PicoSure vs Piqo4? Which is more suitable for acne scar treatment, dark spots and PIH?

Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to decide whether early subcision should be started.

Best,
Dr. Karamanoukian
Realself100 Surgeon

A combination approach will give the most improvement. These types of scars need a combination of lasers, Cosmelan, microneedling/prp, subcision and fillers. Co2 is the best laser for scars, but Erbium is a great alternative. It may take a series of treatments and may need some treatments to maintain. I recommend getting a formal evaluation with an acne scarring expert. Best, Dr. Emer

I think there is some literature about using Picosecond lasers for acne scars but I'm skeptical of the results at this point. The Picosure is mainly an underpowered 755 laser. Piqo4 has 532/1064 and 2 other wavelengths. I would use the 1064 in your skin type. The 755 is still safe but not as safe as the 1064. Its the fractional handpiece that is getting the buzz about this. I would say, alone, they probably won't make a profound difference, but in combination, they couldn't hurt. I wouldn't pay to much for these if used. My opinion might change with more data or nice before and afters.