why treat it?
Everyone desires a clear, even-toned and bright complexion. Unsightly blotches of pigmentation distract from and dull your natural beauty.
Pigmentation can result from inherited factors or environmental damage. Freckles, age spots, cafe au lait macules, Hori’s nevus, Nevus of Ota, post-inflammatory hyperpigmentation and melasma are some of the conditions we have treated frequently.
to treat pigmentation safely and effectively
Discovery Pico Plus
Discovery Pico Plus is a second-generation triple wavelength picosecond laser that generates the highest peak power in the world. With more than 5 times the peak power of the most powerful nanosecond Nd:YAG laser (Starwalker) and 450 picosecond laser pulses that are more than 10 times shorter, it is able to produce more photoacoustic effect with less collateral damage. This means that it can shatter pigmentation more effectively leading to quicker results and lower risk of complications.
The third ruby 694nm wavelength is highly specific for melanin and is able to remove certain types of pigmentation more quickly with less risk of post-inflammatory hyperpigmentation compared to the limited 532/1064nm wavelength of most picosecond lasers.
Fractional Picosecond Laser - Discovery Pico Plus
A special microlens array further focusses the energy into numerous micro-beams 2mm under the skin. This produces very high energy in the microbeams that can clear stubborn pigmentation more effectively while reducing the risk of complications by leaving a fraction of skin untreated to help heal the treated skin.
Fractional Thulium Laser
Thulium laser has a wavelength of 1927nm and is able to selectively remove only the superficial layer of the skin where most of the pigmentation is concentrated, leading to a whitening effect, collagen stimulation and improvement in pigmentation. Due to the very controlled damage when applied in a fractional manner, there is very minimal downtime.
dr wan's perspective
Dr Wan strongly advocates a meticulous and holistic approach. It is imperative to review the patient’s history and skin condition in detail for a proper diagnosis, the crucial first step towards proper removal of pigmentation.
Dr Wan does not subscribe to a one size fits all approach to treating pigmentation, such as the indiscriminate application of laser toning or facials that can lead to slow results and potentially serious side effects. It is important to analyze and customize treatment to each patient’s diagnosis, skin colour and personal characteristics such as response to laser therapy so that the pigmentation can be removed with minimal fuss and risk. Every patient is different and what works for some may not work for others, thus it is important to have a wide range of cutting-edge treatment options available.
While it is possible to lighten pigmentation without lasers, it is often slow, difficult or fails to show a significant result. This is because most pigmentation medications rely on slowing down pigmentation production and encouraging the skin to remove the pigmentation, which this tends to take a long time. Lasers directly destroy built up pigmentation within the skin in a specific manner, producing faster and more obvious lightening.
Dr Wan has performed many thousands of pigmentation laser treatments over more than 5 years. In his opinion, the difficult part about treating pigmentation is often not removal but keeping the pigmentation away, hence aftercare is very important. Treating pigmentation is not just about machine-based treatment, it is also essential to use topical and oral medication as well as sun protection to control pigmentation production.
- Melasma is influenced by genetic, hormonal factors as well as sun exposure and tends to recur
- one of the most common problems that Dr Wan has been treating
- currently, there is no laser or treatment that can get rid of melasma forever
- a combination of laser treatment to lighten the pigmentation and medication (topical and oral) to control pigmentation production will be able to significantly lighten or even clear the melasma in most cases
- medications are essential to suppress the melasma activity
white spots can develop after prolonged or excessive traditional nanosecond laser. Dr Wan prefers to use fractional thulium laser which has added rejuvenation benefits and can keep the melasma away for a longer period of time.
- nanosecond q-switched laser has largely been superseded by newer picosecond lasers which are safer and more effective. Dr Wan prefers to use the fractional microlens array handpiece and ruby wavelength due to higher specificity for melanin and lower risk of noticeable white spots.
- Certain cases may still require traditional full-field picosecond laser as melasma often has a heterogeneous response to treatment.
- Fractional Microneedle Radiofrequency should be added wherever possible to improve the effects of the pigmentation lasers, as it improves efficacy and reduces complications, potentially by stabilizing the activity of melasma.
Freckles and age spots
- fairly easy to remove with the Discovery Pico Plus laser utilizing the 694nm ruby wavelength and usually respond within a few sessions
- very light or faint pigmentation may sometimes respond better to fractional thulium laser
- with appropriate after-care such as pigmentation creams, sun protection and oral supplements, these usually don’t come back very quickly once removed.
Cafe au lait macules
- respond well to the Discovery Pico Plus laser utilizing the 694nm ruby wavelength
- prone to recurrence and may require repeat treatment or combination treatment with fractional thulium laser
Nevus of Ota or Hori’s nevus
- situated deeper in the skin, hence their bluish or greyish appearance
- tend to be more stubborn requiring more sessions and higher power
- will respond to Discovery Pico Plus laser utilizing the 694nm ruby wavelength (for most) and/or 1064nm wavelength (for darker skin types or deeper pigmentation)
- in Dr Wan’s experience, although the process takes longer, the final result is often very gratifying as the difference is very visible and the pigmentation doesn’t tend to recur.
Post-Inflammatory Hyperpigmentation (PIH)
- results from excessive pigmentation produced in response to inflammation such as insect bites, wounds, acne, etc
- facial PIH responds rapidly to Discovery Pico Plus laser utilizing the 694nm ruby wavelength or 1064nm for darker skin types or more sensitive skin
- upper limb and especially leg PIH are trickier to deal with, often requiring longer courses of treatment and sometimes oral medication.