Skin Solutions:

Laser treatments for pigmentation

Pigmentation appears in different forms like freckles and hyperpigmentation from acne. Unfortunately, these spots don’t always go away when they’re left on their own. According to dermatologist DR ANGELINE YONG, lasers like Picosure and Picoway are the gold standard when it comes to treating pigmentation. Why are lasers among the most effective treatments for pigmentation?

Lasers have varying wavelengths measured in nanometres (532nm, 755nm and 1064nm, for example) and these are selectively absorbed into the skin by what we call “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.

One way to think of it is like tiny missiles that can precisely target the chromophore of concern and lead to its specific destruction and clearance; at the same time, there is minimal 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. This is because they have less photothermal effect compared to older Q-switched lasers, and therefore less of a risk of post-laser hyperpigmentation when used by expert hands. They also allow for better, more precise results in each session, including increased clearance rates and efficacy.

Can you explain the differences in the lasers you use in 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, 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 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) and having the option of employing them in different modes gives me the widest array of choice when dealing with a patient’s pigmentation concerns.

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 a 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.

Angeline Yong Dermatology

6 Napier Road, #03-02

Gleneagles Medical Centre

6592 1311 | info@ayd.com.sg | ayd.com.sg