Guide to Pico Lasers in Singapore 2022 by Dr Isaac Wong

In Singapore, lasers are frequently used to treat skin conditions like acne marks and pigmentation as well as to remove tattoos. There is a laser in particular — the pico laser. What is a pico laser, and why is it so popular? Below, everything you need to know about pico lasers.

A pico laser is a pigment laser that operates in ultrashort picosecond laser pulses. Instead of nanosecond pulses in regular Q-switched lasers, the pico laser’s picosecond pulses enable it to carry less photo-thermal effect and a higher photoacoustic effect.

So, with a shorter pulse width, pico lasers are able to:

• Shatter pigmentation into smaller fragments, leading to clearance of pigmentation by the immune system in a shorter amount of time
• Reduce the risk of side effects like post-inflammatory hyperpigmentation

Regular lasers utilise a single wavelength of light to deliver energy to the skin. They can usually reach pigment, water and blood. Pico lasers, on the other hand, belong to a special category of lasers that can deliver energy in several billionths of a second. It is this unique property that enables pico lasers to effectively disrupt pigment-containing cells within the skin at a much faster and higher rate than regular lasers. The energy delivered by pico lasers has also been shown to improve skin texture by remodelling collagen.

Additionally, pico lasers have the unique feature of creating light induced optical breakdown or micro-cavities within the skin, which is extremely beneficial for removing fine lines, acne scars and tattoos. Similar to fractional lasers, the laser energy from pico lasers is delivered as an array of concentrated beam spots — except with no damage to the top layer of the skin, resulting in lesser downtime.

Pico Lasers can be used on the skin for various reasons, including:

Clear pigmentation and blemishes

• Sun spots, freckles and brown spots
• Stubborn melasma
• Birthmarks of different colours including black, grey, blue and brown such as Hori’s nevus, Café-au-lait spots and Nevus of Ota
• Stains on the skin from medication, sclerotherapy and iron injections

Skin rejuvenation

• Laser peels
• Acne scars
• Fine lines, pores and wrinkles
• Skin toning

Tattoo removal

• Professional and amateur tattoos
• Gravel tattoos

Currently, there are four types of pico lasers in the market: PicoSure, PicoPlus, PicoWay and PicoCare. The differences in these pico laser machines are technical details, such as their wavelengths, pulse durations and maximal power. For example, PicoPlus and PicoCare carry 4 picosecond wavelengths, PicoPlus has 3 wavelengths and PicoSure has 2 wavelengths.

Apart from that, pico lasers still work under the same principle and technology. In theory, more wavelengths mean more pigmentation types that can be treated; but there is little evidence to show that one pico laser is better than the other. These technicalities should matter more to the doctor as he/she is the one operating the machine.

As such, results will highly depend on factors like your doctor’s experience and skills, your skin type, skin colour and type of pigmentation.

In short, choosing the right doctor who can diagnose and treat your condition correctly is more important than the type of pico laser.

The Focus Lens Array is a special lens that can be capped onto PicoSure lasers. It’s designed to microscopically concentrate the powerful energy of pico lasers onto small areas of tissue. Each lens array is made up of hundreds of micro lenses per square centimetre that redistributes each PicoSure pulse into tightly focused regions.

This allows each beam to treat a small area of skin with highly focused energy — up to 20 times more of a PicoSure machine without the array lens. Only 10% of skin is treated with highly fluency at one time, leaving the 90% of surrounding tissue to be treated at a lower fluency for a gentler background effect.

As a result, there’s a deeper penetration to the dermis area, allowing for new collagen and elastin for skin rejuvenation while stimulating a non-traumatic tissue response.

Pico Lasers can treat most if not all types of acne scars. In fact, pico lasers have a rather unique way of treating scar tissue — the focused beams create air bubbles within the outer layers of skin, causing a subcision-like effect. This helps lift tethered scars and stimulates collagen production and remodelling over time.

As such, pico lasers can be used on minimal to moderate tethered rolling or boxcar acne scars.

Some lasers cause hyperpigmentation on darker skin types due to burning. However, thanks to the pico laser’s ultra-short pulses that rely on photo mechanical disruption instead of heat to shatter pigmentation, it can be used safely on dark skin without the risk of post-inflammatory hyperpigmentation. All that with zero downtime!

Pico Lasers are used frequently for tattoo removal in Singapore.

In general, tattoo removal works by delivering large amounts of laser energy to tattoo pigments, which are then shattered and removed by your body’s immune system. The pico laser’s higher peak power and shorter pulse duration mean results are achieved.

With that said, the efficacy of tattoo removal also depends on the tattoo’s depth and colour. Black tattoos are a lot easier to remove compared to yellow tattoos. It is recommended to use a pico laser with four different wavelengths.

Pico Laser treatments for acne scars and pigmentation are often well tolerated by patients and do not usually require anaesthesia. The sensation is similar to a rubber band snap. Treatment of deeper pigment like tattoos and birthmarks however may be slightly more uncomfortable and require topical cream or an injectable anaesthetic.

The process of removing a tattoo is almost as painful as getting one. A combination of techniques may be adopted to minimise discomfort:

• Cooler during the treatment
• Icing
• Local anaesthetic 

For all treatment sessions, protective eyewear is required and provided by your doctor to protect your eyes.

The best candidate for pico laser is someone with:

• Good health
• Pigmentation spots or acne scars
• Tattoo(s) of any colour and size more than six months old

You may not be able to undergo pico laser treatment if you fall under the following groups:

• Have seizures triggered by light
• Have active skin conditions at the treatment site

After treatment, your skin may be warm and slightly red, similar to a sunburn effect. This will disappear in 1-8 hours. To soothe this redness, cooling and healing growth creams may be applied.

Other rare side effects include:

• Burns to the skin resulting in blisters and scabs
• Infection
• Hyperpigmentation for darker skinned individuals or those with recent tanning
• Alteration in pigment

For tattoo removal, there is a small risk of scarring and pigmentation changes. You may be at a higher risk of these side effects if you have:

• Dark skin
• Colourful tattoos
• Big tattoos

• No sun tanning and tanning cream 4 weeks prior to treatment. Sun exposure reduces the effectiveness of laser treatment and increases the chance of post-treatment side effects
• Use a broad spectrum sunscreen with SPF 30 or higher
• Remove all creams, oils or makeup prior to treatment

Avoid rubbing, touching or scratching your skin
It is normal to experience slight redness or skin sensitivity after a pico laser treatment. Excessively rubbing, touching or scratching your skin can lead to further irritation or inflammation.

Avoid sun exposure or load up on sun protection for 7-14 days
Sun exposure after laser can cause your skin to become more sensitive, putting you at a higher risk of hyperpigmentation or even scarring. If you need to be under the sun, cover up and apply sunscreen with SPF 30 or higher.

Avoid applying makeup
As your skin is still sensitive after treatment, applying makeup products may clog up your pores, causing irritation and potentially causing sub-optimal results.

Keep your skin hydrated
Keeping your skin properly moisturised and hydrated after a pico laser treatment will help in healing. Most doctors will recommend using a prescribed post-laser cream or balm, followed by an unscented moisturiser. Where possible, opt for moisturisers with added SPF and avoid those that are heavily scented. Ensure to drink plenty of water to help with hydration too.

Gently cleanse your skin
When washing your face for the first time after a pico laser treatment, avoid using hot water as this may cause further burning. Instead, use cool or lukewarm water. While a gentle oil-free or gel cleanser is your best option, do consult your doctor on the types of cleanser you can use after your procedure. Avoid using an exfoliator or washing your face too vigorously for the time being.

In Singapore, the cost of a complete treatment using pico lasers will depend on factors such as:

• Complexity of the target area
• Severity of your condition
• Doctor’s experience

A complete treatment plan usually requires 3-6 sessions. On average, a session of pico laser starts at $250. For problems that are more complex, more treatment sessions may be needed and the cost can go up to $1000 for one session.

Look out for clinics that offer mini treatments at a very low price. Chances are, the settings used in the lasers are not accurate and may damage your skin. Everyone’s skin condition is unique and hence would require personalised treatment.

Yes, although pico laser can treat a broad range of skin conditions, it is sometimes combined with other treatments for optimal results.

I hope this guide proved useful in helping you have a better understanding of pico lasers in Singapore. Remember that the goal of aesthetics is always improvement and not perfection — so it helps to keep an open mind and have realistic expectations as well. The success of a treatment plan lies on not just the equipment used but the skill and experience of the doctor as well. Choose wisely!

Got questions? Feel free to contact me through these various methods:

• direct message me on Instagram (Instagram.com/dr.isaac.wong)
• whatsapp me @ +65 88089887
• email me @ dr.isaac.kj.wong@gmail.com

References

(1) Torbeck RL, Schilling L, Khorasani H, Dover JS, Arndt KA, Saedi N. Evolution of the Picosecond Laser: A Review of Literature. Dermatol Surg. 2019 Feb;45(2):183-194. doi: 10.1097/DSS.0000000000001697. PMID: 30702447.
https://pubmed.ncbi.nlm.nih.gov/30702447/

(2) Torbeck R, Bankowski R, Henize S, Saedi N. Lasers in tattoo and pigmentation control: role of the PicoSure(®) laser system. Med Devices (Auckl). 2016 May 2;9:63-7. doi: 10.2147/MDER.S77993. PMID: 27194919; PMCID: PMC4859414.
https://pubmed.ncbi.nlm.nih.gov/27194919/

(3) Hsu VM, Aldahan AS, Mlacker S, Shah VV, Nouri K. The picosecond laser for tattoo removal. Lasers Med Sci. 2016 Nov;31(8):1733-1737. doi: 10.1007/s10103-016-1924-9. Epub 2016 Apr 7. PMID: 27056705.
https://pubmed.ncbi.nlm.nih.gov/27056705/