picosecond

“Hey doc, I heard this popular Q-switched Nanosecond laser promises to resolve pigmentation/anti-aging/pores/pimples/wrinkles all at once.”

It’s shocking to hear that from my patient as the “famed” Q-switched 1064nm laser DOES NOT achieve the above at all.

Do you do weekly Q-switched “maintenance”? Good luck.

Don’t get me wrong, the Q-switched Nanosecond 1064nm ND:Yag laser (AKA Revlite, SpectraXT, Fotona QxMax) is actually GOOD for brown pigmentation.

The PROBLEM comes when patients start using Q-switched for pores, pimples, wrinkles and saggy skin.

For the Q-switched to have ANY effect at all on the above, it MUST to be used very frequently and at high settings. This causes darkened spots on your face, or worse; permanent white spots!

 

Hyperpigmentation

Looks like acne but its actually Hyperpigmentation!

white spots” after laser treatment

Hypopigmentation or “white spots” after laser treatment

IF YOU START TO NOTICE TINY WHITE/RED DOTS ON YOUR FACE, STOP YOUR FREQUENT Q-SWITCHED IMMEDIATELY!!!

The reason for this is because the Q-Switched laser generates photoTHERMAL effects, leading to HYPER and HYPO pigmentation (PIH). It’s a laser that is designed for INFREQUENT USAGE! Use it carefully, and sparingly, only for brown pigmentation removal.

Q-switched nanosecond lasers shouldn’t be done lifelong. Once pigmentation woes are solved, other lasers help much more with face care/aging maintenance!

Safer Alternatives for Pigmentation

A better choice for pigmentation, in my opinion, is the PICOSECOND laser as it generates lesser photoTHERMAL effects and more effective photoACOUSTIC effects. (1). To further reduce this negative heat, I usually use a Zimmer Skin Cooler to ensure safety and comfort during my Picosecond laser treatments. However, do remember that this is again only an option for treating PIGMENTATION.

Do NOT start to use PICOSECOND lasers for frequent face maintenance or you’d destroy your skin!

PICOSECOND lasers

So Which Lasers Work for Wrinkles, Pores, Saggy Skin?

I always tell patients: Collagen is found only in middle and deeper layers of the skin – so why use lasers that strip the surface for collagen stimulation!!?

The way to go is Non-ablative Fractional Resurfacing as it penetrates into deeper layers of the skin while avoiding ablative effects. (3)

target for non-ablative lase

There are 4 main pros to using non-ablative laser for anti-aging:

  • They accurately target the correct elements in the skin for collagen growth.
  • No Fractional RF/CO2 side effects since they don’t burn the skin.
  • Much lower downtime. Only a mild redness after each session that lasts a day to a week.
  • No risk of hyperpigmentation since it doesn’t target melanin.

Here are some Non-ablative Fractional lasers that I personally feel REALLY WORK FOR ANTI AGING:

1. Fractional Thulium 1927 nm

AKA:  BB laser, LASEMD, LAVIEEN, Fraxel DUAL, De Oro DUAL

The Fractional Thulium laser is effective against wrinkles, scars, pores and even pigmentation such as solar lentigines, freckles and melasma.

2. Fractional Erbium-Glass 1550 nm

AKA:  Fraxel Restore, Sellas Evo, Mosaic, De Oro DUAL

Fractional Erbium Glass reaches the deepest layer of the skin and is best for pores, deep scars and deep wrinkles. It also controls sebaceous glands to treat and prevent acne!Fractional Erbium-Glass alone was shown to be marginally better than fractional RF (Venus Viva/Infini/Intracel) in terms of results, with no side effects from ablation like the fractional RF! (4)

erbium

3. FRACTIONAL Picosecond

Not just a normal Picosecond laser but a FRACTIONAL one. It’s the latest non-ablative resurfacing and promises to bring wrinkle and scar treatments to a completely different dimension. (5).

Why aren’t more clinics using these lasers?

Picosecond, Q-switched, Fractional CO2, Fractional Thulium, Fractional Erbium-Glass, Fractional Picosecond… we’re talking about 6 or more lasers here. Assuming each laser costs $100k, that’d be upwards of $900,000(!!!) for the full set up. Not every clinic will invest in the best laser setup if using something less effective costs 20% the price.

For me, I like to use a combination of Fractional Thulium, Fractional Erbium-Glass, Fractional Picosecond (each has its own advantages) to achieve a multi-layered treatment plan that saves money and time. However, not all clinics use so many lasers so make sure you call and find out before committing.

If you’re interested in more about lasers, I wrote a very comprehensive laser guide for DoctorXDentist here.

But at the very least, don’t use the Q-switched laser for anti-aging or ‘facial maintenance’ anymore!

References:

  1. Trivedi et al; A review of laser and light therapy in melasma; WDS Vol 3, Issue 1, March 2017, Pages 11-20
  2. Nikalji, Nanma, et al; Complications of medium depth and deep chemical peels; Journal of Cutaneous and Aesthetic Surgery, vol. 5, no. 4, 2012, p. 254.
  3. Silonie Sachdeva et al; Nonablative fractional laser resurfacing in Asian skin – a review; JCD Vol9, Issue 4, December 2010, Pages 307 – 312
  4. Nopnarueporn Rongsaard et al; Comparison of a bipolar fractional radiofrequency device and a fractional Erbium-doped Glass 1,550nm device for the treatment of atrophic acne scars: A randomised split-face clinical study
  5. Jeremy A. Brauer et al; Use of a Picosecond Pulse Duration Laser With Specialised Optic for Treatment of Facial Acne Scarring; JAMA Dermatol. 2015;151(3):278-284