Acne scars, which are one of the skin problems, are divided into multiple types according to the condition such as redness and spots, and depending on the type, internal medicine, external medicine, injection, laser treatment, IPL treatment. The treatment method is different .
Pico laser, which is one of the laser treatments, is also used to treat acne scars, but there are acne scars that are suitable for pico laser treatment and acne scars that are not .
By knowing the characteristics of pico lasers, you can see if pico lasers are the best treatment for your acne scars or if you should consider another treatment. In addition, there are risks and side effects in the treatment of acne scars with pico laser, so if you check before performing the procedure, you can receive the procedure with confidence.
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Skin problems such as age spots and red blood cells are caused by substances such as melanin, which is a brown pigment, and hemoglobin, which is a pigment of red blood cells in capillaries.
The causative substance of skin troubles has the property of absorbing the light energy of the laser . The absorbed light energy has the effect of destroying the causative substance by generating a shock called heat or stress wave, and the destroyed causative substance is discharged to the outside of the body by metabolism to the skin. It leads to improvement of troubles.
The length of irradiation time per shot that irradiates the causative substance with the light energy of the laser is called the pulse width, and is expressed in units such as milliseconds, microseconds, nanoseconds, and picoseconds. The pulse width varies from laser machine to laser machine .
|Picoseconds (ps)||1 / 1,000,000,000,000s (1/1 trillion seconds)|
|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|
The shorter the pulse width (the smaller the value per second), the stronger the instantaneous force exerted on the causative substances of skin troubles such as melanin and hemoglobin, and the pulse width of the laser used in current aesthetic medicine. Is the shortest machine in picoseconds. A machine that can irradiate a laser in picoseconds is called a pico laser .
Lasers improve skin problems by irradiating the causative substances of skin problems with light energy and destroying them, but the process by which the causative substances are destroyed differs depending on the pulse width .
When the causative substance absorbs the light energy of the laser, the molecules of the causative substance, which had low energy and were stable, become excited with high energy and not stable. Heat is generated in the process of stabilizing the numerator as it tries to return from the excited state to the original state.
Lasers with a pulse width other than picoseconds are irradiated with light energy from the excited state until the molecule stabilizes after the light energy is absorbed by the causative substance, and the causative substance is generated by the thermal energy generated in the process of stabilizing the molecule. Destroy This is called photothermal action .
A laser with a pulse width of picoseconds finishes irradiating light energy before the molecules excited by the light energy stabilize. The causative substance that is thermally expanded by the excited molecules is impacted by colliding with the surrounding tissue. This shock is called a shock wave, which is one of the stress waves, and the destruction of the causative substance by the shock wave is called the photoacoustic effect .
When the causative substance is destroyed by photoacoustic action, heat may be applied to the surrounding tissue and damaged , but in the case of photoacoustic action, the shock wave is trapped in the causative substance and the surrounding tissue is less likely to be damaged. Become. The less impact it has on the surrounding tissue, the shorter the downtime tends to be, and pico laser treatments are said to have shorter downtime than lasers with longer pulse widths .
The light energy used in a laser has the property of a waveform that repeats peaks and valleys, and the length of the waveform from peak to peak (or valley to valley) is called the wavelength. Wavelengths are expressed in units of nanometers (nm), which is one billionth of a meter, and the longer the wavelength, the deeper the light energy reaches the skin .
Light contains multiple wavelengths, but a laser consists of one wavelength, and the type (name) of the laser is divided according to the wavelength that can be irradiated .
|Main types of laser||wavelength|
|Die laser||Around 585nm-595nm|
|Diode laser||Around 810nm to 1450nm|
|Nd: YAG (neodymium yag) laser||1064nm|
|Er: YAG laser||2940nm|
|Carbon dioxide laser||10600nm|
The target causative substance differs depending on the skin problem, and the wavelength of the laser absorbed by each causative substance differs, so it is necessary to select the type of laser to be used according to the skin problem.
It is said that the wavelengths of KTP laser, die laser, ruby laser, red laser, Alexandrite laser, diode laser, and neodymium yag laser can be expected to be effective in improving acne scars, and wavelengths other than diode laser can be irradiated in pico seconds. is.
There are multiple machines for pico lasers, and each machine has a different pulse width and irradiation wavelength .
|Machine name||Company||wavelength||pulse width||Approved by the Ministry of Health|
|PicoSure||Cynosure (USA)|| 532nm|
|PicoWay||Syneron Candela (USA)|| 532nm|
|enLIGHTen||Cutera (USA)|| 532nm|
|Discovery Pico||Quanta (Italy)|| 532nm|
|SPECTRA PICO||Lutronic (Korea)|| 532nm|
|PICOCARE||WONTECH (Korea)|| 532nm|
Picosure is a machine developed by Cynosure of the United States, and has been approved by the Ministry of Health, Labor and Welfare for its effectiveness in treating benign pigmented lesions (such as age spots) and removing tattoos . (Approval number: 30200BZX00153000)
In addition, the US FDA (US Food and Drug Administration), which is the Ministry of Health, Labor and Welfare of Japan, has recognized the effects of improving spots, wrinkles, and acne scars and removing tattoos. (FDA Approval Number: K161222)
Picosure is equipped with three types of laser wavelengths: KTP laser, alexandrite laser, and neodymium yag laser. The wavelength of 755nm of the alexandrite laser is a wavelength that is absorbed only by melanin, and it leads to improvement of skin troubles by destroying accumulated melanin. Since wavelengths other than melanin are not absorbed, it is said that the damage to the skin is small.
The Picoway is a machine manufactured and sold by Syneron Candela of the United States, and is equipped with a 532 nm KTP laser and a 1064 nm neodymium yag laser. Among the pico lasers used in medical institutions in Japan, it is possible to irradiate with the shortest pulse width and the maximum irradiation output (as of August 2020).
A medical device approved by the Ministry of Health, Labor and Welfare (approval number: 230020BZX0270000) has been shown to be effective in treating deep and superficial pigmented lesions (stains, etc.) on the body surface and removing tattoos . In addition, we have obtained the CE mark that can be displayed on products by meeting the safety performance standards stipulated by EU (European Union) law.
Enlighton is a machine developed by Cutera of the United States and is equipped with a 532nm KTP laser and a 1064nm neodymium yag laser. A medical device approved by the Ministry of Health, Labor and Welfare has been shown to have the effect of evaporating and removing benign pigmented lesions (stains, etc.) on the body surface .
(Approval number: 22800BZX00138000 )
Enlighton is a pico laser, but it has the feature that it can irradiate even with a pulse width of nanoseconds.
Discovery Pico is a series of pico laser machines manufactured and sold by Quanta of France.
There are two types, Discovery Pico and Discovery Pico Plus. Discovery Pico is equipped with a 532nm KTP laser and 1064nm neodymium yag laser, and Discovery Pico Plus is equipped with a 532nm KTP laser, 694nm ruby laser, and 1064nm neodymium yag laser. I am.
In addition, a handpiece (part that irradiates the laser) that can irradiate the 2940 nm Elpium Yag laser can be added as an option. It is the longest wavelength that can be irradiated with a pico laser ( as of August 2020).
The machine Spectrapico manufactured by Lutronic of South Korea is equipped with a 532nm KTP laser, a 595nm die laser, a 660nm red laser, and a 1064nm neodymium yag laser.
In addition, Spectrapico can irradiate not only picoseconds but also nanosecond pulse widths .
Pico Care is a pico laser machine manufactured and sold by WONTECH of South Korea. It is equipped with a 532nm KTP laser, a 660nm red laser, and a 1064nm neodymium yag laser.
It is a machine approved by the Ministry of Health, Labor and Welfare as a medical device and has excellent safety . (Approval number: 30100BZX00216000) It is also approved by the US FDA, which is the Ministry of Health, Labor and Welfare of Japan. (FDA Approval Number: K181272 )
There are three types of irradiation methods for pico lasers: spot irradiation, toning irradiation, and fractional irradiation . The intensity (output) and action of light energy on the causative substance when irradiated are different .
It is an irradiation method that acts on the causative substance in a narrow range, and is characterized by a stronger output than the other two types of irradiation methods. Irradiate only the causative substance and destroy the causative substance.
However, the stronger the irradiation output, the more likely it is to damage the tissue surrounding the causative agent. Therefore, it is not suitable for wide range irradiation.
Unlike spot irradiation, it is an irradiation method with a weak output , so it is less likely to damage the surrounding tissue of the causative substance and is suitable for irradiation in a wide range.
By irradiating the entire face, it improves the dullness of the skin, improves the tone, and leads to smooth skin . Since the output is weak, the destructive action on the causative substance is mild compared to spot irradiation.
The human body has the ability to restore the damaged area to normal. For example, if you fall and have an abrasion accompanied by bleeding, the function of platelets first causes blood to clot (hemostatic), promotes the production of collagen and elastin, and regenerates the injured epidermis and dermis.
Fractional irradiation uses the function of returning the damaged part of the human body to normal, intentionally damaging the dermis layer of the skin and promoting the production of collagen and elastin, leading to improvement of skin problems. I will .
In spot irradiation and toning irradiation, the laser is irradiated in a plane without gaps, but in fractional irradiation, a laser with an irradiation diameter smaller than that of the hair is irradiated in dots, and the irradiated part and the unirradiated part are intentionally irradiated. I will make it. When performing fractional irradiation, use a handpiece (part that irradiates the laser) that can irradiate regularly in dots, like the trace of a stamp injection (BCG injection).
When fractional irradiation is performed with a laser other than picoseconds, the light energy causes a photothermal effect on the dermis layer, and the effect of heat damages not only the dermis layer but also the epidermis layer. On the other hand, it is said that the fractional irradiation of pico laser damages only the dermis layer by photoacoustic action and does not damage the epidermis layer .
In pico laser treatment, the output and action differ depending on the irradiation method. The recommended number and frequency of treatments will vary.
|Irradiation method||Recommended number of times||Treatment frequency|
|Spot irradiation||1 to 5 times||1 month interval|
|Toning irradiation||5 to 10 times||2 week intervals|
|Fractional irradiation||Around 5 times||1 month interval|
Acne scars are divided into 5 types according to the condition, and 3 types of post-inflammatory hyperpigmentation, post-inflammatory hyperpigmentation, and atrophic scars can be expected to be improved by pico laser . Hypertrophic scars and keloids that cannot be improved by pico laser can be expected to be improved by oral or external medicine or steroid injection.
|Types of acne scars||Acne scars||Pico laser treatment|
|Post-inflammatory erythema||The area where the acne was present turned red even after the acne inflammation had subsided.||△|
|Post-inflammatory hyperpigmentation (enshogoshikisochinchaku)||The area where the acne was present is pigmented like a spot after the inflammation of the acne has subsided.||△|
|Atrophic scar (Ishukuseihankon)||A condition in which the area that was acne was damaged by inflammation up to the dermis layer, and the skin became dented after the acne had healed.||〇|
|Hypertrophic scar (Hikoseihankon)||After the acne has healed, the area where the acne was located has risen red.|
|keloid||A state in which the red bulge is wider than the hypertrophic scar|
There are three types of acne scars that can be expected to improve with pico laser: post-inflammatory hyperpigmentation, post-inflammatory hyperpigmentation, and atrophic scars, but the main treatment for acne scars with pico laser is fractional irradiation. It is a treatment for atrophic scars .
Atrophic scars are caused by the acne becoming more inflamed and damaging the dermis layer, which becomes thinner than normal skin when the acne heals. Fractional irradiation intentionally damages the thinned dermis layer, promotes the production of collagen and elastin, and brings the dermis layer closer to the normal thickness , leading to improvement of atrophic scarring .
In rare cases, pico laser treatment may cause vitiligo (a condition in which the pigment on the skin is removed and becomes white) or pigmentation on the irradiated area. Vitiligo can be expected to improve by using topical drugs, and pigmentation is said to subside in about 3 to 6 months.
Pico lasers are said to be less painful than lasers other than picoseconds because they destroy the causative substances that cause skin problems by photoacoustic action and cause less damage to surrounding tissues. If you are worried about pain, you can relieve it by using an anesthetic cream .
In addition, there is little downtime due to less damage to surrounding tissues . Redness may appear for 2 to 3 days after the treatment, but it can be covered with makeup.
The price of pico laser varies depending on the irradiation method. In the case of treatment for acne scars for beauty purposes, the insurance is not covered, so the treatment fee will be borne by you.
|Irradiation method||Price market (per treatment)|
|Spot irradiation||Fees vary depending on the medical institution. There are many medical institutions whose fees are set according to the machine used and the range of spot irradiation.|
|Toning irradiation||10,000 yen to 50,000 yen|
|Fractional irradiation||14,000 yen-100,000 yen|
|Oral medicine Topical medicine||Laser treatment other than pico laser||Chemical peeling collagen injection||Hyaluronic acid collagen injection||IPL treatment||Steroid injection|
The most commonly used treatments for acne scars are internal and topical medications, which are said to be effective against all five types of acne scars .
Since it has been the most used in the treatment of acne scars to date, drug development is progressing and the types of drugs used are diverse. The effects of antibacterial, bactericidal, and exfoliation of keratin differ depending on the ingredients contained, and side effects may occur when taking or applying, so it is prescribed according to the condition of the skin .
Although it is covered by insurance, it is said that the effect on acne scars is mild and the treatment period is several years .
Lasers with pulse widths other than picoseconds can also be expected to improve post-inflammatory hyperpigmentation, post-inflammatory hyperpigmentation, and acne scars on atrophic scars . As with the pico laser, it is not covered by insurance, so you will be responsible for all the treatment fees.
By acting on the thinness of hemoglobin, melanin, and dermis layer, which are the causes of acne scars, it has the effect of improving post-inflammatory hyperpigmentation and post-inflammatory hyperpigmentation due to the destruction of hemoglobin and melanin, and atrophy due to the proliferation of collagen and elastin. It can be expected to improve scarring.
Pico lasers approach the cause of acne scars by photoacoustic action, but lasers with pulse widths other than picoseconds approach by photothermal action, so there is a high possibility that surrounding tissues will be damaged, which is lower than pico lasers. The time tends to be longer .
Chemical peeling, which promotes skin regeneration by applying the drug directly to the skin and peeling it off thinly, can be expected to be effective for acne scars on atrophic scars .
After peeling the skin thinly with chemical peeling, the skin surface becomes flat and the dents are reduced in the process of skin regeneration .
When aiming to treat acne scars with chemical peels, drugs such as glycolic acid, macrogol salicylate, and ethanol salicylate are used, but the thickness of the skin that can be peeled off depends on the drug. Since the procedure is not covered by insurance, you will be responsible for all costs.
Hyaluronic acid / collagen injection is a treatment that can be expected to have an effect on acne scars of atrophic scars . Because the treatment is not covered by insurance, you will be responsible for all the treatment fees.
By injecting hyaluronic acid / collagen into the thinned dermis layer that causes atrophic scarring, the volume of the dermis layer is physically increased, and the dented skin is supplemented to make it flat .
Post-inflammatory hyperpigmentation and post-inflammatory hyperpigmentation are the acne scars that can be improved with IPL (light) treatment.
Laser treatment, which also includes pico lasers, approaches the causative agent of acne scars at one wavelength, but the light energy used in IPL (light) treatment has multiple wavelengths. The wavelength of light energy used in aesthetic medicine is around 500nm to 1200nmm, and the IPL treatment machine cuts unnecessary wavelengths that are not absorbed by the causative substance and irradiates the treatment site. Since it has multiple wavelengths, it is possible to treat the causative substances hemoglobin and melanin without changing the machine .
Since the irradiation output is smaller than that of a laser, it is said that there is almost no damage to surrounding tissues, but the effect on acne scars is mild and multiple treatments are recommended.
Since there is almost no damage to surrounding tissues, there is almost no downtime, and it is said that pain during the procedure is less likely to be felt. Since the treatment for acne scars is for beauty purposes, it is not covered by insurance, and the treatment fee will be borne by you.
Unlike atrophic scars, the condition in which new skin cells are created in excess during the healing process of acne and the skin is raised is called hypertrophic scar or keloid. Steroid injection is an insurance-covered procedure that can be expected to be effective for hypertrophic scars and keloid acne scars .
The mechanism of how steroid injections act on hypertrophic scars and keloids is unknown, but clinical data showing improvement in hypertrophic scars and keloids by injecting steroids into areas where the skin has risen. There are many .
This procedure is also recommended by the Japanese Dermatological Association's guidelines for acne scar treatment.
Since the wavelength, pulse width, and irradiation output of the laser that can be irradiated differ depending on the machine, the effect can be expected for each acne scar.
Even if the type of acne scar is known, there are individual differences in the condition of acne scars such as the depth of dents and the degree of redness. Since it is necessary to adjust the wavelength, pulse width, and output of the machine according to the condition of acne scars, it is safe to have a doctor's examination before the treatment and the medical institution where the treatment is performed by the doctor .
Even if you see a doctor before the procedure, some medical institutions will perform the procedure by a nurse, so if you have any concerns, please check with the medical institution in advance.