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Treatment of spots and bruises and tattoo removal that can be expected to be effective with less ...

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Nariaki Miyata
Dr. Nariaki Miyata

Miyata Plastic Surgery & Skin Clinic

Japanese Society of Plastic Surgery Specialist Councilor of the Japan Society for Cosmetic Surgery (JSAPS) Councilor of Japan Laser Medical Society Member of Japan Society of Aesthetic Dermatology Member of the Japan Burn Association Member of the Japanese Society for Medical Hair Removal medical doctor

2人のドクターがいいねしています

Shigeaki Miyata Medical institution with doctor

Miyata Plastic Surgery / Skin Clinic Miyata Plastic Surgery / Skin Clinic:
Contact: 03-5510-3931

In aesthetic medicine, treatments such as stains, bruise, and color tattoos are performed with external medicines, internal medicines, light, lasers, etc., but picosecond lasers can be expected to improve symptoms that are difficult with conventional Q-switched lasers. In addition, it is said that the risk is reduced.

There are multiple machines for picosecond lasers, and PicoWay is one of them. It is a good idea to know the characteristics compared to others and confirm the benefits before receiving the treatment by PicoWay.

I asked Professor Miyata about PicoWay

PicoWay is a picosecond laser machine

Treatment of spots and bruises and tattoo removal that can be expected to be effective with less damage by PicoWay

PicoWay is a laser machine called picosecond laser by Candela (formerly Syneron Candela).

It is used to treat age spots and freckles caused by melanin pigments, age spots caused by injuries, bruises and tattoos, and is approved by the Ministry of Health, Labor and Welfare . It has also been approved by the US FDA's US Food and Drug Administration for its effectiveness and safety in improving acne scars and wrinkles.

Approval in Japan Medical approval number: 230020BZX0270000
FDA (US Food and Drug Administration) Approval K191685
K162454

"Short pulse width" is a picosecond laser

In addition to continuous irradiation, there is "pulse irradiation", which is an irradiation for a very short time, and the width of the irradiation time per shot (one shot) by pulse irradiation is called "pulse width". I will.

The picosecond laser has a pulse width of one trillionth of a second, which is a picosecond unit, and is characterized by a very short pulse width. The shorter the pulse width, the less the laser energy propagates to the surroundings, and only the target substance can be selectively destroyed. In other words, it can destroy only melanin pigments and tattoo pigments without leaving scars on the skin.

Before the advent of picosecond lasers, Q-switched lasers (nanosecond lasers) were used to remove stains and tattoos, but nowadays, picosecond lasers are now selected in addition to Q-switched lasers depending on the symptoms. became.

The Q-switched laser, which has a pulse width of nano (1/1 billion) seconds, also has a short pulse width, but the picosecond laser has a further 1/1000 second shorter pulse width after pain and inflammation during the procedure. It is possible to receive treatment with a reduced risk of pigmentation .

Features of picosecond lasers compared to Q-switched lasers

Q-switched lasers, like picosecond lasers, are used to remove blemishes, bruises, and tattoos.

A Q-switched laser is a technology that pulsates a laser with a very high output by emitting the stored light energy in a very short time. Based on this, nanosecond lasers and picosecond lasers can be used. I was born.

Picosecond lasers are also Q-switched lasers, but in general, "Q-switched lasers" do not mean technology, but nanosecond lasers, and are often compared to picosecond lasers .

Picosecond laser enhances the action of shock waves

If the pulse width of the laser is longer than the picosecond unit like a Q-switched laser, the "photothermal action" that damages the object with heat becomes stronger. However, if it is shorter than picoseconds, the irradiation time will be shorter than the heat damages the object, and the action of the "photoacoustic effect" (photoacoustic, shock wave) generated by the rapid expansion of the substance will become stronger. I will.

Removes tattoos with less treatment because it can be crushed

Since the shock wave has a large destructive force and a high peak energy of energy , when a picosecond laser is used to remove the tattoo, the pigment particles, which were rock-like masses before the treatment, are shattered like sand after the treatment. Become.

The tattoo pigment in the dermis, which is destroyed by the Q-switched laser or broken by the shock wave of the picosecond laser, is partially discharged directly to the outside of the skin and becomes "macrophages" of cleaning cells, which are a type of white blood cell. It is said to be taken up and excreted from the body via blood vessels and lymph vessels by metabolism.

At this time, the finer the pigment particles, the easier it is to be taken up by macrophages, so it can be said that the picosecond laser, which can crush the object, requires fewer treatments than the Q-switched laser .

Removes tattoos with less treatment because it can be crushed

Even light stains can be treated with less risk of post-inflammatory hyperpigmentation

The darker the stain with more pigment particles, the more likely it is to be thinned with a laser, but with a picosecond laser, even light stains with few pigment particles can be crushed. Therefore, it can be expected to be effective in removing stains that are difficult to improve with a Q-switched laser.

The effect of picosecond laser on spot treatment different from Q-switched laser

Picosecond pulses reduce the risk of skin tissue damage With Q-switched lasers, the energy of the laser light tends to spread to the surroundings, which can lead to post-inflammatory hyperpigmentation.

The picosecond laser traps the energy of the shock wave in the object and crushes only the object .

Since the peak energy power is high, the effect can be expected with lower energy (fluence) than the Q-switched laser, the possibility of damaging surrounding cells is low, and the risk of burns and post-inflammatory hyperpigmentation tends to be low.

Post-inflammatory hyperpigmentation will eventually disappear

Post-inflammatory hyperpigmentation occurs when laser-treated skin stimulates to produce melanin pigments to protect skin cells from irritation. In most cases, it disappears in about 3 to 6 months due to "turnover", which is the metabolism of skin cells.

However, depending on the condition of the skin, such as when the turnover cycle is disturbed, it may take about a year to disappear and it may occur at the site where the stain was found, so it is misunderstood that the stain has recurred and "return stain". It may also be expressed as.

It is a side effect that is likely to occur with laser treatment, but it is said that the incidence is low with picosecond laser.

Picosecond laser is less painful

Treatment with less damage due to picosecond pulse oscillation

When treating the same object with a Q-switched laser and a picosecond laser, the picosecond laser with a shock wave (photoacoustic effect) can crush the object with lower energy (fluence), reducing pain during the procedure. I will.

The graph shows that the photothermal effect is more painful.
Photoacoustic / Photothermal

Q-switched laser is effective for large pigment particles

Not all lasers with shorter pulse widths are better. A picosecond laser can crush even a small object, but if the object is large, it is more likely to be destroyed by photothermal action than by crushing it into small pieces with a shock wave .

For example, if the laser used for "hair removal" that targets the melanin pigment in the hair root is a long pulse laser with a pulse width of millimeter (1/1000) second, when aiming at a large target such as the hair root. , Long pulse width is effective.

Symptomatology that can be expected to improve with PicoWay

With PicoWay, which is a picosecond laser, we will confirm what kind of symptoms will lead to improvement.

Superficial pigment lesions

The skin is layered from the outside to the epidermis and dermis, but the symptom generally called spots (= sun-induced pigmented spots = senile pigmented spots) has melanin pigments present in the epidermis. The following symptoms, including stains, are called "superficial pigmented lesions" and can be expected to improve with PicoWay.

  • Stain
  • Sparrow egg spot (= freckles)
  • Nevus spilus (brown bruise without swelling)
  • Overall dullness

Deep pigmented lesions

PicoWay also acts on "deep pigment lesions" where melanin pigment is present in the dermis layer. Deep pigmented lesions include the following symptoms:

  • ADM (= Acquired Dermal Melanocytosis, bruise that looks bluish from gray)
  • Nevus Ota (Otabohan, a bruise that appears on one side of the face)
  • Pigmented nevus (= mole)
  • Nevus of Ito (bruises around the shoulders)
  • Traumatic tattoo (= traumatic pigmentation, pigmentation due to foreign matter contamination in accidents or injuries)
  • Ectopic Mongolian spot

Permanent makeup and color tattoos

PicoWay is used not only to improve the above-mentioned skin problems, but also to remove permanent makeup that pigments the epidermis and color tattoos that pigment the dermis.

Why PicoWay can handle multiple symptoms

With PicoWay, the energy of laser light can be delivered to both the shallow layer (epidermis) and deep layer (dermis) of the skin, and not only melanin pigments, but also various colors such as blue, green, red and yellow. It is also possible to remove color tattoos with various tones.

For these multiple symptoms, PicoWay responds by switching the "wavelength" and "irradiation method" suitable for the symptom by replacing the handpiece at the tip of the machine that is irradiated with the laser.

PicoWay wavelength to adapt to various skin problems

There are multiple lasers used in aesthetic medicine, but the symptoms that can be dealt with differ depending on the pulse width as well as the "wavelength".

Energy called electromagnetic waves, such as lasers and light, travels in space as waves (wavelengths). Light contains multiple wavelengths, but lasers are single-wavelength energy because they are created by extracting specific wavelengths from light, such as "532 nm wavelength" and "730 nm wavelength."

Depending on the wavelength, the color tone that is easy to react and the depth of reach to which layer of the skin differ, and the treatment content that can be performed depends on the wavelength of the laser. Therefore, wavelength is an important factor in laser treatment.

In addition to 1064 nm and 532 nm, PicoWay now has a new 730 nm wavelength, which allows one machine to perform treatments using three wavelengths.

Wavelength of PicoWay Reactive color tone Adaptation
1064 nm Black / brown / green / blue / purple Removal of deep (dermis) melanin pigments and color tattoos
730 nm Green / blue Removal of superficial to deep melanin pigments and color tattoos
532 nm Red / orange / yellow Removal of superficial (epidermis) melanin pigments and color tattoos

At the three wavelengths of PicoWay, the longer the wavelength, the deeper the skin, so the treatment is performed at wavelengths of 1064 nm and 730 nm for the pigments present in the dermis and 532 nm and 730 nm for the pigments present in the epidermis. It will be.

Newly added wavelength 730 nm for spot treatment with few side effects

The wavelength of the laser has an object that is easily absorbed (easily reacts) for each wavelength.

Although 532 nm is a wavelength that is easily absorbed by melanin pigments, it also has the property of being absorbed by hemoglobin (red) in blood vessels, so it is sharp in the treatment of age spots, but it is also easily absorbed by surrounding blood vessels and redness is likely to remain. It's a trend.

On the other hand, the newly added wavelength of 730 nm reduces the absorbance to hemoglobin, which reduces the risk of damaging surrounding blood vessels compared to 532 nm .

Graph of absorbance and wavelength

Multiple irradiation methods are possible with PicoWay

In PicoWay, the method of acting on the pigments that exist in spots and the method of irradiating the entire face lead to improvement of skin problems.

The appropriate irradiation method may be selected depending on the symptomatology, but the treatment may be performed by combining the irradiation methods. This makes it possible to improve freckles and blemishes that spread over the entire face, dullness, and remove local blemishes and bruises, and tattoos and permanent makeup .

PicoWay has a shorter pulse width than other picosecond lasers

There are multiple picosecond laser machines, but there are differences in wavelength and pulse width.

* Ps: Picosecond (1/1 trillion second)
Machine name wavelength pulse width
PicoWay 532 nm
730 nm
1064 nm
294 ps
246 ps
339 ps
PicoSure 532 nm
755 nm
1064 nm
Variable type of 550 ps-750 ps
enLIGHTen3 532 nm
670 nm
1064 nm
750 ps / 660 ps, 2 ns
Discovery Pico Plus 532 nm
694 nm
1064 nm
370 ps
30 ns
450 ps
PICOCARE 532 nm
595 nm
660 nm
1064 nm
450 ps

PicoWay has less stress on the skin

Although the pulse width of the picosecond laser is in picosecond units, it varies from machine to machine, and you can see that the pulse width of the PicoWay is shorter than other picosecond lasers .

The shorter the pulse width, the stronger the photoacoustic effect of crushing with a shock wave than the photoacoustic effect of destroying with heat energy, and the narrower the range of action. From this, it can be said that even light spots with little melanin pigment do not require strong energy (fluence), so treatment with less damage to the surroundings is possible.

What you need to know before taking PicoWay

Side effects / risks of PicoWay treatment

Post-inflammatory hyperpigmentation
When post-inflammatory hyperpigmentation occurs, it is said to gradually disappear in about 3 to 6 months. In order to avoid prolongation, take measures against ultraviolet rays as much as possible after the treatment to avoid irritation.
Blistering
It tends to occur when the laser output is strong. It is important to consult with the medical institution that received the treatment and take appropriate measures, as scars may remain if you take self-judgment treatment such as breaking blisters.
Vitiligo
Vitiligo is a symptom of partial whitening of the skin when melanocytes, which produce melanin pigment, are damaged by laser irradiation. Symptoms may appear after multiple treatments and often have no subjective symptoms. If symptoms are observed during the treatment period, it may be discontinued.
Redness / swelling / pain
If you experience redness, swelling, or pain, it usually subsides within a few days. In addition, it is said that these are also caused by excessive contact with the treatment site, and after the treatment, moisturize well and be careful not to give irritation.

PicoWay treatment downtime and recommended number / frequency

After treatment with PicoWay, it is recommended to refrain from making if the laser reaction is strong, but in most cases it will be possible from the next day.

In addition, a thin scab (microcrust) may be formed on the dye part that reacts to the laser, but it will come off in about 1 week to 10 days .

Regarding the number and frequency of treatments, local irradiation can be expected to improve even once, but for irradiation of the entire face, once every 3 to 4 weeks, 3 to 5 times are required. Recommended. After the recommended number of treatments, some people continue to maintain their skin once every few months.

If post-inflammatory hyperpigmentation occurs, a second treatment will be possible after 3 to 6 months, so please consult your doctor for details on the pace of treatment.

Those who cannot receive PicoWay and who need attention

  • Site with malignant skin tumor
  • Sites with herpes simplex virus type 1 or type 2 active lesions
  • Open wound, infected skin
  • Those who are sensitive to 532 nm, 730 nm, 1064 nm, or have photosensitivity
  • Those who are tanned
  • Those with a pacemaker
  • Those who have gold thread
  • Those who have a history of taking gold-containing medicines such as rheumatism medicine
  • Those who are pregnant or may be pregnant

If you have "chloasma", which is a type of stain, it is effective to first review the skin care and then treat with internal or external medicine.

PicoWay rates

Cosmetology treatments are not covered by insurance and are free medical treatment, and the cost varies depending on the medical institution. Irradiation of the entire face varies from 13,000 yen to 35,000 yen when using one irradiation method , and from 30,000 yen to 100,000 yen when using multiple irradiation methods, depending on the number of combined irradiation methods. there is.

Some medical institutions set a low initial fee or the second and subsequent fees. Prices for spot-like spot treatment and tattoo removal vary from medical institution to medical institution, such as per shot, per 1 ㎠, per 1 ㎟, and less than 3 ㎟, so please check with the medical institution receiving the treatment for details. ..

In addition, traumatic tattoos (= traumatic pigmentation) that cause foreign substances to enter the skin due to accidents or injuries, treatment of bruises, nevus Ota (Otabohan), ectopic Mongolian spots (Ishosei Mongolian spot) ) May be covered by insurance.

Treatment flow and effective spot treatment with PicoWay

(1) Counseling / medical examination

Tell the doctor about your skin problems and wishes for treatment and decide on a treatment policy. If you have any concerns or concerns, ask questions and be convinced before receiving the treatment.

(2) Cleansing / face washing

For facial treatments, cleanse to remove make-up and wash your face to keep your skin clean. If the make-up remains, the laser irradiation effect will be reduced, so make-up removal will be performed firmly.

(3) Taking a photo and changing clothes

Photographs may be taken to check the condition of the skin before the procedure. In the case of body treatment, change into a special clothing for the treatment.

(4) Treatment

To lie on your back on the bed and protect your eyes from the laser beam, wear protective glasses / goggles before irradiating. Basically, no anesthesia is required, but tattoo removal can be very painful, so local anesthesia may be used depending on the procedure.

(5) Cool and finish

Cool the treatment area and finish.

Precautions after PicoWay treatment

After irradiating the laser, you will be in a slight burn, so do not rub the treated area strongly. It is also recommended to take UV protection to prevent pigmentation and moisturize the skin to prevent it from drying out.

Effective in combination with topical and internal medicines for the treatment of age spots

When receiving treatment with PicoWay, it can be expected to be effective when used in combination with a cream containing hydroquinone or tretinoin as an external medicine.

In addition, if you have chloasma, it is said that the therapeutic effect will be enhanced by using oral medicines such as vitamin C and tranexamic acid together.

Hydroquinone cream (topical drug)
It is also called a whitening agent that thins spots because it suppresses the activity of the enzyme "tyrosinase" that produces melanin pigments. If you use it in the wrong way, you may get a rash or sore, so be careful about the amount and number of times you use it. Commercially available hydroquinone-containing cosmetics have a lower concentration than those that can be purchased at medical institutions.
Tretinoin cream (topical drug)
It has the effect of removing dead skin cells and is often used in combination with hydroquinone cream, which is not highly permeable.
Vitamin C (oral medication)
Ingredients that lead to beautiful skin by antioxidative action, suppression of melanin production, thinning of spots and pigmentation, improvement of pores, etc.
Tranexamic acid (oral medication)
Approved by the Ministry of Health, Labor and Welfare as a whitening active ingredient for chloasma. It has the effect of suppressing the action of "plasmin" that promotes the activation of the cells "melanocytes" that make melanin pigment, and the effect is further enhanced when used in combination with vitamin C. It is necessary to be careful because it may be easy for blood clots to form by swallowing, so start taking it under the diagnosis of a doctor. Also, depending on your constitution and physical condition, stomach discomfort and loss of appetite may occur, so if you experience any symptoms, consult a medical institution.

How to choose a doctor to receive PicoWay treatment

The treatment with PicoWay is a delicate treatment in which the effect of irradiation varies depending on the distance and angle from the skin surface. For this reason, such as to check the medical institution site or SNS, a doctor of the blog, HP recommends that you receive the treatment at medical institutions with a proven track record.

Also, while PicoWay is unlikely to have post-inflammatory hyperpigmentation, it is not zero. In some cases, the effect can be obtained by repeating the number of treatments. If you receive treatment without knowing these things, you may interrupt the treatment at your own discretion and you may not get the desired effect.

If you are a doctor who can explain the side effects, risks, and the course after the treatment so that you do not leave the symptoms that should improve, you can receive the treatment with confidence.

Miyata Plastic Surgery / Skin Clinic Pico Way

Professor Shigeaki Miyata, who supervised the article, taught me about PicoWay.

KIREI
Please tell me the treatment fee of PicoWay at Miyata Plastic Surgery / Skin Clinic.
Dr. Shigeaki Miyata
It is 33,000 yen (tax included) each time. The entire face is treated by switching the handpiece and using multiple irradiation methods.
KIREI
It is recommended to continue about 3 times, but can you feel the effect even once? On the contrary, is it important to continue even if the first time has no effect?
Dr. Shigeaki Miyata
Especially for stains, the effect is felt even once in most cases, and the effect is enhanced by repeating it. It may take some time for other treatments, but in most cases, the effect will be noticed after about 3 treatments.
KIREI
Is the treatment more effective if you take it regularly, not just the recommended number of times, and continue?
Dr. Shigeaki Miyata
Regular irradiation suppresses the generation of melanin and improves skin quality. However, continuing for a long period of time with a high frequency such as every month may cause various problems such as ataxia of melanin in the skin, so if you want to continue, you should consult with an appropriate interval. is.
KIREI
During the procedure, the stronger the output, the easier it is to feel the pain. Is it more effective to use the stronger output even if you endure the pain?
Dr. Shigeaki Miyata
Proper irradiation settings are more important than the degree of pain. It doesn't work painfully. Rather, the risk of side effects such as post-inflammatory hyperpigmentation and pigmentation increases. If you feel strong pain, adjust the output, so don't be patient and tell the practitioner.
KIREI
Please tell me any points to check when choosing a medical institution or doctor when undergoing PicoWay treatment.
Dr. Shigeaki Miyata
A laser is just a device, but you can't get the maximum effect just by irradiating it properly. Make sure your doctor will see you and see if you can tailor a treatment program to each person.
KIREI
Thank you, Professor Miyata.

Introduction of supervising doctor

Dr. Shigeaki Miyata, the director of Miyata Plastic Surgery and Skin Clinic, was one of the first to adopt laser skin quality improvement treatment and currently owns more than 40 aesthetic medicine machines. All treatments other than skin care, hair removal, and slimming are performed by the director himself. A lot of research is published every year at academic societies in Japan and overseas, and abundant medical knowledge and experience are utilized to establish joint development and treatment protocols with medical device manufacturers. He has written many books on aesthetic medicine and is a leader in comprehensive aesthetic medicine as a plastic surgeon.

Shigeaki Miyata Medical institution with doctor

Miyata Plastic Surgery / Skin Clinic Miyata Plastic Surgery / Skin Clinic:
Contact: 03-5510-3931

I asked Professor Miyata about PicoWay.

KIREI
Please tell us about the charm of PicoWay and the treatments that can be done only with PicoWay. Also, please tell us if there is any point that "it would be better if this happens more".
Dr. Shigeaki Miyata
It has the shortest pulse width and can be treated with sharpness, and it is attractive that even very thin stains can be removed. In addition, it has a great advantage that it can be equipped with many wavelengths and can irradiate them with a practical output. However, short pulse width is not good at all, so I think it would be better if it could be changed.
KIREI
There is light (IPL) treatment as a treatment method that can irradiate the entire face. Is there any difference? Please let me know if there are any points to use properly.
Dr. Shigeaki Miyata
If you mainly use melanin, texture, and firmness of the skin, IPL is not necessary if you have Picoway, but IPL is a device that has a wide wavelength band and responds to "red". It is also possible to treat with heat with a long pulse width. In some cases, IPL is effective for treating redness and hair loss.
KIREI
Are there any irradiation methods, symptoms or skin types that are prone to burns and pigmentation? Also, please tell me what to do if these occur.
Dr. Shigeaki Miyata
Setting a high irradiation fluence just because it is ineffective is a source of trouble. The sharper the treatment, the narrower the safety margin. Of course, you will have to determine the indications for skin types with chloasma, sunburned skin, and strongly dry skin.
If pigmentation occurs, time will be resolved, but in addition to UV care and moisturizing, topical treatments such as hydroquinone are prescribed.
KIREI
Is there anything I should tell you before the procedure to avoid complaints in the PicoWay procedure?
Dr. Shigeaki Miyata
It's not a magical cure. Recently, picosecond lasers have been touted as devices that can take anything with melanin, but that is not the case, and poor care will not give good results. I remind you that patient cooperation is also important.
KIREI
Does the result of PicoWay treatment vary greatly depending on the practitioner? Please tell me the reason.
Dr. Shigeaki Miyata
Although the pulse width is short and the sharpness is good, the safety range may be narrow depending on the wavelength, so it is a device that tends to make a difference depending on the experience of the practitioner. In addition, there are many irradiation settings such as wavelength selection, which is both an advantage and a disadvantage.
KIREI
Thank you, Professor Miyata.
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