Q-switched Nd:Yag or Picosecond laser for treatment of dermal PIH? (photos)

Question

I've had PIH under my right eye for almost 2 years now. It's responding poorly to topical bleaching so I'm considering laser to get rid of it, but my derm only has the Q-switched laser. Are there really any advantages of the Q-switched laser over a picosecond laser for treatment of dermal hyperpigmentation? Or is the Q-switched just outdated in this field? From what I find the ps-laser just seems superior. Don't want to risk my results/face with old technology.

Raffy Karamanoukian, MD, FACS · Answer

In my practice, I try to stay away from these combination regimens, as cortisones are non-selective inhibitors of melanocytes.  I would recommend my patients to start Melarase AM and Melarase PM for the pigmentation.
I would start with an intense skin rejuvenation protocol for age spots that includes fractional laser, Covalent chemical peels, and daily skin brightening creams to improve your skin’s complexion. Laser therapy, he adds, must be combined with a proper skin regimen to enhance and maintain youthful results.
He recommends the following skincare products for dark age spots: Melarase
MelaClenz Brightening CleanserMelarase AM: Day-time skin lightener with SPF 30Melarase PM: Night-time skin lightenerMelapads: Daily Exfoliating PadsReplenish Retinoid Cream: Exfoliating and skin-stimulating night creamBest, 
Dr. Karamanoukian
Realself100 Surgeon

Harold J. Kaplan, MD · Answer

Hi URLM.  The Picosecond is also a q-switched laser.  Same technology as traditional q-switched lasers, just a marginally faster burst of light.  
What's important in this situation is not the technology as both will work, but how the treatment is performed.  It is a gentle treatment in comparison to most treatments because the post inflammatory hyperpigmentation needs to be coaxed out rather driven out.  If the treatment is too aggressive, you can wind up with darkening because of the treatment.
Finally, in the picture you posted, it's very difficult to see any hyperpigmentation.  Treating hyperpigmentation when it is virtually the same color as the skin can be difficult and lead to creating another problem.

Jason Emer, MD · Answer

A combination approach will give the most improvement. PIH can be improved with a combination of lasers (Fraxel, Tattoo, IPL), Aerolase, microneedling/prp, skin lightening, peels, and skin care. Sun protection is essential. I recommend getting a formal evaluation with a cosmetic dermatologist. Best, Dr. Emer

Q-switched Nd:Yag or Picosecond laser for treatment of dermal PIH? (photos)

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