Is success with the PicoSure Focus laser for melasma operator dependent?

Question

I recently had the picosure focus done to address my hyperpigmentation on my upper lip. I had it done by an RN at a reputable med-spa because my dermatologist doesn't offer that laser yet and it was such a better deal than at the Beverly Hills doctors offices I called. I had high hopes for this laser but unfortunately my hyper pigmentation has gotten worse after the picosure. Do you think it's becuz I may not have gone to the most skilled practitioner? Should I try it again with a dermatologist?

Harold J. Kaplan, MD · Answer

Hi CA Runner.  Unfortunately, it doesn't matter what practitioner you have.  When treating Melasma with a laser, it is very common for it to get worse.  We are not sure why medical practices do this (other than greed), but Melasma is a chronic and incurable condition.  You can manage it, but you cannot cure it and often treating it with q-switched (like Picosure) or fractional lasers makes it rebound worse than it was before.  
An experienced practitioner would have encouraged you to stick with hydroquinone based solutions rather than laser treatments.

Anna Avaliani, MD · Answer

Thank you for your question.  The short answer is that every laser treatment or treatment in general is operator dependent. Laser is simply a tool.  I have performed over 1500 Picosure treatments to date and I can safely state I have never ever ever made anyone's melasma worse.  Melasma is a chronic skin condition and treating it is generally difficult, but upper lip has always responded to treatment really well, at least for me. I treat all skin tones, mostly skin types 3 or 4, but have type 5 as well.  My protocols are 4 treatment sessions every 4 weeks and maintenance every 6 months.  You should have your melasma reexamined by dermatologist  and find a real Picosure expert in your area.  This treatment has been a life saver for women with melasma and I'm sorry you haven't experienced it yet.  best of luck. Dr.Avaliani

Craig Schwartz, DO · Answer

PicoSure Focus is an excellent laser modality to treat hyperpigmentation, but it will likely require several treatments. We typically perform a 3 treatment package to obtain the best results, so you will need to be patient. It is not unusual for pigmented areas to become slightly darker at first, and then slowly slough off over time. To answer your specific question, to a certain extent these types of devices are operator dependent. Which is to say that experience matters, and the more treatments an office performs, typically the better the results they see. You may want to ask your providers how long they have had the device, and how many patients they have treated.

Lichun (Li) Huo, MD · Answer

Hi, PicoSure is great for hyper pigmentation.  Spots do appear darker at first then become lighter.  Peeling and an acne breakout sometimes is normal as well.  Hyperpigmentation is a condition that requires patience, perseverance & consistency to treat.  Also multiple modalities are needed to see success such as a consistent skincare regimen, peels, and lasers.  Best of luck.

Emil A. Tanghetti, MD · Answer

There are certainly many factors that could possibly effect the treatment outcomes of the PicoSure Focus for melasma. First, you don't mention how many treatments with the PicoSure Focus Optic you had. To treat melasma, I typically recommend 4-6 treatments to see results. If you only had one treatment, it would not surprise me at all that you aren't starting to see results yet. Additionally, it looks like you are based in a sunny climate, so you have to be extremely diligent with your sun protection to prevent your melasma from worsening. Finally, treatment outcomes may also depend on the experience of the provider administering your treatment. It is important to choose a provider that has experience with both the device and condition they are treating so they know how to choose the optimal settings for your treatment. It's hard to pinpoint why you aren't seeing the results you desire without more information, but hopefully this helps!

Laura Riehm, MD · Answer

Thanks for your question.  Treating melasma is very tricky.  It makes your pigment very reactive to heat.  Based on your description, we would probably recommend retreating with the PicoSure FLAT lens while using a "zimmer" chiller to blow cool air on the area while being treated.  Treat the area with a very low number of pulses and watch it for a few weeks.  The pigment should initially get slightly darker over the first 48 hours and then begin to significantly lighten.  Best of luck.

Davin Lim, MBBS, FACD - Account Suspended · Answer

Absolutely, I delegate a lot of laser work such as tattoo removal, hair removal, Fraxel and nanosecond laser for melasma to my nurses however for bespoke melasma treatment is should ALWAYS be done by a Specialist. It is tricky to use, and experience with an understanding of the medical science behind not only Pico lasers, but melasma is the key to success. I have explained this in great detail in a YouTube video regarding 'How to treat melasma'. 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. 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. 
  
All the best, Dr Davin Lim. Laser, surgical and aesthetic dermatologist. Brisbane, Australia.

Is success with the PicoSure Focus laser for melasma operator dependent?

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Answers (7)

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