLINIC
Contact: 045-651-1117

Real effects, risks and side effects you need to know to avoid failure with pico lasers

A picosecond laser (hereinafter referred to as pico laser) is a laser that can crush melanin and tattoo ink pigments with the shock wave (photoacoustic effect) of the laser . Therefore, it is said that the Q-switched laser can crush pigment particles that are too small to be destroyed, and can improve skin problems while reducing the risk of scabs and pigmentation after treatment.

However, in rare cases, it is said that there are cases in which the effect of pico laser treatment cannot be felt, such as "stains do not disappear" or "no change". Pico laser has many features such as crushing pigments, tone-up of dull skin, and improvement of skin quality. It is important to check the effects and risks before the procedure and receive appropriate treatment.

Pico laser crushes the cause of skin problems with little damage

A pico laser (picosecond laser / picosecond laser) is a laser that can irradiate in picoseconds (1/1 trillion seconds) .

Since the irradiation time of the pico laser is extremely short, there is almost no heat generation, so it is said that the burden on the skin is small and the downtime is relatively short.

Laser treatment selects and irradiates different wavelengths depending on the symptoms

A laser is an artificial light created by extracting a specific wavelength from light containing multiple wavelengths and amplifying it. The wavelength of light or laser has the property of being absorbed by a specific substance, and heat energy is generated when the wavelength is absorbed by a specific substance. These are the same phenomena that make you feel warm when the sun hits your skin.

Laser treatment by aesthetic medicine improves by destroying various causes of skin problems such as spots, freckles, bruises, and reddish faces by using a laser with a wavelength that is absorbed by the black pigment of melanin and the red pigment of hemoglobin. Lead to. The destroyed pigment is excreted by the metabolism (turnover) of the skin.

Irradiation time and energy of pico laser that mainly destroys only the target

In the case of laser treatment, if the irradiation energy is low, the effect cannot be expected, and if it is too high, it will cause heat damage to healthy skin other than skin problems such as age spots. In order to perform appropriate treatment, it is important not only to select the wavelength for each symptom, but also the laser irradiation time and irradiation energy.

Laser pulse width (irradiation time) used in laser treatment

For example, if you continue to irradiate a spot with a laser, the heat will also affect the skin tissue around the spot. This is because the wavelength is absorbed by the stain and heat energy is generated, and heat is transferred to the skin tissue around the irradiation by dissipating heat, and the epidermis temperature rises.

The stains that have absorbed the wavelength gradually dissipate heat, so the heat stays for a while. It is said that if the heat action is settled in the stain and does not spread to the surrounding skin tissue (heat relaxation time), the spot can be destroyed while preventing damage to the surrounding skin tissue.

The laser irradiation method is not continuous irradiation, but pulse irradiation, which irradiates intermittently at regular intervals, and this laser irradiation time is called "pulse width". If the pulse width is within the heat relaxation time, it can be said that damage to the surrounding skin can be suppressed and only the target area can be destroyed.

Lasers used in laser treatment have the following pulse widths, and lasers with pulse widths in picosecond units are called picosecond lasers (picosecond lasers and picosecond lasers).

Picoseconds (ps) 1 / 1,000,000,000,000s (1 / trillionth of a second)
Nanoseconds (ns) 1 / 1,000,000,000s (1 billionth of a second)
Microseconds (μs) 1 / 1,000,000s (1 / 1,000,000 second)
Milliseconds (ms) 1 / 1,000s: Long pulse

About pulse width

Laser irradiation energy that destroys the cause of skin problems

By shortening the pulse width of the laser, even if the irradiation energy (fluence) is low, the shock wave can destroy small substances. Although it is local, it has a large destructive power, and it can be crushed into pieces by suppressing the impact only on the spots and other parts . Since the pico laser with a short pulse width has low irradiation energy, it hardly damages normal cells around the irradiation site.

Pico lasers are not good at targeting large substances

Pico lasers are good at crushing small substances. To destroy a large substance, it is necessary to increase the pulse width and apply thermal energy. Therefore, long pulse lasers with long pulse widths are used instead of pico lasers for treatments that irradiate large targets such as hair follicles (hair loss), which are organs that make hair, and blood vessels (treatment of red face and telangiectasia). I will.

Why pico lasers can be expected to improve skin problems compared to conventional lasers

Pico laser treatment has minimal damage

In general, Q-switched nanosecond lasers (hereinafter referred to as Q-switched lasers) are used to thin or remove pigments such as spots, freckles, blemishes, and tattoos.

In the treatment of spots and tattoo removal with a Q-switched laser, it is necessary to increase the irradiation energy of the laser as the pigment becomes thinner over time, which puts a strain on the skin tissue around the irradiation site. Therefore, it can be said that the risk of causing burns, blisters, and post-inflammatory hyperpigmentation tends to increase.

On the other hand, pico laser is said to be able to crush and remove melanin granules of stains and pigment particles of tattoos with shock waves due to low irradiation energy with almost no damage to the tissues around the irradiation site.

"Post-inflammatory hyperpigmentation" that appears to be a recurrence of age spots is less likely to occur

After laser treatment, it is not uncommon for spots to recur. This is caused by the inflammation caused by laser irradiation, which stimulates the cells that produce melanin (melanocytes). Post-inflammatory hyperpigmentation appears about 4 weeks after the procedure, so it looks like the spots that have been removed have recurred.

Post-inflammatory hyperpigmentation is not a stain. Post-inflammatory hyperpigmentation is said to be naturally eliminated in about 3 to 6 months by turnover, which is the metabolism of the skin, after the activity of melanocytes has subsided.

The incidence of post-inflammatory hyperpigmentation with pico lasers is less than half that of Q-switched lasers

With Q-switched laser treatment, the risk of post-inflammatory hyperpigmentation is 30% to 50%. Although it depends on the laser irradiation method, the risk of post-inflammatory hyperpigmentation with pico lasers is reported to be less than half that of Q-switched lasers.

Although there are differences depending on the wavelength, the pulse width of the pico laser is 15 to 100 times shorter than that of the Q-switched laser when compared in terms of pulse width. The shorter the pulse width, the lower the radiation energy required, reducing the risk of damage to the surrounding normal skin tissue. From this, it can be said that post-inflammatory hyperpigmentation is less likely to occur with picolaser treatment.

Pico laser can treat light spots

Since pico lasers crush stains with shock waves of low irradiation energy, they are not good at treatments targeting large substances such as hair loss and reddish face, but they are low-density pigments that are left behind by phototherapy (IPL treatment) and Q-switched lasers. It is possible to approach particles.

With pico lasers , even light spots that cannot be removed by phototherapy or Q-switched lasers have less risk of post-inflammatory hyperpigmentation and can be made even thinner.

Benefits of pico laser treatment

A major feature of the pico laser machine is that it can perform three types of irradiation: fractional irradiation, toning irradiation, and spot irradiation.

Fractional irradiation with pico laser improves pores, acne skin and fine wrinkles

Fractional irradiation irradiates the skin with a laser in dots. It is said that the recovery of the skin will be accelerated by interspersing the non-irradiated area and the irradiated area. The skin is roughly divided into two layers, the epidermis layer and the dermis layer from the outside, and the second layer, the dermis layer, contains fibroblasts that produce fibers that supplement the elasticity of the skin, such as collagen and elastin. Fractional irradiation with a pico laser (pico fractional) produces collagen and other substances by applying appropriate stimulation to the fibroblasts in the dermis layer, promoting the reconstruction of the dermis.

Fractional irradiation with a pico laser is said to aim to improve the firmness of the skin, tighten pores, and improve fine wrinkles and acne scars.

Pico fractional laser pain and downtime

The laser light converges (aggregates) at each dot of the picofractional irradiation. Therefore, compared to treatments other than fractional irradiation, shock waves that are many times stronger act on the dermis layer and damage the capillaries in the dermis layer, which may cause petechiae . However, it is said that it will recover in a few days because it does not damage the epidermis layer, and it is said that downtime can be spent by covering it with a medical concealer. In addition, make-up is possible from the day.

If you are worried about the pain of laser irradiation, cream-type anesthesia can relieve the pain.

Effect of toning irradiation with pico laser and treatment of chloasma

Toning is a treatment method that promotes epidermal turnover by eliminating melanin granules in the cells of the epidermis layer (keratinocytes) without stimulating the cells that produce melanin (melanocytes).

Toning irradiation with a pico laser (pico toning) can be performed efficiently even with lower irradiation energy than a Q-switched laser, so it does not stimulate the cells (melanocytes) that produce more melanin, and improves liver spots and causes light spots. You can expect it to be even thinner.

Pico toning pain and downtime

Pico toning causes little pain or downtime when using low radiation energy, but may be anesthetized when treated with high radiation energy. Petechiae may occur in redness or under the eyes, but most of the time, they will subside within a few hours or days after the procedure. Makeup is possible from the day of the event.

Remove stains and tattoos with spot irradiation with pico laser

With spot irradiation with a pico laser (pico spot / pico shot), it is not necessary to increase the irradiation energy as with a Q-switched laser, even if the pigment becomes thinner over time. Therefore, it is said that pigment can be removed with a small number of treatments without causing scars on healthy skin tissue.

Pico spot pain and downtime

Compared to Q-switched lasers, there is less inflammation, so the degree of scabs (scar formation) and bruises (purpura formation) is minor, and it may not be necessary to protect the irradiated area with tape as in the case of Q-switched laser treatment. .. Makeup is supposed to start the next day.

If you are worried about pain, cream-type anesthesia can help.

Pico laser adaptation

  • Those who are worried about spots (deep spots such as chloasma) and freckles (liver spots require careful diagnosis)
  • ADM (Acquired Dermal Melanocytosis) Those who are suffering from bruises and scars such as nevus of Ota and Mongolian spot
  • Those who are worried about the opening of pores
  • Those who want to erase tattoos
  • Those who want to remove permanent makeup
  • Those who want to brighten one tone, whiten, dull, and are concerned about pigmentation due to laser, burns, trauma, etc.
  • Those who are worried about acne scars (unevenness)
  • Those who are worried about fine wrinkles
  • Those who are too busy to take downtime

Those who cannot receive the pico laser

  • Those who are tanned or plan to get tanned
  • Pregnant and lactating
  • Those with wounds or herpes on the treatment site
  • Those with a history of epileptic seizures
  • Those with photosensitivity
  • Those with diabetes, heart disease, brain disease, malignant tumor

Pico Laser Machine Types and Prices

Machines that can irradiate lasers in picosecond units have different wavelengths and pulse widths for each machine.

* Ps: Picosecond (1/1 trillion second)
Machine name wavelength pulse width Approved by the Ministry of Health
PicoSure 532 nm
755 nm
1064 nm
Variable type of 550 ps-750 ps
PicoWay 532 nm
730 nm
1064 nm
294 ps
246 ps
339 ps
enLIGHTen 532 nm
1064 nm
750 ps / 2 ns
Discovery Pico Plus 532 nm
694 nm
1064 nm
370 ps
30 ns
450 ps
---
SPECTRA PICO 532nm
595nm
660nm
1064nm
750 ps / 2 ns ---
PICOCARE 532 nm
595 nm
660 nm
1064 nm
450 ps

Pico Laser Price Market

Pico fractional is about 14,000 to 100,000 yen, pico toning is about 10,000 to 50,000 yen, and pico spots have different price settings depending on the medical institution. In many cases, it is set for one part, one shot, one ㎠, etc.

Some pico laser machines are unapproved. In addition, since the medical treatment is not covered by insurance, the full amount will be borne by you and the fee will vary depending on the medical institution.

PicoSure
Approval in Japan Certification acquisition 30200BZX00153000: Sinosure Co., Ltd.
FDA (US Food and Drug Administration) Approval K173199: FDA
PicoWay
Approval in Japan Certification acquisition 23000BZX00270000: Cineron Candela Co., Ltd.
FDA (US Food and Drug Administration) Approval K191685: FDA
enLIGHTen
Approval in Japan Obtained certification 22800BZX00138000: Kyutera Co., Ltd.
FDA (US Food and Drug Administration) Approval K182997: FDA
PICOCARE
Approval in Japan Certification acquisition 30100BZX00216000: WONTECH JAPAN Co., Ltd.
FDA (US Food and Drug Administration) Approval K181272: FDA
Discovery Pico
Approval in Japan Obtained certification 22700BZI00042000: Big Blue Co., Ltd.
FDA (US Food and Drug Administration) Approval K191842: FDA
SPECTRA PICO
SPECTRA PICO is a medical device not approved by the Ministry of Health, Labor and Welfare.
Medical device acquisition route: The acquisition route is individual import from the manufacturer by the doctor of each medical institution.
Drugs to be aware of when importing personally (Ministry of Health, Labor and Welfare page)
Whether or not it is approved in Japan: There is no medical device that has the same performance and operation as SPECTRA PICO and has been approved in Japan.
Information on safety in other countries: SPECTRA PICO has obtained the following approval from the FDA in the United States. [* 1]
Approval date Approved indications
2012.02.22 Laser surgical instruments

[* 1] K113588: FDA

Pico laser treatment at KO CLINIC

We interviewed Dr. Huang Sei Amber, who supervised the article, about the pico laser.

Pico laser is said to crush stains etc. finely, but it is said that it tends to be difficult to realize the effect in the case of dark stains or thick stains. How is it actually?
Huang Holy Amber Doctor
For dark or thick stains, there is also a treatment method in which phototherapy or irradiation treatment with a Q-switched laser with a long pulse width is performed, the pigment is thinned to some extent, and then a pico laser is used.
Huang Holy Amber Doctor
Alternatively, it is possible to make the pico laser thinner to some extent by increasing the irradiation energy (fluence) of the pico laser from the beginning and irradiating dark spots or thick spots with a firm reaction (whitening). The thinned stains will be further thinned by low fluence pico laser irradiation.
Please tell me about the treatment of chloasma with pico toning.
Huang Holy Amber Doctor
For chloasma, so-called conservative treatments such as taking tranexamic acid, daily skin care, and UV protection are the first priority. Once the melasma has improved to some extent and the melanocyte activity has subsided with conservative therapy, picotoning can further reduce the melasma.
Huang Holy Amber Doctor
When repeatedly performing toning treatment for chloasma, it is necessary to pay attention to the complications of vitiligo development. As a preventive measure, it is recommended to check in advance with a diagnostic imaging machine whether the chloasma is prone to depigmentation.
Please tell me how to choose a medical institution to receive a pico laser.
Huang Holy Amber Doctor
With the advent of pico lasers, the risk of post-inflammatory hyperpigmentation has been reduced and even lighter pigments can be made even thinner. However, pico lasers do not solve all skin problems.
Huang Holy Amber Doctor
It is important to thoroughly diagnose the condition of the skin with a reproducible diagnostic imaging machine (which can confirm the same symptoms under certain conditions) and identify the machine according to the symptoms.
Huang Holy Amber Doctor
In addition, skin treatment is not something that can be improved only by machine treatment, but it is very important for patients to carry out continuous treatment such as daily skin care and internal and external medicine.
Thank you, Mr. Huang.

Introduction of supervising doctor

Dr. Seiko Huang, the director of KO CLINIC. As a leading expert in "customized treatment" that performs appropriate treatment by analysis with a diagnostic imaging machine, he has participated in many academic societies and lectures. Started clinical research on chloasma in 2007, and now teaches many doctors and medical professionals how to treat with multiple pico lasers. Established a treatment centered on skin care medical treatment aiming for healthy and beautiful bare skin. His major books include "Life changes when your bare skin is clean!" And many others.

Medical institution with Dr. Huang Holy Amber

KO CLINIC KO CLINIC
Contact: 045-651-1117

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