Good to hear that you are taking action to improve your acne scars and pores! Picosecond Q-switched Lasers are indeed becoming more popular as a treatment for acne scars and pores. Your excellent question would certainly help patients that are considering a low downtime treatment for their scars.
Can you combine different Pico lasers to treat acne scars and pores?
By ‘combine’, I am assuming that you mean to try different Picosecond Q-switched Lasers sequentially and not at the same time. Of course, doing too many different lasers together at the same sitting would not be advisable as firstly, you would not be able to tell which laser is actually producing results or complications; secondly, too much stimulation of the skin may increase the risk of complications such as Post Inflammatory Hyperpigmentation.
Otherwise, it’s absolutely fine to try out the various picosecond lasers available provided you are aware of the following key points
1. There should be an adequate gap between trying out each treatment to allow for skin recovery
Essentially, laser skin treatment is a form of controlled damage to the skin. Effects on the skin depend on how the laser interacts with the skin, as well as how the skin reacts to the laser stimulus. It is best to give the skin some time for recovery ranging from 2-4 weeks at least, depending on the intensity and aggressiveness of the treatment.
2. It’s hard to compare machines fairly to say which is best
Different settings such as fluence, shot count produce different discomfort levels, effects and downtime even with the same machine. Generally speaking, more aggressive treatment with high settings and shot counts would produce more collagen stimulation and skin remodelling but also more downtime and risk of complications. Conversely, the same settings using different machines would produce different effects. Thus you may not find it so straightforward to compare different machines fairly.
3. Doctors often start with more conservative settings. Following up with the same doctor allows better effects during subsequent sessions. The doctor would be able to observe your skin’s response and your feedback and adjust treatments accordingly.
Each patient’s skin reacts differently. While we can approximate starting settings after skin evaluation based on experience and recommendations, it is often prudent to start with lower settings and titrate up according to the clinical reaction. Hence you may not be able to see a truly representative results from just one session.
4. Improvements for scars and pores are often gradual and slow.
Studies have shown that after fractional lasers, collagen synthesis is increased at 1 month and up to 6 months. Furthermore, each session in a course of treatment has an incremental effect. Trying a few different lasers for 1 time each sequentially would make it hard to evaluate the actual effect of each laser.
5. Some picosecond lasers are not ‘true’ picosecond lasers.
Picosecond Lasers break up pigments more effectively (source)
True picosecond lasers (such as Discovery Pico, Picoway, Picosure, Pico Plus) have pulse durations measured in picoseconds (1/1000th of a nanosecond) and resulting high peak powers (e.g Discovery Pico 1.8GW). This better confines the laser energy to the target pigment, breaking it up more effectively and reducing collateral damage.
In particular, Fractional Picosecond Q-switched Laser treatment of scars and pores requires high peak power to generate Laser Induced Optical Breakdown (LIOBs) and subsequent plasma formation.
While some lasers are marketed as picosecond lasers, they do not have true picosecond laser pulses but rather nanosecond pulses modulated into picosecond spikes of power. As a result, they are able to produce only 0.5GW (similar to a nanosecond q-switched laser which has around 0.3 to 0.32GW) and poorer thermal confinement (since the overall pulse is actually not an ultrashort picosecond pulse).
In addition, there are often special attributes for each laser that may make it more versatile or more suitable for certain scenarios or conditions. This may be why the doctor chose to purchase that particular laser.
For example, Discovery Pico Plus has 3 wavelengths (without requiring dye converters), 3 pulse durations and high peak power, while Picosure is the only 755nm picosecond laser available. I would encourage you to speak to a doctor who can better explain how his/her Picosecond Q-switched Laser will be able to help in your particular case.
Hope this helps!
Warmest regards,
Dr Wan Chee Kwang
References
1. El-Domyati M et al.Multiple fractional erbium: yttrium-aluminum-garnet laser sessions for upper facial rejuvenation: clinical and histological implications and expectations. J Cosmet Dermatol. 2014 Mar;13(1):30- 7.
