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
Shigeaki Miyata Medical institution with doctor
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.
Table of contents
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|
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 .
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 .
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.
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 .
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.
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 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.
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
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.
With PicoWay, which is a picosecond laser, we will confirm what kind of symptoms will lead to improvement.
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.
PicoWay also acts on "deep pigment lesions" where melanin pigment is present in the dermis layer. Deep pigmented lesions include the following symptoms:
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.
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.
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.
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 .
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 .
There are multiple picosecond laser machines, but there are differences in wavelength and pulse width.
|Machine name||wavelength||pulse width|
|PicoWay|| 532 nm|
| 294 ps|
|PicoSure|| 532 nm|
|Variable type of 550 ps-750 ps|
|enLIGHTen3|| 532 nm|
|750 ps / 660 ps, 2 ns|
|Discovery Pico Plus|| 532 nm|
| 370 ps|
|PICOCARE|| 532 nm|
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.
|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.|
|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 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.|
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.
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.
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.
(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.
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.
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.
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.|
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.
Professor Shigeaki Miyata, who supervised the article, taught me about PicoWay.
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