Picosure Focus Lens or no Focus Lens for extremely stubborn sunspots?

In order to answer your question, it would best useful to know your skin type from the photos and the lightness of the pigmented areas. Also power settings might be important. 10 rounds of picosure are usually quite sufficient for treatment. If you have a darker complexion, you might want to stop where you are at.. The picosure focus lens does focus the beam and it is gentler and used at a lower power with less energy than a nonfocused lens. It compensates for the lower power by using multiple hits to the same area. I use the focus and non focus lens for treatment. Use of the focus lens only will require many more sessions than use of the non focus lens for pigmented lesions, because it has a lower power and is gentler.With careful Patient selection, improvement is possible with three sessions, primarily using the non focused lens. But remember, I usually use both unless the lesions are very separate and discrete. This is where photos will help.

More complex than that. You really do need a diagnosis. For melasma and or pigmentation that is due to sundamge only 2-3 picosure treatments are needed, in some cases I use the Focus, in others I use older nano lasers- video explains. Melasma is a very common cause of skin pigmentation. It can not be completely cured, however effective treatment are possible. This is because your skin is extremely sensitive to UV and even the smallest amount can stimulate your pigment cells to produce colour. The mainstay of treatment is strict UV protection- hats, sunglasses and SPF every 4 hours. This forms the foundation of all treatments. 



I prefer to use a combination of creams and laser for melasma. Hydroquinone can be used (5-8%), along with vitamin A creams or Meladerm. I start my patients on laser (low dose Q switch or Picosure) as this has shown to decrease pigment production by decreasing the activity of the cells that produce pigment. Laser itself is not aimed at ‘blasting’ pigment, but to slow down the rate of melanin production. Another laser I use is the Clear and Brilliant in the 1927 Permea setting combined with creams. IPL should never be used to treat mixed melasma as it often worsens the condition (this is termed ‘Rebound Melasma’) 



In some cases I combine glycolic AHA peels, and in other cases I use a tablet called Tranexamic acid to help. Melasma treatments should be tailored to each patient according the type of melasma. Majority of patients will have mixed dermal and epidermal melasma. Approach melasma as a medical condition and not a cosmetic concern, and the success rate will be much higher. 

Consult a Board Certified Laser dermatologist with a special interest in disorders in pigmentation as well as one who has experience in treating all skin types, including darker Ethnic skin. 



All the best, Dr Davin Lim. Laser, surgical and aesthetic dermatologist. Brisbane, Australia.