### Date : 2025-11-15 14:35 ### Topic : Pico Laser ---- # **1. What is a Pico Laser? (Definition)** A **picosecond laser** delivers energy pulses in the **picosecond domain (10⁻¹² seconds)**. This is significantly shorter than: - **Nanosecond Q-switched lasers** (10⁻⁹ seconds) - **Microsecond lasers** - **Millisecond lasers** This ultra-short pulse duration produces a **dominantly photomechanical/photoacoustic effect**, which is the defining characteristic of a pico laser. --- # **2. Core Physical Principle** ## **2.1 High Peak Power + Ultrashort Pulse** Pico lasers deliver energy so quickly that **thermal conduction cannot occur**. Instead of heating, they create: ### **Photoacoustic Shockwaves** - Sudden expansion → cavitation - Breaks pigment into extremely fine particles - Less collateral heat damage ### Compared to nanosecond Q-switched: - **Pigment fragmentation is finer** - **Thermal damage is much lower** - **Risk of PIH is reduced** - **Clearance is faster** --- # **3. Mechanisms of Action** ### **3.1 Pigment Removal** Primary mechanism: **Photoacoustic fragmentation of melanin or tattoo ink.** Melanin particles → shattered into dust-sized particles → rapidly removed by macrophages. This explains: - Faster clearance - Fewer sessions - Lower PIH rate ### **3.2 Dermal Remodeling** At higher peak energies or fractional mode, pico lasers generate: **LIOB (Laser-Induced Optical Breakdown)** - Formation of micro-cavitation bubbles in upper-to-mid dermis - Stimulates fibroblasts - Triggers neocollagenesis - Improves texture, pores, scars This is why pico lasers can be used for: - Acne scars - Enlarged pores - Fine lines - Skin rejuvenation --- # **4. Available Wavelengths** Typical pico laser platforms offer: 1. **1064 nm (Nd:YAG)** - Deep penetration - Safest for Asian skin - Melasma, PIH, pores, scars 2. **755 nm (Alexandrite)** - Strong melanin absorption - Effective for tattoos and epidermal pigmentation - Higher PIH risk in Asian skin 3. **532 nm** - Superficial pigment - High PIH risk - Used selectively --- # **5. Clinical Indications** ### **5.1 Pigment Disorders** - Melasma - PIH - Freckles - Lentigines - Ota-like lesions - Tattoos (professional or amateur inks) ### **5.2 Skin Texture & Pores** - Enlarged pores - Textural roughness - Early photoaging ### **5.3 Acne Scars** - Rolling and shallow boxcar scars respond the best - Usually requires combination therapy ### **5.4 Rejuvenation** - “Glass skin” effect - Tone and brightness improvement --- # **6. Benefits of Pico Laser** |Benefit|Explanation| |---|---| |**Lower PIH risk**|Less heat → safer for Fitzpatrick III–V| |**Faster pigment clearance**|Finer fragmentation of melanin| |**Minimal downtime**|No ablation unless fractional mode| |**Dual-purpose**|Pigment + Texture| |**More comfortable**|Less heat sensation| --- # **7. Limitations** 1. Not as effective as ablative lasers (CO₂/Er:YAG) for deep scars 2. Pigmentary disorders such as melasma still require **conservative protocols** 3. Tattoos with certain inks (green/blue) may require specific wavelengths 4. Results are **gradual**, requiring multiple sessions --- # **8. Safety in Asian Skin** Pico lasers are considered one of the safest energy-based devices for Asian skin: - Minimal epidermal heat - Lower risk of rebound hyperpigmentation - Ideal for melasma maintenance However, excessive fluence or poor technique may still cause PIH. --- # **9. Treatment Protocol Framework** ### **9.1 Frequency** - 2–4 weeks intervals - 5–10 sessions for pigment - 5–8 sessions for pores/texture ### **9.2 Common Settings** (Typical ranges, device-dependent) - Fluence: **0.3–1.2 J/cm²** - Spot: **6–10 mm** - Mode: - Non-fractional for pigment - Fractional MLA for texture/scars ### **9.3 Before/After Care** - Sun avoidance, sunscreen - Minimal downtime - Avoid irritants for 3–5 days - Vitamin C or growth factors may enhance recovery --- # **10. Comparison with Nanosecond Lasers** |Feature|Picosecond|Nanosecond| |---|---|---| |Mechanism|Photoacoustic|Photothermal + photoacoustic| |Pigment fragmentation|Very fine|Moderate| |Pain|Lower|Higher| |PIH risk|Lower|Higher| |Sessions needed|Fewer|More| |Scar/texture use|Yes (LIOB)|No (limited)| --- # **11. What Pico Laser Cannot Do** - Cannot replace **ablative resurfacing** for deep scars - Cannot remove **vascular lesions** (PDL or Nd:YAG required) - Cannot treat deep wrinkles as effectively as ablative lasers - Must be cautious in melasma (low fluence essential) --- # **12. Best Clinical Use Cases (Evidence-Based)** 1. Melasma maintenance (low-fluence 1064 nm) 2. PIH reduction 3. Pore + texture improvement (fractional MLA) 4. Tattoo removal (755/1064 nm combination) 5. Acne scar improvement as part of a combination protocol 6. Brightening and skin tone evening --- # **Summary in One Sentence** **Pico laser is a high-precision, low-thermal, photoacoustic laser platform ideal for pigment clearance and dermal remodeling with minimal downtime, especially safe and effective for Asian skin.** --- # **1. Cynosure Pico Laser Platform Overview** Cynosure’s pico laser line includes: - **PicoSure (755 nm + optional 532 nm)** - **PicoSure Pro (755 nm + new optics)** - **PicoSure with Focus Lens Array (FLA)** – fractional mode **Key differentiator:** 755 nm Picosecond Alexandrite laser, not Nd:YAG. **Clinical implication:** - Strong melanin absorption (30–40× higher than 1064 nm) - Excellent for epidermal pigmentation - Requires careful fluence control in darker skin types --- # **2. Physics of Cynosure PicoSure** ### **2.1 Pulse duration** - **750 picoseconds** (original PicoSure) - **<600 picoseconds** (PicoSure Pro) ### **2.2 Mechanism** Unlike most picosecond Nd:YAG systems, the Cynosure pico platform uses: - **Photomechanical/photoacoustic fragmentation** - **Minimal thermal damage** - **Unique “Focus Lens Array (FLA)” fractional optics** which magnify peak power 20× at microspots to induce **LIOB**. --- # **3. Wavelengths** ### **755 nm Alexandrite – primary wavelength** - Very strong melanin absorption - Excellent for freckles, lentigines, tattoos - More aggressive than 1064 nm - Not the first-line wavelength for melasma (risk of PIH if poorly controlled) ### **532 nm (optional handpiece)** - Superficial pigment - High PIH risk in Asian skin → used with extreme caution --- # **4. Clinical Indications** ### **PicoSure 755 nm (non-fractional)** - Freckles - Lentigines - Tattoo removal - PIH - Ota-like macules - Sun-damaged skin ### **PicoSure Focus Lens Array (fractional mode)** - Pores - Skin texture - Acne scars (mild-to-moderate) - Photoaging - Dull skin tone - Skin rejuvenation - Fine lines - Overall skin tightening --- # **5. Cynosure’s Focus Lens Array (FLA) – Key Technology** This is the strongest part of the PicoSure technology. ### **How it works** The FLA converts a single beam into **100–200 microbeams**, each concentrating energy by up to **20 times** at microspots. This creates **dermal LIOB (cavitation bubbles)** while leaving the epidermis intact. ### **Outcomes** - Dermal remodeling - Neocollagenesis - Pore reduction - Scar improvement - Minimal downtime (mild erythema for <24 hours) --- # **6. Recommended Clinical Parameters (Cynosure Pico)** (Values differ slightly by device generation, but the following are widely used in Korean dermatology clinics.) ### **6.1 Pigment – lentigines, freckles** **Mode:** 755 nm, non-fractional - Spot size: 2–3 mm - Fluence: **0.40–0.70 J/cm²** - Frequency: 5–10 Hz - Endpoint: Immediate light whitening (“frosting”), no epidermal burn **Sessions:** Often 1–2 sessions (very fast clearance) --- ### **6.2 Melasma / PIH (Very cautious protocol)** **Mode:** 755 nm non-fractional - Spot size: 6–8 mm - Fluence: **0.20–0.35 J/cm²** - Repetition: 6–10 Hz - Endpoint: Gentle erythema only **Interval:** Every 2–4 weeks **Sessions:** 5–10 sessions **Clinical note:** 755 nm addresses epidermal component, but **1064 nm is safer for dermal melasma**. Most Korean clinics **combine Nd:YAG toning (1064 nm)** with **PicoSure FLA** for best results. --- ### **6.3 Pores / Texture (using Focus Lens Array)** **Mode:** 755 nm FLA - Spot size: 6–8 mm - Fluence: **0.60–0.80 J/cm²** - Frequency: 5–10 Hz - Passes: 2–3 smooth passes **Endpoint:** Mild erythema, immediate glow **Sessions:** Every 3–4 weeks × 5–8 sessions --- ### **6.4 Acne Scars (FLA mode)** **Mode:** 755 nm fractional - Spot size: 6 mm - Fluence: **0.80–1.0 J/cm²** - Passes: 3 passes (criss-cross pattern) - Endpoint: Mild edema, erythema **Sessions:** Every 4–6 weeks, 5–8 sessions **Clinical note:** For moderate scars, combining with: - RF microneedling - Subcision is significantly more effective. --- # **7. Safety Considerations for Korean Skin** ### **7.1 Avoid high fluence** The 755 nm wavelength is potent; PIH can occur if parameters are too high. ### **7.2 Avoid aggressive overlap** Overlap increases thermal accumulation despite pico technology. ### **7.3 Always observe endpoint** Cynosure’s recommended endpoint: - **“Even, light erythema”** not erythematous edema. ### **7.4 For melasma** Use low-fluence 755 nm very carefully or use the **FLA fractional mode** to avoid thermal triggers. --- # **8. Comparative Strengths vs. Other Pico Lasers** |Feature|Cynosure Pico|Nd:YAG Pico (e.g., PicoPlus, Discovery)| |---|---|---| |Wavelength|755 nm|1064 nm (primary)| |Melanin absorption|Strong|Moderate| |Pigmented lesions|Excellent|Excellent| |PIH risk|Higher|Lower| |Fractional technology|Focus Lens (LIOB)|MLA (varies by device)| |Pores/texture|Strong|Strong| |Melasma|Sensitive|Safer| **Conclusion:** Cynosure PicoSure is a **“precision pigment + texture laser”**, particularly powerful for freckles, lentigines, pores, and rejuvenation. For deep melasma and dermal pigment, Nd:YAG picosecond often complements it. --- # **9. Suggested Clinical Protocols for Your Practice** ### **A. Freckles / Lentigines Package** - 755 nm - 2–3 mm spot - 0.5–0.7 J/cm² - 1–2 sessions ### **B. Pores / Texture (Glass Skin)** - FLA mode - 2–3 passes - 0.7 J/cm² - Every 3 weeks × 5–8 sessions - Combine: Skin Botox or exosomes ### **C. Acne Scars** - FLA 0.8–1.0 J/cm² - Subcision if tethered - RF microneedling between sessions ### **D. Melasma Adjunct** - Low-fluence 755 (0.2–0.3 J/cm²) - No epidermal “frosting” - Combine with Nd:YAG toning (1064 nm) --- # **10. Summary** Cynosure PicoSure is a powerful, highly precise system. Its strengths include: - Strong melanin targeting - Excellent pigment clearance - Unique Focus Lens Array for dermal remodeling - Minimal downtime - Strong pore/texture rejuvenation - Safe with conservative parameters in Korean skin Areas requiring caution: - High fluence on Korean skin - Melasma (must be low-fluence) - Avoid excessive overlapping passes ---