I fully agree with Dr David's advice to take a break from laser treatments for the time being. I also agree with his approach of emphasizing on the diagnosis and holistic approach to skin treatments.
IPL is a valuable light treatment and the LASEMD and Dual Yellow are both wonderful lasers for treating solar lentigo and melasma. I highly doubt that adding a picosecond laser would have made a large difference in treating your pigmentation. In fact, there are some studies to show that the long pulse visible light lasers treat lentigenes and melasma better than the pico or nanosecond lasers.
A few truths about Picosecond lasers that get drowned out in the ongoing hype:
1. People like to refer to Qswitch lasers as old nanosecond lasers. They are not! Q-switching is just a technique to obtain short and energetic laser pulses! Many famous Picosecond lasers use Q-switching to generate this: Discovery, Picoway, Fotona Starwalker to name a few.
2. Picosecond lasers in the hands of an inexperienced doctor are still less useful than a old nanosecond laser in the hands of an experienced one!
3. Picosecond lasers claim to be much safer because of generating less heat than the old nanosecond lasers. But adopting proper skin cooling measures with an old nanosecond laser will probably give you more margin of safety than using a picosecond laser without skin cooling! A proper skin cooling machine can bring skin temperature down to below room temperature easily, whereas a picosecond laser used without skin cooling will definitely elevate skin temperatures despite generating less heat.
Have a good laser break and as Dr David mentioned, let your doctor reassess the options for you. Discussing with your current doctor that has been taking care of you all these months could prove to be more fruitful than you think. Based on the fact that he/she has this wide array of options shows that he/she is serious about the work. Most doctors don't have that much investment and options!
Wish you the best.
