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Understanding Pico Laser and Its Role in Melasma Treatment
Pico laser treatment has emerged as a popular method for addressing pigmentation issues, including melasma. This popular laser technology uses ultra-short pulses to break down pigmentation into tiny particles, which are then naturally eliminated by the body's immune system. Despite its growing popularity and effectiveness for many, some individuals find that Pico laser treatment doesn't work as expected. This article explores the reasons behind such outcomes and discusses alternative treatments for melasma.
What is Melasma?
Melasma, also known as chloasma or "the mask of pregnancy," is a common skin condition characterized by symmetrical, blotchy, brownish facial pigmentation. It typically appears on sun-exposed areas such as the cheeks, forehead, upper lip, and chin.
While more prevalent in women, especially during pregnancy, melasma can also affect men. Its exact cause is not fully understood but is believed to result from a combination of genetic predisposition, UV exposure, and hormonal influences. Although melasma is benign, it can be cosmetically distressing.
What is Pico Laser?
Pico laser technology has become a popular option for pigmentation treatment, including melasma, age spots, freckles and solar lentigo. In Singapore, common brands of pico laser include Picosure, Discovery Pico, Picoway, Picoplus, and PicoLO. Most picosecond lasers operate at wavelengths of 532nm or 1064nm, while Picosure has a unique wavelength of 755nm.
Pico lasers use ultra-short pulses of laser energy to target and break down pigment particles in the skin. Unlike traditional lasers that rely on heat, pico lasers work at picosecond speeds (less than 0.001 nanosecond). This enables accurate targeting of pigmented areas with minimal damage to surrounding tissues, making it an attractive option for treating melasma. Besides fading pigmentation, pico lasers can also break down tattoo ink and stimulate collagen production, which is essential for skin rejuvenation, reducing fine lines and wrinkles, and improving skin tone and texture.
Effectiveness of Pico Laser for Melasma
Pico laser treatment can effectively reduce the appearance of melasma, particularly for patients with superficial pigmentation. The rapid pulse duration allows for smaller fragmentation of melanin, which the body can then naturally eliminate. However, for deep and complex melasma, pico laser treatment alone may not be enough.
Why Pico Laser May Not Work for Everyone
While Pico laser treatment is versatile and effective for many skin conditions, its success rate can be influenced by several factors:
- Complex Nature of Melasma: Melasma is a multifactorial pigmentation condition that requires a multi-faceted approach. Combining laser treatments with topical agents (such as hydroquinone, retinoids, liposome cream), radiofrequency microneedling, and rigorous sun protection typically yields optimal outcomes than relying on a single laser treatment.
- Role of Non-Pigment Producing Cells: Recent studies indicate that keratinocytes (normal skin cells) and blood vessels also contribute to melasma development. Effective treatment should target these skin cells and reduce the number of blood vessels.
- Depth of Pigmentation: Melasma involves multiple layers of skin and various skin cells, including melanocytes (pigment-producing cells). The pigment is often deposited deeply in the dermis, making it difficult for a single type of laser to target all the affected areas effectively.
- Multiple Pigmentation Conditions: Many patients have a combination of pigmentation conditions, including sunspots, spider veins, and pigmented growths, alongside melasma. The response to laser treatment varies based on skin type, the depth of pigmentation, and the specific characteristics of their melasma. A single laser type may not be effective for all patients.
Figure 3 : Types of Melasma
- Continuous Triggers: Ongoing exposure to melasma triggers, such as sunlight and hormonal fluctuations, can cause the condition to persist or recur even after treatment.
- Post-Inflammatory Hyperpigmentation: Incorrect use of laser treatments or settings can sometimes lead to post-inflammatory hyperpigmentation, especially in individuals with darker skin tones, complicating the condition further.
What are the treatment for Melasma?
One of the most frequently asked question we receive is, "What is the best treatment for melasma?" The truth is, there isn't such thing as one effective laser treatment for pigmentation. Melasma is a complex skin condition that involves more than just overactive melanin production. While Pico lasers break down melanin, treating the root causes requires a combination of lasers and energy-based devices to prevent melasma from recurring.
1. Melanocyte Activity
- Hyperactive Melanocytes: Melasma involves an increased activity of melanocytes, the cells responsible for producing melanin (the pigment in the skin). These cells become overactive and produce excessive melanin, leading to hyperpigmented patches.
- Melanin Distribution: The excess melanin can be deposited in both the epidermis (outer layer of the skin) and the dermis (deeper layer of the skin).
2. Skin Inflammation
- Skin Inflammation: Inflammation in the skin stimulates melanocytes, leading to increased melanin production.
- Oxidative Stress: Environmental factors like pollution can cause oxidative stress, increasing melanin production and worsening melasma.
- Increased Vascularization: High levels of Vascular Endothelial Growth Factor (VEGF), a protein that promotes blood vessel formation, have been found in melasma lesions. This suggests that melasma also involves significant vascular changes. Chronic inflammation can stimulate the production of inflammatory mediators, promoting the growth of blood vessels.
3. Damaged Basement Membrane in Melasma
- Melanocyte Migration: Damage to the basement membrane can alter the interaction between melanocytes and keratinocytes, leading to abnormal melanocyte activity and increased melanin deposition in the dermis.
Choosing the right pigmentation treatment isn’t just about the machine
In addition to Pico lasers, other treatments like Nd:YAG laser, yellow laser, erbium laser, and radiofrequency microneedling can help reduce skin inflammation, target blood vessels, and repair the damaged basement membrane. Given the complexity of melasma, combining laser treatments and energy-based devices is important for achieving optimal results. A comprehensive approach with post-treatment management is essential for effectively managing this challenging condition.
According to Dr Thean, choosing the right treatment isn’t just about the machine; it’s about selecting the appropriate laser modalities and energy-based devices suitable for your skin, as well as the doctor’s experience and knowledge. Ask questions to help you choose the right aesthetic clinic for your melasma.
If you are considering Pico laser treatment, consult with your aesthetic practitioner to discuss your specific condition and develop a comprehensive treatment plan. Remember, a multifaceted approach that includes sun protection and possibly other treatments will yield the optimal outcomes in managing this persistent skin condition.