Indication
Pigmentation
Solar lentigines are rich in melanin, which absorbs the light from a picosecond or Q-switched laser and is fragmented into tiny particles. The PicoSure Pro (755 nm) and the PicoPlus do this with picosecond pulses, the Hollywood Spectra with Q-switched pulses. For diffuse photodamage on fair skin, we offer the ReClear IPL.
PicoSure Pro
Pigmentation: excess melanin as the target for light energy
Hyperpigmentation covers a broad spectrum of conditions in which melanin is overproduced locally or diffusely. The causes range from sun damage and hormonal influences (melasma) to post-inflammatory hyperpigmentation (PIH) after acne or skin trauma. Each type calls for a different treatment strategy, based on the depth, severity and cause of the pigmentation.
Choosing the technology based on pigment type and skin profile
IPL (Intense Pulsed Light) is effective for superficial, diffuse pigmentation such as sun damage and lentigines in light skin types. Its broad spectrum treats several chromophores at once and lends itself to treating larger areas.
Q-switched and picosecond lasers offer greater precision for concentrated pigment lesions. Picosecond systems such as the PicoSure Pro and the PicoPlus break melanin clusters into smaller particles than nanosecond systems, with less heating of the surrounding skin. On pigment spots, results are comparable to those of Q-switched lasers or slightly better.
Fractional lasers such as the Mosaic 3D, the eCO2 3D and the UltraClear work through skin renewal and can be used as a supplementary treatment for deeper or more pronounced pigmentation combined with wrinkles or texture problems.
In darker skin types, every pigment treatment calls for extra caution: higher fluences or the wrong wavelengths can worsen post-inflammatory hyperpigmentation. For pigment in darker skin types, 1064 nm in picosecond or Q-switched mode is usually used, as on the PicoPlus and the Hollywood Spectra. Long 1064 nm pulses, intended for hair removal and vessels, have little effect on pigment.
The practice perspective
Pigmentation is an indication with broad patient demand and a clearly visible result — which makes it a commercially strong treatment for clinics. Combining IPL for maintenance with laser treatment for targeted correction gives practices the flexibility to offer a complete treatment pathway.
Medi-Invest helps you put together a considered range for pigment treatment — matched to your patient population, skin type profile and the level of result you are aiming for.
Technologies for this indication
Alexandrite (755 nm)
Erbium
Ablative erbium can reduce mainly superficial, epidermal pigment, because the epidermis is renewed. In a randomised comparison in Asian patients with photoageing, pigment and uneven skin tone improved more with fractional Er:YAG than with non-ablative 1550 nm Er:glass [3]. Melasma calls for its own approach; see the melasma page.
Nd:YAG (1064 nm)
With Q-switched or picosecond pulses; a long pulse at 1064 nm has little effect on pigment. At 1064 nm for dermal pigment, such as naevus of Ota, because the light reaches deep and the epidermis absorbs little [4]. At 532 nm for epidermal pigment, such as solar lentigines. For lentigines, picosecond gave a comparable or slightly better result than Q-switched in two randomised studies [5][6]. In a Korean series, one in five patients developed post-inflammatory hyperpigmentation (PIH) after Q-switched 532 nm [7].
Devices for this indication
Etherea MX
UltraClear
Clarity II
FlexSys Laser
Hollywood Spectra
Healite II
PicoSure Pro
ReClear IPL
ZYE – 755 nm Alexandrite laser platform
ZYE – 1064 nm Nd:YAG laser platform
DermaV
Elite iQ
LaseMD Ultra
PicoPlus
Which device suits your practice?
Schedule a consultation and we will help you make the right choice.
References
- Ho SG, Yeung CK, Chan NP, Shek SY, Chan HH. A comparison of Q-switched and long-pulsed alexandrite laser for the treatment of freckles and lentigines in oriental patients. Lasers Surg Med. 2011;43(2):108–113. doi:10.1002/lsm.21045
- Ge Y, Yang Y, Guo L, Zhang M, Wu Q, Zeng R, Rong H, Jia G, Shi H, Fang J, Lin T. Comparison of a picosecond alexandrite laser versus a Q-switched alexandrite laser for the treatment of nevus of Ota: a randomized, split-lesion, controlled trial. J Am Acad Dermatol. 2020;83(2):397–403. doi:10.1016/j.jaad.2019.03.016
- Moon HR, Yun WJ, Lee YJ, Lee MW, Chang S. A prospective, randomized, double-blind comparison of an ablative fractional 2940-nm erbium-doped yttrium aluminum garnet laser with a nonablative fractional 1550-nm erbium-doped glass laser for the treatment of photoaged Asian skin. J Dermatolog Treat. 2015;26(6):551–557. doi:10.3109/09546634.2014.999020
- Husain Z, Alster TS. The role of lasers and intense pulsed light technology in dermatology. Clin Cosmet Investig Dermatol. 2016;9:29–40. doi:10.2147/CCID.S69106
- Kim JY, Yang J, Huh G, Choi YJ, Kim WS. A split-face, single-blinded, randomized controlled comparison of 532 nm picosecond neodymium-doped yttrium aluminum garnet laser versus 532 nm Q-switched neodymium-doped yttrium aluminum garnet laser in the treatment of solar lentigines. Ann Dermatol. 2020;32(1):8–13. doi:10.5021/ad.2020.32.1.8
- Vachiramon V, Iamsumang W, Triyangkulsri K. Q-switched double frequency Nd:YAG 532-nm nanosecond laser vs. double frequency Nd:YAG 532-nm picosecond laser for the treatment of solar lentigines in Asians. Lasers Med Sci. 2018;33(9):1941–1947. doi:10.1007/s10103-018-2560-3
- Kang HJ, Na JI, Lee JH, Roh MR, Ko JY, Chang SE. Postinflammatory hyperpigmentation associated with treatment of solar lentigines using a Q-switched 532-nm Nd:YAG laser: a multicenter survey. J Dermatolog Treat. 2017;28(5):447–451. doi:10.1080/09546634.2016.1254330
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