Picoway Treatments At A Glance
- Best Results2-4
- Treatment Recovery0- 3 days
- Procedure Time10-20 min
- Skin SpecialistDermal Therapist, Nurse, Consultant
- Duration of Results12-60+ months
- Back to WorkNext Day- 3 days
- Cost$- $$
Picoway is the newest generation three Pico Laser. The first & oldest model is Picosure by Cynosure. Pico Lasers can address many skin conditions ranging from pigmentation due to melasma, sun damage, freckles, as well as textural changes including wrinkles, enlarged pores, fine lines, and early and mild acne scarring. Pico lasers are the definitive laser for treating skin of colour, including Asian, & ethnic skin.
FactsFacts on Picolaser skin rejuvenation
- This laser is called Picoway & is the very latest generation of picolasers
- Picoway has many advantages over Picosure, namely more accessible power
- Picoway can treat skin pigmentation including melasma & sunspots
- Picoway can also improve pigmented acne scars & post inflammatory hyperpigmentation
- This laser can also be used to treat mild & early acne scars
- Birthmarks can also be treated with picolasers
What is Pico Laser?
Pico laser refers to the pulse duration of laser light. The very first generation of laser was called Picosure. This laser had its debut in 2013 & has remained largely unchanged for the past 7 years. Regardless, it still can give good results when it comes to treating green tattoos. I was an early adopter of pico technology and ran the Picosure system till late 2019.
Clinic Cutis has updated the pico lasers to third generation systems, namely the Picoway by Candela. This laser has much more power than the Picosure & has many more usable wavelengths including the 532, 785 & 1064 nm, together with fusion modes. This system allows us to treat a wide range of skin conditions including pigmentation, fine lines, enlarged pores, age spots, birthmarks & mild or early acne scarring.
What clinical indications do best with Picoway?
Pico lasers have a narrow therapeutic window, they are not the answer for every single case of pigmentation. Picoway is best for –
- Skin rejuvenation in darker skin types: This includes Asians, Middle Eastern, Central & South American as well as Islander skin. Pico lasers can provide dermal toning as well as a reduction in sun spots, background pigment, post inflammatory pigmentation & non-specific dyschromia (pigment).
- Post inflammatory hyperpigmentation in all skin types. This can be secondary to acne, dermatitis, burns, & other causes of PIH
- Dark marks from acne, namely PIH. Picoway can also remodel early acne scars that are red (PIE). Pico laser does not treat significant atrophic scars, so don’t waste your money.
If you have lighter skin types, you will get more traction out of IPL, BBL, fractional lasers, Q switch lasers & peels. Don’t waste your money on Pico lasers as this is overkill.
What is the best treatment for melasma, Picolasers or others?
Melasma is a unique form of pigmentation. This is a medical condition, even though it is managed by cosmetic clinics. Treatments are based around decreasing the activity of the pigment cell called the melanocyte. Lasers, including PicoWay, Picosure, Enlighten, Picoplus, Revlite & Spectra are all appropriate ways of treating melasma.
Pico Lasers can give marginal improvements over nano lasers & we do use them in our clinical practice as adjunctive treatments for melasma. Please visit the comprehensive melasma section of this website for much more information on how dermatologists treat this condition.
What is the recovery with Picoway - Picolasers?
It really depends on what we are treating and the settings of the laser. For cases of melasma, downtime is zero, whilst treating birthmarks & acne scars, downtime ranges from 3 to 6 days. We will give you an accurate healing up time frame based upon your clinical examination.
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Is Picoway better than Picosure?
Picoway is a third generation pico laser, compared to Picosure which is a first generation laser. Picosure has not been updated as of 2021, and the laser is 6 years old. The new device will be out in 2022, however they have kept the 755 nm alex. wavelength.
I do think that Picosure was way ahead of any other nano laser in 2014 -2015, however time has moved on & other competitors such as Picoway have caught up- until the release of Picosure Pro in 2022. I do believe that the 755 is way ahead of Picoway. Picosure can improve some forms of pigmentation & can be effective in treating green tattoos. The low power output of Picosure, coupled with filter wavelengths & cost of consumables, make this less than ideal for most dermatologists. These issues have largely been resolved with the gen 2 Picosure Pro.
Does Picoway hurt?
In most settings treatments are well tolerated. Unlike Picosure laser, no numbing gel is required.
Pico lasers are termed photoacoustic lasers, meaning they transfer light energy to sound. This transfer of energy is what produces pain. For extremely high settings on Pico lasers I prefer the use of numbing gel as it makes treatments comfortable for patients. Examples including treating birthmarks & tattoos.
What are the side effects of Picoway & Picolasers?
There is a marked difference between side effects (unwanted outcomes) & expected recovery (predictable & often necessary outcomes). For example, broken skin & crusting is an expected outcome if I am treating some birthmarks, but it is a side effect if we are using pico for skin rejuvenation. Unwanted side effects include-
- Prolonged healing, crusting & bruising (esp in high settings)
- Skin colour changes lasting more than 10 days (esp in darker patients)
- Acne like spots & dots (termed LIOBs, fade in 2-6 days)
- Infection (esp if you have a history of coldsores)
- Scarring (very rare)
- Oxidation of tattoo ink is usually predictable (skin-coloured cosmetic tattoos)
- Worsening or flare up of melasma is very rare in our clinic
Does Pico really treat acne scars?
Pico lasers including Picosure, Picoway, Picoplus, & Enlighten are all good at treating pigmentation, including pigmented acne scars- namely grade 1 scars. Pigmentation can be classed as red, a term commonly called PIE or Post Inflammatory Erythema. If you have red acne scars, vascular lasers such as V BEAM Perfecta or Prima is best. I also use IPL or BBL to address red scars.
If acne scars are brown, a term called Post Inflammatory Hyperpigmentation, then Pico lasers are appropriate. If you have depressed acne scars (usually visible on angled or tangential lighting), Pico lasers can be marginally effective. Studies show that pico can improve this type of scarring by 20-40% after 6 treatments. I do think that other less expensive treatments that have less downtime are better at treating acne scars compared to Pico lasers. Regardless if there is nothing available but a Pico laser, then certainly this can be effective in some patients.
- Pico lasers can treat acne scars
- Pico laser are best used to treat brown pigmentation scars
- Other lasers & treatments are better at treating depressed acne scars
- Pico lasers can give an improvement in pore sizing & overall skin quality
To understand if Pico is appropriate for your acne scar type, please book an appointment with my clinical team @cliniccutis.
How long does it take pico laser to work?
A few days to a few months, depending on what we target. Sun & age spots take the fastest time to clear, usually within a few days to a week. An approximate guideline is as follows-
Pigmentation: Age spots & flat warts often require 1-2 sessions. You should start to see a difference within 3-8 days, depending on the lesion & settings.
Melasma: Pico, or any other laser – peel are adjunctive treatments for melasma. This condition requires gentle laser treatments. Too fast, too powerful & melasma WILL flare-up. Most patients will notice a difference within 2- 4 weeks of pico laser. Maximal results are seen around week 10 to week 16. Regardless what the ads say, pico is not a miracle treatment for melasma.
Fine lines/Wrinkles/Skin rejuvenation: 1-3 sessions are required for best results, again depending on your skin type, treatment settings & downtime. It takes 3-8 weeks to see results, best results are seen when collagen stimulation is maximal at week 12 to 16.
Enlarged pores: Most cases require 2-4 sessions depending on your expectations. Results can be seen at 4 weeks, again maximal at 16 weeks.
Acne scars: Probably the biggest over hype of all. Pico treats PIH or post inflammatory hyperpigmentation associated with acne scars, however there are much better alternatives when it comes to true scars. Pico can be useful to improve pores, pigmentation & early / mild acne scars (less than 4 to 6 months old).
Tattoos: Pico gives better results than nano lasers. Black and reds are the easiest to treat, greens, yellows & multicoloured / layered tattoos are harder to treat.
Birthmarks: Marginally better than nano lasers. CALM birthmarks, late onset Hori’s, Ota, other dermal melanosis can improve. Still will require between 2-12 sessions depending on the pathology.
Can you wear makeup after a pico laser?
Yes, however we prefer an interval of several hours prior to placing on your makeup. In some cases your face may be red for 3 to 24 hours. Depending on the settings, you may get some swelling and short-term bruising. Your skin care expert will discuss downtime prior to laser treatments.
How long does redness last after pico laser treatment?
In most cases, only an hour or two. For more powerful treatments, you may be red for a few days. We will warn you prior to the procedure of the expected healing times.
This laser is especially useful in the management of ethnic skin disorders & pigmentation as it has no downtime.
Which Pico laser is the best?
It’s like asking which is the best tool for a carpenter- it really depends on the job! I have used several pico lasers, including the Picosure from 2014 to 2019. The main reason we replaced the Picosure with the Picoway in 2020 is the fact that Picosure did not update their device for the past 6 years, essentially this is a generation one device, compared to generation three Picoway. The Picosure can give good results with the 755 alex wavelength, however their 532 & 1064 wavelengths are extremely underpowered & in most cases useless.
Picoway & other second & third generation devices give better results in the above wavelengths, however, out comes depend on the how the lasers are used.
Davin’s Viewpoint on Pico Lasers
Pico is an instrument, that’s it. Much like how a carpenter uses his or her tools, the efficacy of pico is dependent on the context of the job. Pico lasers have a very, very narrow application window. The question is not ‘can pico treat xyz condition?’ It should be ‘when is it appropriate to employ pico lasers?’
Pico lasers have a distinct advantage over Q Switch or fractional lasers such as Fraxel when it comes to treating or addressing pigmentation in ethnic skin types, as well as providing low downtime skin rejuvenation in appropriate skin types. It can improve mild acne scaring, however other devices provide better outcomes with less downtime.
In the context of tattoos, pico can improve clearance of ink compared to traditional Q Switch lasers such as the Revlite, C6, Pastelle & others. Regardless of the pulse duration, tattoos require multiple treatment sessions. The Picoway laser is much better at tattoos compared to generation one Cynosure Picosure as the 2 primary wavelengths of Picoway actually work! Picosure had a marginal advantage with their 755 wavelength in the context of treating green ink. If you have red, black or other ink colours, second or third generation lasers work better than gen one.
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