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The Picosecond (PS) laser has enjoyed great popularity since its introduction into aesthetic medicine as early as three decades ago.[1]

Initially used for tattoo removal, pico lasers today are recognised for their powerful abilities to treat a myriad of skin conditions, including acne scarring and pigmentation disorders.

Almost every if not all aesthetic clinics in Singapore provide pico laser services – suffice to say, this technology is really popular.

But many don’t know this ‘pico laser’ term they throw around loosely is a technology that exists in many forms (or rather, brands and machines); in Singapore, common brands include Picosure, Discovery Pico, Picoway, Picoplus, and PicoLO.

Picosecond lasers also vary in the wavelength – 755nm (picosure) and 1064nm (the rest). 755nm has a higher affinity for melanin compared to 1064nm; it targets melanin in the skin. 1064nm has higher affinity for hemoglobin (blood) compared to 755. This affinity has an effect on treatment efficiency and possible side effects.

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Why does this matter?

Recently, I’ve been seeing a lot of advertisements for pico laser packages priced at $88. Many patients have also stepped forward to compare prices.

In aesthetics or any service for that matter, pricing and outcome certainly isn’t always directly correlated; but factors like the machine used, laser setting and skill of the doctor play a huge role in treatment outcome.

From an aesthetic doctor’s standpoint, $88 for a pico laser treatment sounds too good to be true. Let me explain why.

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How does the pico laser work?

The Picosecond laser uses a picosecond (less than 0.001 nanosecond) pulse duration. This causes mainly photoacoustic (mechanical) damage rather than photothermal (heat) destruction of pigment or ink particles.

For example, as the laser light energy is delivered so rapidly, it creates swift vibrations of the pigmentation it targets. This results in rapid heat dissipation, i.e. the skin only experiences very little heating effect and thus minimal discomfort. All this results in:

• Effective clearance of abnormal pigment
• Minimised heat damage to the surrounding tissue and hence lower chance of side effects

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Why choose a picosecond laser?

With treatment efficacy optimised, possible side effects (such as post-inflammatory hyperpigmentation, heating, prolonged redness post treatment) commonly experienced with traditional nanosecond domain lasers (e.g. Q-switch lasers) are also reduced.

In Asian patients, because our skin contains more melanin, we are more prone to PIH – this is why the pico laser should be the treatment of choice for hyperpigmentation, acne scarring and photoaging. Your treatment should not be worsening your condition!

What makes the Pico laser truly stand out is its potential for collagen stimulation WITHOUT breaking the skin barrier!

This is achieved through the use of a special FOCUS lens handpiece with a Diffractive Lens Array. With this focus lens, laser energy that passes through smaller spots is magnified by up to 20 times.

This creates laser-induced optical breakdowns (LIOB) or small microscopic microcavities in the skin without disrupting the skin surface, resulting in a controlled micro-injury that serves as a stimuli for subsequent collagen production.

This allows Picosecond lasers to be used to treat skin texture problems such as pores, fine lines and also atrophic acne scars! With no skin disruption, the Picosecond laser can deliver:

• Improvement in acne scars with faster recovery than traditional ablative laser treatments 
• Less discomfort during and immediately after treatments. 
• Lower risks of complications such as PIH, prolonged redness and skin sensitivity than conventional ablative lasers such as the fractional CO2 or Erbium YAG lasers.

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Introducing PicoSure Pro for pigmentation and melasma

As good as the Picosure laser is, a limitation it has is its difficulty in treating stubborn deeper pigmentation conditions, such as melasma and Hori’s nevus.

The depth of penetration of the 755nm laser is slightly more shallow than its 1064nm counterparts. But all is not lost! ENTER PicoSure Pro, a 2022 update of the old picosecond laser.

PicoSure Pro is the enhanced, upgraded version of PicoSure, in which it can remove pigmentation with lesser pain and downtime than its predecessors.

It’s also currently the only FDA-approved laser for melasma, Hori’s nevus and Nevus of Otus.‍

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What’s the secret?

PicoSure Pro comes in 755nm wavelength, which primarily targets the root of pigmentation, melanin instead of water and hemoglobin thus sparing damage to surrounding tissues and reducing side effects. This formidable laser also comes with a flat optic lens that addresses discrete targeted pigmentation lesions in all skin types.

In a recent clinical study[2] done on Asian patients, the majority of participants achieved at least 60% and 90% pigment clearance after two and three sessions respectively.

If you’ve been struggling with pigmentation for a long time, I highly recommend you give PicoSure Pro a go.

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PicoSure Pro vs Old Picosure: Additional benefits

You can expect:

• Improvement in target pigment with minimal collateral damage to surrounding tissue 
• Collagen stimulation 
• Overall skin rejuvenation 
• Minimal downtime that lasts for only 1-2 days 
• Effective pigment clearance within a week 

Of course, depending on the extent and severity of the pigmentation/treatment concern and lifestyle factors, more laser sessions may be required.

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Why a $88 picolaser session is unlikely to work

Good and trustworthy Picosecond laser machines are usually very expensive, and to market a PS laser treatment for $88 or less would not be cost effective to a clinic.

For one, the focus lens handpiece is a clinic consumable with a finite number of shots (yes, each shot fired is cost to the clinic, which is why it is very hard for clinics to sell $88 Picosure treatments).

In order for a clinic to charge a treatment at $88, I am assuming that

• The treatment time is short or abbreviated. I’ve heard patients complain that “the laser was done in less than 5 minutes” or “ the doctor only used one handpiece for the entire treatment” and “the laser was so weak, I couldn’t feel any difference in my face after the treatment”. 
• The Doctor may have to do many treatments in a short span of time like a factory line and hence is unable to customize each treatment to the patient’s condition and skin type. 
• With the wrong or lower power settings, it is difficult for patients to get the desired results. In the worst case scenario, their pigmentation may be made worse.

These are of course merely assumptions – from an aesthetic doctor’s standpoint, the low price is likely a marketing gimmick meant to lure patients in, with the purpose of upselling more sessions.

The length of treatment might be shorter than a regular treatment, and the doctor might not have time to attend to individual pigment concerns (it is very possible to have different types of pigmentation present at the same time).