- Best Results1-3 months
- Treatment Recovery0 days
- Procedure Time10-20 minutes
- Skin SpecialistDavin Lim, Nurse
- Duration of ResultsMonths to years
- AnaestheticNot required
- Back to WorkImmediately
Picosure Laser for melasma
Picosure laser can be a useful treatment for melasma. Unlike other lasers that reduce pigment transfer, Picosure disrupts the pigment in the upper layers of skin. This can markedly clear melasma within a few sessions. Unlike Dermamelan & Cosmelan peels, Picosure has no downtime. Lasers are always combined with medical therapy.
FactsFacts on Picosure for Melasma
- Picosure works by clearing pigment in the upper layers of skin
- Results can be seen in as little as one week
- 2-5 sessions produce the best results
- Unlike peels, Picosure has no associated recovery
- Treatment takes less than 5 minutes & are comfortable
- Lasers are part of the multimodality approach to treat melasma
- Other super important treatment includes creams, sun protection & tablets
What can Picosure do for melasma pigmentation?
Picosure is the latest generation of picosecond lasers. It is the best laser for skin rejuvenation & pigmentation, including melasma. Picosure uses ultrashort pulses of energy, minimizing heat transfer to the surrounding skin. This means pigment removal with little to no collateral damage to the unaffected areas.
We also use another picosecond laser, the Picoway. This laser is best for non-melasma pigmentation, including birthmarks as well as treating red & black tattoos.
*Note: settings & technique are critical when treating melasma, performed incorrectly, pico lasers can worsen melasma pigmentation.
How many sessions will I require?
Between two to five, spaced 3 to 6 weeks apart. The lower number represents lighter skin types with superficial melasma, whilst more sessions are required if you have darker skin type with deeper pigmentation.
When will I see the results from Picosure?
Most patients will see results within 1 to 4 weeks of treatment. You may have slight darkening of melasma initially, however this is short lived. Maximal results are seen 2-3 months after starting Picosure.
Is Picosure laser painful & what is recovery like following treatment?
In the context of melasma treatments, Picosure is well tolerated as the energy we use is very low (unlike high-power high-pass Picosure Pro toning). No numbing cream is required. After Picosure, your skin will be red for 1-3 hours. Recovery thereafter is uneventful.
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Can Picosure be used on all skin types & colors?
Sure can. Picosure is made for darker skin types, including Asian, Middle Eastern & ethnic skin. It is super safe, provided correct settings are utilized.
How long does treatment take?
Treatment time ranges between 5 to 12 minutes, depending on the extent of pigmentation. We typically space treatments 3-6 weeks apart.
*Combination QSL & Picosure treatments extend treatment time to 15 minutes.
What lasers do I employ to treat melasma?
My team & I employ over 11 different types of lasers to treat melasma, depending on your skin type (color), depth of melasma pigment, previous treatments you have attempted & how fast you want results.
Spectra, Spectra Hollywood, C6, RevLite, Pastelle lasers. These lasers work by reducing pigment production over weeks to months. They are low risk, slower to work, however cost less than Picosure Pro. For patients who are after faster results, we often combine Picosure with these older tech lasers.
Fraxel, Lase MD. These lasers are best used for treating non-melasma pigment, & should not be used as the primary treatment for melasma. They can be employed in a special setting to deliver skin ‘actives’ to reduce pigment.
Clear & Brilliant Diode lasers. Best used after Picosure or Spectra as a maintenance laser.
Hybrid lasers. 1570 & 1550 non-ablative lasers can be used for resistant deep dermal cases of melasma. They work by pushing pigment in the deeper layers of skin upwards- the melanin shuffle.
VBeam Prima, Perfecta, DermaV lasers. These lasers are best used in conjunction with pigment lasers & work by reducing vascular input. Best combined with t.acid.
Are lasers the best answer for treating melasma?
No, but they are very useful. The answer for treating this condition is a combination of creams, sun protection, & oral agents to reduce cell signaling to the melanocyte or pigment cell. Dermatologists prescribe creams that contain-
- Arbutin: a naturally occurring pigment inhibitor.
- Azelaic acid: an anti-inflammatory agent.
- Ascorbic acid: an antioxidant, also known as vitamin C.
- Kojic acid: an oldie but a goodie, 0.5 to 1.5%.
- Glycolic acids: in low concentration.
- Botanicals: such as bearberries.
- Hydroquinone: the best pigment inhibitor but used in caution.
Are laser brands important when treating melasma?
Yes & no, think of lasers as a pair of scissors for cutting hair. Just as long as it is sharp, the end results depend on your hairdresser. Having a good & reliable laser is essential. In the context of melasma treatment, peak operating power is not an important factor, but consistency of power is. It is more complex than that, see the section on ‘Davin’s viewpoint’ below for a full explanation.
What is our success rate when it comes to treating melasma?
80 to 90%. Higher success rates in primary melasma, epidermal pigment, patients who are good with sun protection.
Lower success from microneedling melasma, dermal disease. I have zero chance of improving melasma if you are not good with sunscreens.
What is the cost for Picosure in the context of melasma treatment?
Treatments start from $390 (nurse performed procedure). Add $150 for combined Picosure Pro & nano Spectra laser.
My fees for Picosure Pro melasma laser is $890 per session, hence it is more cost effective if my nurses perform this procedure.
*Note Picosure for melasma is different from Picotoning. The latter requires 3-4 times the energy & passes.
How do I find out if Picosure is the best treatment for my melasma?
Book a consultation with my team at Cutis Dermatology, Brisbane. My colleagues & nurses are experienced in assessing patients with pigmentation.
A virtual consultation with myself is possible, acknowledging limitations apply; especially when it comes to dermatologic examination of pigment depth.
Why are medical treatments essential?
Lasers & peels such as Cosmelan & Dermamelan are adjunctive therapies to medical management of melasma. Medical therapy modulates pigment production, namely to reduce pigment cell activity. We achieve this with the use of tyrosinase inhibitors & vascular endothelial growth factor modulation.
Medical therapy entails the use of HQ, ascorbic acid, kojic acid, arbutin, & botanicals as first line, whilst tranexamic acid orally is used as second line therapy, followed by lasers & peels.
Are peels better than Picosure for treating melasma?
No. I personally love chemical peels, I use them daily, however in the context of melasma pigmentation, lasers are more precise, cost less, & are more effective. Occasionally I do use Dermamelan & Cosmelan peels in select patients. These peels can give fast results; however they have a higher rebound rate, cost more, & are associated with a recovery period of 1 to 2 weeks.
In select patients, I do employ retinoic acid, TCA, lactic & glycolic acid in low concentrations as part of rotational therapies for melasma.
Can my team & I cure melasma?
No, I cannot, but chances are we can help most patients. Remission from melasma typically is 4 to 18+ months, depending on endogenous factors (your genetics) as well as exogenous factors, namely sun exposure.
Davin’s viewpoint on Picosure for melasma
If you notice my older write ups on the use of picosecond lasers for melasma (including the older Picoway & first generation Picosure), I was totally against these ultra short pulse duration lasers. I DID believe they have a minimal, if any, role against melasma. Fast forward to 2023, & my viewpoint has shifted somewhat- especially after the newest generation of pico lasers, namely the Picosure Pro.
Use in the correct setting as adjunctive therapy, low fluence, low to moderate pass, fractional and full beam Picosure Pro can markedly reduce pigmentation in most cases of melasma. It does so with added safety & effectiveness over nano lasers which were the gold standard in the treatment of melasma.
In 2023 my team & I are combining Picosure Pro with lasers that reduce pigment transfer, namely Q switch lasers. The logic is as follows; Picosure still follows the theory of selective photothermolysis, working on the basis of photomechanical over photothermal outcomes. This means much less heat transfer to the surrounding skin during the lasing procedure. This translates to a marked reduction in pigment load in the epidermis, & possibly the dermal layer. Epidermal exfoliation is straightforward & usually occurs within 3-5 weeks, depending on the age of the patient & hence epidermal turnover. Dermal clearance, if any, is delayed. Think tattoo pigment, however in melasma we have misplaced melanocytes in the deeper layers of skin- unlike tattoos. The cross talking between cells such as fibroblasts, endothelial cells, macrophages & even the keratinocytes to dermally placed melanocytes is a mystery. This means (surprise, surprise), epidermal melasma is easier to treat.
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