Pigmentation appears in different forms, including sun spots, freckles and hyperpigmentation from acne. Unfortunately, these pesky spots don’t go away on their own! According to dermatologist Dr Angeline Yong, lasers like Picosure and Picoway are the gold standard when it comes to pigmentation treatment. We chat with her about the different lasers for pigmentation that can help.
Can I get rid of pigmentation with skincare only?
Pigmentation can be improved with some over-the-counter skincare products with brightening agents, and can also be better improved with certain prescription-grade lightening creams. However, it’s hard to completely get rid of pigmentation using just skincare. These products are best used preventatively, or as part of a complete treatment regime that incorporates other options like chemical peels, intense pulsed light (IPL) and lasers, which are still the gold standard option for most types of pigmentation. Skincare has limitations in what it can do; so, if the aim is purely for maintenance or improvement, then good, appropriate products can help achieve the goal.
Why are lasers among the most effective treatments for pigmentation?
Lasers have varying wavelengths, and these lasers of specific wavelengths (532nm, 755nm and 1064nm for example) are selectively absorbed into the skin by target chromophores. The target chromophore for pigmentation is melanin in the skin, and based on the type and depth of the pigmentation (epidermal, dermal or mixed), lasers of varying wavelengths can be selected to specifically target these pigmentary concerns in varying levels of the skin.
They are like missiles that can precisely target the chromophore of concern and lead to its specific destruction and clearance, whilst minimising any collateral damage to surrounding tissue and structures. In fact, with the picosecond lasers that we now have in our toolkit, we are more able to precisely target unwanted pigments and reduce post-inflammatory hyperpigmentation due to their photoacoustic instead of photothermal effect. With less photothermal effect compared to older Q-switched lasers, there is much less risk of post-laser hyperpigmentation when yielded appropriately in expert hands. In addition, more precise, better results such as increased clearance rates and efficacy per session can be achieved.
Tell us about the popular lasers for pigmentation offered at the clinic.
I love using my picosecond (pico) lasers, which are leading technologies globally. I employ two of the most well-regarded picosecond laser technologies – the Picosure laser (755nm pico laser), and the Picoway laser (532nm, 730nm and 1064nm pico laser). These are from two of the best regarded laser manufacturers in the world, Cynosure and Candela respectively.
I typically like to use both pico lasers when treating a patient with pigmentation problems as most patients usually have mixed pigmentation at varying depths, instead of just one type of pigmentation. The same patient may have ephelides (freckles), solar lentigines (darkened skin caused by UV radiation), melasma, Hori’s nevus (a type of pigmentation commonly found in middle-aged Asian women), uneven skin tone, acne hyperpigmentation, and textural concerns such as enlarged pores, fine lines and depressed acne scars. By having a big toolkit, I’m able to select the right wavelength and energy to treat the varying types of pigment and textural concerns in the same patient in the same setting. I usually call this a picosecond laser hybrid treatment, as I’ll employ both lasers so the patient can benefit from them.
This really allows me to precisely calibrate the treatment to suit the patient’s skin, available downtime and pigmentation concerns (be it epidermal or dermal-type pigment), as well as match to the patient’s own skin phototype. Skin phototype is an important factor to consider, as different types of skin can tolerate different treatment parameters. I treat patients of all skin tones in my practice; being able to selectively target the varying pigmentation concerns in different skin tones allows me to precisely treat each patient effectively and safely.
On top of the two pico lasers, I also have a Q-switched Nd-Yag laser, and a Gentlemax Pro Long-Pulsed Alexandrite and Nd-Yag laser to treat other types of pigmentation when needed. Having lasers of the three main wavelengths (532nm, 755nm and 1064nm lasers) and having the option of employing them in different modes give me the widest array of choice when dealing with a patient’s pigmentation concerns.
What are the different types of lasers on the market?
There are many different types of lasers on the market, and they can be classified in different ways. We can firstly look at them from an ablative or non-ablative standpoint, and a fractional or non-fractional standpoint. We can also consider and classify them based on what they’re used to treat. For example, there are hair-removal lasers, lasers for pigmentation, lasers that treat vascular and vessel concerns, lasers for rejuvenation, and even lasers to treat scars.
We can also consider lasers based on their wavelength, which is what a lot of professionals do; so, we discuss them based on their technical specifications. We differentiate lasers based on what sort of pulse duration they have – for example, long-pulsed, q-switched and picosecond. It’s useful when seeing a doctor to ask them what sort of lasers they have, and what they propose using to treat your concern. You’ll then be able to take the above specifics and do some background research on it. You can discuss the options with other professionals better in the future; in turn, they’ll be able to understand what you’ve had done, and how well it worked for you.
Just knowing whether a laser is a “pigmentation laser” or a “laser for rejuvenation” isn’t very useful; so many options can be employed, and it would be hard for another professional to advise you should you need treatment again next time. But knowing the wavelength and the type of pulse duration is useful as these lasers have specific characteristics that another practitioner will understand.
What should you look for when choosing a laser treatment?
It’s important to look for the best technology in each class. For example, if you decide that pico lasers are what you’re looking for, you should also look at the specific brand and manufacturer – like when you’re buying a car or household appliance.
It’s also important to note that not all pico lasers are the same – they can have different wavelengths. For example, my Picosure laser has a 755nm wavelength; my Picoway has 532nm, 1064nm and 730nm wavelengths. The treatment is different because of these different wavelengths – the reliability and pulse duration are different. Even though some lasers are classified as “picosecond lasers”, they’re closer to a nanosecond wavelength. So it’s important to go for globally recognised, market-leading brands due to the stability of the technology. There are cheaper alternative lasers on the market in each class but the precision and stability may not be there.
Can lasers be customised to different skin conditions?
Yes, lasers can and should absolutely be customised to every individual’s skin condition and phototype. It’s definitely not a one-size-fits-all treatment, and expert practitioners should never treat patients this way. If a practitioner only has one type of laser or energy-based device and suggests using this to treat all sorts of concerns, from red vessels to pigmentation and texture, I would be cautious; different conditions require varying lasers of different wavelengths and pulse duration to precisely target the tissue.
To get good outcomes and efficacy with limited surrounding tissue damage, it’s important to precisely target these chromophores with the most specific lasers. Using a non-specific energy-based device can lead to collateral damage; optimal outcomes are unlikely if the tissue of interest isn’t specifically targeted with maximal efficacy.
So yes, lasers must and should be precisely calibrated to suit each individual’s needs; this includes their skin concern and condition, skin phototype (very, very important) and also their acceptance of downtime and their lifestyle. You need a wide array of lasers to deliver this, and no one machine can do everything for all patients.
After the spots are removed via laser, will they resurface again?
Most spots when completely removed by lasers usually don’t resurface again; but be sure to take proper care using after-care creams and good skincare to maintain the results. Most importantly, use adequate photoprotection to prevent further pigmentation from reforming or developing.
However, certain conditions are prone to more than just sun exposure. For example, melasma has other factors at play including hormonal fluctuations and genetics. These conditions tend to be harder to control, as pigmentation may come back again even after series of treatments, depending on your age and hormonal status. In these cases, adjunctive management is essential to sustaining the improvement.
What are some post-laser aftercare tips to take note of?
We usually stress to patients to keep the skin well hydrated and adequately moisturised. This helps with post-laser recovery. It’s also important to avoid the sun and use adequate sun protection; this is because the skin is more sun sensitive, so there is a small risk of post-laser hyperpigmentation. The aftercare during the week following the procedure is usually the most important. Also, if you’re having a laser treatment where scabs do form, such as an ablative fractional or non-fractional laser, make sure you gently pat your face when cleansing so as not to knock off the scabs; let them fall off on their own for optimal healing.
To find out more about the different treatments for pigmentation, spots and more, visit Dr Angeline Yong.