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




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


Medical institutions with Dr. Shigeaki Miyata

Miyata plastic surgery and skin clinic Miyata Plastic Surgery/Skin Clinic:
Contact: 03-5510-3931

In aesthetic medicine, treatments such as removing spots, bruises, and colored tattoos are performed using topical drugs, oral drugs, light, lasers, etc., but picosecond lasers can be expected to improve symptoms that are difficult to treat with conventional Q-switched lasers. In addition, the risk is said to be reduced.

There are multiple machines for picosecond lasers, and PicoWay is one of them. Before undergoing PicoWay treatment, it is safe to know the features compared to others and check the benefits.

PicoWay is a picosecond laser machine

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

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

It is approved by the Ministry of Health, Labor and Welfare as a treatment for lightening spots and freckles caused by melanin pigment, spots caused by injuries, bruises and tattoos . It has also been approved by the US Food and Drug Administration (FDA) for its effectiveness and safety in improving acne scars and wrinkles.

Approval in Japan Medical approval number: 230020BZX0270000
Approved by FDA (U.S. Food and Drug Administration) K191685

A picosecond laser with a short pulse width

In addition to continuous irradiation, laser irradiation methods include "pulse irradiation", which is irradiation for a very short time, and the width of the irradiation time per shot by pulse irradiation is called "pulse width" . increase.

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

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

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

Characteristics of picosecond lasers compared to Q-switched lasers

Q-switched lasers are used in the same way as picosecond lasers to remove spots, bruises, and tattoos.

A Q-switched laser is a technology that emits stored light energy in a very short time and emits a very high output laser pulse. was born

Picosecond lasers are also Q-switched lasers, but "Q-switched lasers" generally refer to nanosecond lasers rather than technology, and are often compared to picosecond lasers .

Picosecond lasers intensify the action of shock waves

If the pulse width of the laser is longer than the picosecond unit like the Q-switched laser, the "photothermal effect" that damages the target with heat becomes stronger. However, if it is shorter than the picosecond unit, the irradiation time becomes shorter than the heat damages the object, and the "photoacoustic effect" (photoacoustic, shock wave) generated by the rapid expansion of the material becomes stronger. increase.

Removes tattoos with fewer treatments because it can be crushed

Since the shock wave has a large destructive power and a high peak power of energy, when a picosecond laser is used for tattoo removal, the pigment particles, which were lumps like rocks before the treatment, are finely shattered like sand after the treatment. Become.

A part of 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 directly discharged outside the skin, and also into the "macrophage", a type of white blood cell cleaning cell. It is taken in and is excreted from the body through blood vessels and lymphatic vessels through 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 picosecond lasers, which can crush the target, require fewer treatments than Q-switched lasers .

Removes tattoos with fewer treatments because it can be crushed

Even light spots can be treated with less risk of post-inflammatory pigmentation

Dark spots with many pigment particles tend to be thinner with a laser, but with a picosecond laser, even light spots with few pigment particles can be crushed. Therefore, it can be expected to be effective in removing spots that are difficult to improve with Q-switched lasers.

Effect of picosecond laser in blemish 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, and post-inflammatory hyperpigmentation may occur.

A picosecond laser traps the energy of the shock wave in the target and crushes only the target .

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

Post-inflammatory hyperpigmentation that eventually disappears

Post-inflammatory hyperpigmentation occurs when skin stimulated by laser treatment produces melanin pigment 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 for it to disappear, and because it occurs in the area where the blemish was present, it is misunderstood as a recurrence of the blemish and is called "return blemish". It is sometimes expressed as

It is a side effect with a high probability of occurring in 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 the same object is treated with a Q-switched laser and a picosecond laser, the picosecond laser using a shock wave (photoacoustic effect) can crush the object with lower energy (fluence), reducing pain during treatment. increase.

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. Picosecond lasers can pulverize small objects, but large objects are more easily destroyed by photothermal action than by shock waves .

For example, the laser used for hair removal, which targets the melanin pigment in the hair root, is a long pulse laser with a pulse width of milliseconds (1/1000). , a long pulse width is enabled.

Symptoms that can be expected to improve with PicoWay

PicoWay, which is a picosecond laser, will check what kind of symptoms specifically lead to improvement.

Superficial pigmented lesion

The skin is layered from the outside to the epidermis and dermis, but melanin pigment is present in the epidermis in the symptoms commonly referred to as age spots (sun pigmentation = senile pigmentation). The following symptoms including spots are called "superficial pigmented lesions" and can be expected to be improved with PicoWay.

  • stain
  • freckles (= freckles)
  • flat nevus (brown birthmark without elevation)
  • overall dullness

deep pigmented lesions

PicoWay also works on “deep pigment lesions” where melanin pigment exists in the dermis layer. Symptoms of deep pigmented lesions include:

  • ADM (=acquired dermal melanocytosis, a bruise that appears gray to bluish)
  • Nevus of Ota (a birthmark that appears on one side of the face)
  • Pigmented nevus (= mole)
  • Ito nevus (a birthmark around the shoulder)
  • Traumatic tattoo (=traumatic pigmentation, pigmentation due to foreign matter contamination in accidents/injuries)
  • Ectopic Mongolian spots

Permanent makeup and color tattoos

In addition to improving the above skin problems, PicoWay is also used to remove permanent makeup that puts pigments in the epidermis and color tattoos that put pigments in the dermis.

Why PicoWay can treat multiple symptoms

With PicoWay, laser light energy can reach both the superficial layer (epidermis) and the deep layer (dermis) of the skin. It is also possible to remove dark colored tattoos.

In such multiple symptoms, PicoWay responds by changing the "wavelength" and "irradiation method" suitable for the symptoms by replacing the handpiece at the tip of the machine where the laser is irradiated.

Wavelength of PicoWay that adapts to various skin problems

There are multiple lasers used in aesthetic medicine, but the symptoms that can be treated differ depending on the pulse width and "wavelength".

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

Depending on the wavelength, the color tones that are easily responsive and the depth to which layers of the skin can reach differ, and the possible treatment contents change depending on which wavelength the laser is. Therefore, wavelength is an important factor in laser therapy.

In addition to 1064 nm and 532 nm, PicoWay can now use a new 730 nm wavelength , making it possible to perform treatments using three wavelengths with one machine.

Wavelength of PicoWay Responsive color tone adaptation
1064 nm black, brown, green, blue, purple Deep (dermal) melanin pigment, removal of color tattoo
730 nm green/blue Removal of superficial to deep melanin pigments and color tattoos
532 nm red, orange, yellow Superficial (epidermal) melanin pigment, removal of color tattoo

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

Newly added wavelength of 730 nm for blemish treatment with few side effects

Laser wavelengths have objects that are easily absorbed (reactive) 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. It's a trend.

On the other hand, the newly added wavelength of 730 nm reduces the absorbance of hemoglobin, so the risk of damaging surrounding blood vessels is lower than at 532 nm .

Graph of absorbance vs. wavelength

PicoWay allows multiple irradiation methods

PicoWay leads to improvement of skin troubles by a method of acting on spot pigments and a method of irradiating the entire face .

The appropriate irradiation method may be selected depending on the symptoms, but sometimes the treatment is performed by combining irradiation methods. As a result, it is possible to improve freckles and spots that spread over the entire face, improve dullness, and remove local spots, bruises, tattoos and permanent makeup .

PicoWay has a shorter pulse width than other picosecond lasers

There are several picosecond laser machines, but there are differences in wavelength, pulse width, etc.

* ps: picosecond (one trillionth of a second)
machine name wavelength pulse width
PicoWay 532 nm
730 nm
1064 nm
PicoSure 532 nm
755 nm
1064 nm
550 ps-750 ps variable
enLIGHTen3 532nm
1064 nm
750ps/660ps, 2ns
Discovery Pico Plus 532 nm
1064 nm
30 ns
595 nm
660 nm
1064 nm

PicoWay has less burden 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 PicoWay is shorter than other picosecond lasers .

The shorter the pulse width, the stronger the photoacoustic effect, which destroys with shock waves, than the photothermal effect, which destroys with thermal energy. From this, it can be said that even light spots with little melanin pigment do not require strong energy (fluence), so treatment with little damage to the surroundings is possible.

Things to know before receiving PicoWay

Side effects and 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, after the treatment, take thorough measures against ultraviolet rays as much as possible and do not give stimulation.
This tends to occur more easily when the laser output is strong. It is important to consult with the medical institution where the treatment was performed and take appropriate measures, as scars may remain if self-judgmental measures such as breaking the blisters are performed .
Vitiligo is a symptom in which the skin partially turns white when melanocytes that produce melanin pigment are damaged by laser irradiation. Symptoms may appear after multiple treatments, and in many cases there are no subjective symptoms. Treatment may be discontinued if symptoms are identified during treatment.
redness, swelling, pain
If redness, swelling, or pain occurs, it usually subsides within a few days. In addition, it is said that these are caused by excessive touching of the treated area, so be careful not to irritate the treated area by moisturizing it well after the treatment.

Downtime of treatment by PicoWay and recommended number and frequency

After the PicoWay treatment, it is recommended to refrain from applying makeup if the laser reaction is strong, but in most cases it is possible from the next day .

In addition, a thin scab (microcrust) may form on the pigmented area that reacts to the laser, but it will fall off in about a week to 10 days .

Regarding the number and frequency of treatments, if it is local irradiation, improvement can be expected even once, but if the whole face is irradiated, it is necessary to perform treatment once every 3 to 4 weeks for 3 to 5 times . Recommended. After completing the recommended number of treatments, some people continue to use it once every few months as skin maintenance.

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

Areas that cannot receive PicoWay and those who need attention

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

If you have melasma, a kind of blemish, it is effective to first review your skin care, and then treat with internal or external medicines.

Price of PicoWay

Treatment for cosmetic purposes is not covered by insurance and is a free medical treatment, and the cost varies depending on the medical institution. Irradiation of the entire face is about 13,000 yen to 35,000 yen when using one irradiation method, and when using multiple irradiation methods, it varies depending on the number of irradiation methods combined, but the price ranges from 30,000 yen to 100,000 yen. there is.

Some medical institutions set the initial fee or the fee after the second time at a low price. Prices for spot spot treatment and tattoo removal vary by medical institution, such as per shot, per 1㎠, per 1㎟, less than 3㎟, etc. Please check with the medical institution receiving the treatment for details. .

In addition, traumatic tattoos (=traumatic pigmentation), which are tattoos due to foreign substances entering the skin due to accidents or injuries, treatment of bruises, nevus of Ota, and ectopic Mongolian spots. ) may be covered by insurance .

Flow of treatment by PicoWay and effective spot treatment

(1) Counseling/examination

Tell the doctor about your skin troubles and wishes for treatment and decide on a treatment policy. Ask any questions you may have about anything you are unsure about or worry about, and make sure that you are satisfied before undergoing the procedure.

(2) Cleansing/face washing

In the case of facial treatment, cleanse to remove makeup and wash your face to keep your skin clean. If makeup remains, the laser irradiation effect will be reduced, so make sure to remove the makeup properly.

(3) Taking pictures and changing clothes

Photos may be taken to check the condition of the skin before the treatment. Also, in the case of body treatment, change into special clothes for treatment.

(4) Treatment

You will lie on your back on the bed and put on protective glasses/protective goggles to protect your eyes from the laser light before irradiating. Generally, no anesthesia is required, but local anesthesia may be used depending on the procedure, as tattoo removal may be painful.

(5) Finish with cooling

Finish by cooling the treated area.

Precautions after PicoWay treatment

After the laser irradiation, there will be a light burn, so do not rub the treatment area strongly . In addition, it is recommended to take measures against ultraviolet rays to prevent pigmentation and to prevent dryness of the skin by moisturizing .

It is effective to use topical medicines and oral medicines in combination with blemish treatment.

When receiving treatment with PicoWay, it is expected to be effective when used in combination with a cream containing hydroquinone or tretinoin as a topical drug.

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

Hydroquinone cream (external medicine)
It is also said to be a whitening agent that lightens blemishes because it suppresses the activity of the enzyme tyrosinase that produces melanin pigment. If used incorrectly, it may cause rashes or sores, so pay attention to the amount and frequency of use. Cosmetics containing hydroquinone on the market have a lower concentration than those available at medical institutions.
Tretinoin cream (external medicine)
It removes dead skin cells and is often used in combination with hydroquinone cream, which is not highly permeable.
Vitamin C (oral medicine)
Ingredients that lead to beautiful skin through effects such as antioxidant action, inhibition of melanin production, lightening of spots and pigmentation, improvement of pores, etc.
Tranexamic acid (oral drug)
Approved by the Ministry of Health, Labor and Welfare as a whitening active ingredient for melasma. It has the effect of suppressing the action of "plasmin" that promotes the activation of cells "melanocytes" that produce melanin pigment, and its effect is further enhanced when used in combination with vitamin C. It is necessary to be careful because there is a possibility that blood clots may be easily formed by taking this medicine together. Also, depending on your constitution and physical condition, stomach discomfort and loss of appetite may occur, so if symptoms appear, consult a medical institution.

How to choose a doctor for PicoWay treatment

Treatment with PicoWay is delicate, with different effects depending on the distance and angle from the skin surface in irradiation. Therefore, it is recommended that you receive treatment at a medical institution with a proven track record, such as checking the medical institution's website, SNS, and doctor's blog.

Also, although PicoWay is unlikely to cause post-inflammatory hyperpigmentation, the possibility is not zero. In some cases, the effect can be obtained by repeating the treatment. If you receive treatment without knowing these things, you may stop treatment on your own judgment and you may not be able to obtain the desired effect.

It can be said that you can receive treatment with peace of mind if you are a doctor who thoroughly explains the side effects, risks, and progress after the treatment so that you do not leave the symptoms that are supposed to improve.

Miyata Plastic Surgery Skin Clinic PicoWay

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

Please tell me the cost of PicoWay treatment at Miyata Plastic Surgery / Skin Clinic.
Dr. Shigeaki Miyata
It is 33,000 yen (tax included) per session. By switching the handpiece and using multiple irradiation methods, the entire face is treated.
It is recommended to continue using about 3 times, but can you feel the effect even if you only use it once? On the contrary, even if the first time was zero effect, is it important to continue?
Dr. Shigeaki Miyata
Especially for blemishes, in most cases, you can feel the effect even once, and the effect will be enhanced by repeating it. For other treatments, it may take several times, but in most cases, you will notice the effect after about 3 treatments.
Is the treatment not limited to the recommended number of times, and is it a treatment that will be more effective the longer it is received?
Dr. Shigeaki Miyata
Regular irradiation suppresses the production of melanin and improves skin quality. However, if it is continued for a long period of time at a high frequency such as monthly, it may cause various problems such as the imbalance of the melanin pigment in the skin. is.
During the treatment, I think that the stronger the output, the easier it will be to feel pain.
Dr. Shigeaki Miyata
Appropriate irradiation settings are more important than the degree of pain. It's not painfully effective. Rather, the risk of side effects such as post-inflammatory hyperpigmentation and depigmentation increases. If you feel strong pain, the output will be adjusted, so please do not hold back and tell the practitioner.
Please let me know if there are any points that should be checked 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. See if your doctor can give you a proper examination and put together a personalized treatment program.
Thank you very much, Mr. Miyata.

Introduction of supervising doctor

Dr. Shigeaki Miyata, 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 cosmetic medical machines. All treatments other than skin care, hair removal, and slimming are performed by the director himself. He presents many studies every year at academic conferences in Japan and overseas, and utilizes his wealth of medical knowledge and experience to establish joint development and treatment protocols with medical device manufacturers. He has written many books on aesthetic medicine, and is a leader in general aesthetic medicine as a plastic surgeon.

Medical institutions with Dr. Shigeaki Miyata

Miyata plastic surgery and skin clinic Miyata Plastic Surgery/Skin Clinic:
Contact: 03-5510-3931

We asked Dr. Miyata about PicoWay [only for doctors]

Dr. Nariaki Miyata's Picco Way Instruction

  • Irradiation method that makes it difficult for picoway to cause blisters and pigmentation and what to do if it occurs
  • Things to tell the patient before surgery to avoid trouble
  • What is the reason why the results of the pico way vary greatly depending on the practitioner?
  • Among the pico laser machines, what can be done because it is a pico way, charms and drawbacks, etc.
Please tell us about the appeal of PicoWay and the treatments that can only be done with PicoWay. Also, please let me know if there are any points that you think would be better.
Dr. Shigeaki Miyata
It has the shortest pulse width, making it possible to perform sharp treatment, and it is attractive that it can remove even very thin spots. In addition, it is a big advantage that there are many wavelengths that can be installed and they can be irradiated with practical output. However, a short pulse width is not always superior, so I think it would be better if it was variable.
There is light (IPL) treatment as a treatment method that can irradiate the entire face. Is there a difference? Please let me know if you have any points to use.
Dr. Shigeaki Miyata
When focusing on melanin, texture, and skin firmness, I don't think IPL is necessary with Picoway, but IPL has a wide wavelength band and responds to "red". It is also possible to treat using heat with a long pulse width. There are cases where IPL is effective, such as treatment of redness and hair removal.
Are there any types of irradiation methods, symptoms, or skin types that tend to cause burns or pigmentation? Also, please let me know what to do if this happens.
Dr. Shigeaki Miyata
Setting the irradiation fluence high just because there is no effect is the source of trouble. The sharper the treatment, the narrower the safety margin. Also, of course, it is necessary to determine the indications for skin with chloasma, sunburned skin, and strong dry skin.
If pigmentation occurs, time will resolve it, but in addition to UV care and moisturizing, external application such as hydroquinone is prescribed.
Is there anything I should tell before the treatment so that I do not complain about the treatment by PicoWay?
Dr. Shigeaki Miyata
It's not a magical cure. Recently, picosecond lasers have been advertised as devices that can remove anything from the melanin system. We also emphasize the importance of patient cooperation.
Do the results of PicoWay treatment vary greatly depending on the practitioner? Please tell me why.
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 differ 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.
Thank you very much, Mr. Miyata.