Is Pico Laser Really the Best Way to Treat Acne Scars?

By now, most if not all of you should know that I’m a huge fan of the PicoSure laser — not only is it used for pigmentation and tattoo removal, it’s also used for removing acne scars. Granted, different patients have different skin conditions, which means not everyone would respond equally to the same treatment type. However, my patients would know that I like to incorporate in PicoSure technology for their acne scars whenever possible.

In this article, I will explain why I favour the pico laser over other lasers to treat acne scars and how I combine the pico laser with other acne scar treatments.

A pico laser, or picosecond laser, is a laser technology that delivers laser pulses at one trillionth of a second. To be precise, it’s a pulse width of 0.0000000000001 seconds — 12 digits behind the decimal point. Compared to nanosecond lasers, pico lasers produce pulse widths that are 1000 times shorter, thus breaking down pigments into smaller fragments. It also decreases the risk of side effects like post-inflammatory hyperpigmentation.

When laser light is absorbed by pigmented lesions, the light will vibrate and fragment these particles into ultra thin sand-like pieces. During this process, the pigment articles and melanin are broken down in pico seconds with a pico laser. The laser pulses generate a photo acoustic effect and targets the pigments without damage surrounding tissue.

In Singapore, lasers used for acne scar removal typically fall into two main categories:

• Ablative lasers
  These are the Erbium YAG and Fractional CO2 lasers, commonly used in clinics for improving acne scars. Ablative lasers work by removing damaged tissue and melting or vaporising it. They erode the scar surface and tighten collagen fibres under your skin. However, ablative lasers are known to have a longer recovery time.
• Non-Ablative Lasers
  Instead of removing tissue from your skin, non-ablative lasers boost collagen production instead to improve the appearance of skin. While non-ablative lasers have shorter recovery times, they are better used on less severe acne scars. Common non-ablative lasers are the diode and Nd:YAG lasers.

While fractional ablative lasers like the CO2 laser can remove acne scars, it works on only 20-30% of the top layer of skin, leaving the surrounding untouched healthy skin to revitalise removed skin.

A common acne scar treatment for deep acne scars is INFINI. This procedure combines two technologies: Microneedling and radiofrequency. Radiofrequency is delivered via microneedles deep into the dermis, which encourages the production of collagen and elastin. This tightens scar tissues, reduces the depth of acne scars and improves overall skin texture. However, what I do not like about INFINI is that it requires the physical poking of fine needles into acne scars before it releases Radiofrequency energy, which happens to be full of heat. This commonly results in heat damage and side effects such as poor wound healing, post-inflammatory hyperpigmentation and further scarring.

Subcision is also another popular method for severe acne scars, but many patients find that this procedure is often quite painful and carries a bad downtime of swelling, pain and even bruising. However, this is due to the nature of the treatment, which involves using special hypodermic needles to break open tethering acne scars.

The pico laser, on the other hand, is able to remove acne scars without removing the top layer of skin. This also means there is virtually no downtime.

Another thing I especially like about the pico laser is that it’s able to fit on the Focus Lens Array, a special lens that allows the power of pico lasers to microscopically penetrate through smaller treatment areas. This allows for focused and more specific treatment with highly focused energy — up to 20 times more than a pico laser without the array lens! Patients who have tried this have reported not only an improvement in their acne scars but overall smoother skin too due to the collagen generated.

Pico Lasers are my top choice for mild to moderate depressed acne scars, such as icepick scars, boxcar scars and rolling scars. For such patients, I like to combine picosure with fractional mode handpieces and topical creams and serums containing tranexamic acid, vitamin C, arbutus and hydroquinone.

I also treated moderate boxcar acne scars with pico lasers, but I make sure to inject growth factor cytokines into the scars right after the treatment. The growth factors from the cytokines boost the recovery process and collagen production of picosure, thus providing even better results.

Deeper rolling scars and boxcar scars unfortunately will require subcision. For such scars, I inject a collagen stimulator such as calcium hydroxyapatite or polycaprolactone immediately after the treatment process to produce collagen in the empty spaces available.

To sum up, most acne scars can be treated with the pico laser, which is my treatment of choice. However, as every patient’s skin is different, it is best to have an in-person consultation before deciding on a procedure.

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