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Huiqi from Singapore asked a question

What is the difference between Pico Plus, Pico Way and Pico Sure?

I am a 28 year old female and am looking at Pico laser for treatment for pigmentation. I have seen clinics in Singare that offer different type of Pico laser machines. How do I know which Pico laser to choose, as this enables me to select the right clinic?

DOCTOR’S ANSWER (5)
Dr Kelvin Chua
Aesthetic
Singapore
(7 Ratings)
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Dr Kelvin Chua
Aesthetic
Singapore
(7 Ratings)
Answered on Wed Jun 13 2018 23:55:19 GMT+0000 (UTC)

Hi Huiqi,

PicoWay, PicoPlus and Picosure lasers are different brands of laser where lasers are delivered in a much shorter time (i.e. picosecond rather than the nanoseconds) that Q switch lasers deliver it. The claim to these lasers is that with shorter burst of pulse, it will theoretically means less thermal damage to the surrounding skin. Some of these companies also claim that that also means it can deliver more energy and therefore is more effective. 

The truth is that there is no real strong head to head studies to show that picosecond laser is better than the conventional Q switch lasers in pigmentation reduction. Q switch laser has been around for several decades and picosecond lasers are a new trend with lots of marketing campaigns done on the internet. More recently, there is a ongoing lawsuit against PicoSure laser and its harm.

I think the important point I want to make is that it is hard to know the difference between what is marketing dollars talking and what is real evidence based medicine. Many studies have small sample size and are sponsored by the product company itself. So are many claims on the internet. 

My personal opinion is that many pico lasers used in the hands of the right doctor will function very much like the conventional Q switch lasers if the power, duration and diagnosis of your pigmentation is correct and the aftercare from the doctor is followed. I am honestly doubtful about claims of significant superiority to Q switch lasers in pigmentation removal. In fact doctors thinking that such picosecond lasers are much safer and therefore increase the power wrongly may result is greater damage than good. 

In short, go to a doctor who is experienced in pigmentation reduction rather than focusing so much on what laser is being used.

Hope that helps.

0 719 views 1 Doctors agree Wed Jun 13 2018 23:55:19 GMT+0000 (UTC)
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Dr Terence Tan
Aesthetic
Singapore
(8 Ratings)
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Dr Terence Tan
Aesthetic
Singapore
(8 Ratings)
Answered on Thu Jun 21 2018 04:01:09 GMT+0000 (UTC)

Dear Huiqi,

PicoSure, PicoPlus, and PicoWay are new picosecond lasers which are very effective in treating pigmentation of the skin. PicoPlus and PicoWay utilise a compound called Nd:YAG to generate the laser beam while PicoSure is currently the only Alexandrite picosecond laser.

While the characteristics of the two types of picosecond lasers are different, they are all very effective for treatment of pigmentation with minimal downtime. Picosecond lasers work by delivering an intense burst of energy within a very short time, within picoseconds to be precise!

This enables the lasers to work very effectively while reducing unnecessary production of heat, therefore reducing the side effects. Picosecond lasers are technologically more advanced than the older Q-Switched or nanosecond lasers, which have a longer nanosecond laser pulse.

PicoSure has an additional Focus Lens Array, which also enables the laser to treat acne scars, wrinkles, loose skin, and rejuvenates the skin. You may want to see an experienced doctor to discuss your concerns and discuss unique characteristics of each laser before deciding. Cheers!   

Dr. Terence Tan

0 331 views 0 Doctors agree Thu Jun 21 2018 04:01:09 GMT+0000 (UTC)
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Dr Chua Cheng Yu
Aesthetic
Singapore
(9 Ratings)
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Dr Chua Cheng Yu
Aesthetic
Singapore
(9 Ratings)
Answered on Sun Jun 24 2018 11:24:40 GMT+0000 (UTC)

Dear Huiqi,

Asking about different brands of lasers often gets many clinics come out and speak about their own brand defensively. I use a picosecond laser which comes with a fractional lens array (FLA) in my clinic too but I will not speak about what I use, rather, what the facts are.

The 'facts' of the debate behind picosecond lasers are:

1. Picosecond lasers use a shorter pulse duration so should be more effective and safer
2. Most of them also come with a fractional lens array (FLA) which are VERY useful for certain types of acne scars (keep in mind: only CERTAIN TYPES, and must be used carefully on certain skin types)
3. Dr Kelvin Chua is absolutely correct in saying that there is currently no strong clinical studies that show the superiority of the Picosecond lasers over the older Nanosecond ones - at least not yet.
4. There is even scantier evidence that one picosecond laser is better than the other! Much less the talk of a gold standard amongst Picosecond lasers. For example, I know an esteemed colleague who uses the Enlighten Pico (not what I use) which uses the longest picosecond pulse duration amongst the range, but still achieves fantastic results backed up by a lot of science.
5. That being said, the picosecond lasers should theoretically not do worse than the old lasers. 

These are way more important factors in my humble opinion:

1. In looking for something more effective, the doctor's diagnosis and decided treatment protocol is WAY MORE IMPORTANT than the picolaser choice. 
2. Proper pre-laser treatment creams, proper care during the procedure, and proper post-laser care are key to a successful treatment. 
3. Why look for a picosecond laser for pigmentation to reduce heating the skin unnecessarily, when the clinic does not even use a skin cooler while performing the laser? A cryotherapy device cooling the skin during the treatment would make an OLD nanosecond laser safer than a latest picosecond laser used without skin cooling!
4. Doctor's experience with the particular machine and his protocol for doing a certain treatment makes all the difference ultimately. There are some business-owned clinics doing 30 second laser facials - how much science is behind that? - and do you think the latest picosecond lasers used for these 30 second laser facials would help more than a dedicated doctor with an old nanosecond laser?

As Dr Kelvin said, there's a lot of marketing dollar at talk nowadays. Read wisely and all the best at making the best choice for your skin!

0 267 views 1 Doctors agree Sun Jun 24 2018 11:24:40 GMT+0000 (UTC)
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Dr Justin Boey
Aesthetic
Singapore
(16 Ratings)
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Dr Justin Boey
Aesthetic
Singapore
(16 Ratings)
Answered on Wed Jun 13 2018 15:37:37 GMT+0000 (UTC)

Dear Huiqi,

This is a question that I get quite commonly. PicoPlus, Pico way and Picosure are different brands of quality Picosecond lasers. 

There are other picolaser brands like discovery picolaser, Picocare and Enlighten.

This being said, there are several differences amongst Picolasers:

1. Pulse duration 

- the hallmark of Picosecond lasers is the ultra-short pulse duration as compared to nanosecond  in Q switched lasers. Pulse duration is important as shorter pulse duration means less photo thermal effect (less heat) to surrounding skin. 

- the "gold standard" pulse duration is widely accepted to be 450 Picoseconds. Picolasers like PicoPlus, Discovery pico and Picocare have 450 Picosecond pulse durations. 

2. Number of Picosecond Wavelengths 

- more wavelengths means more types of pigmentation conditions that can be treated.

- PicoPlus & Picocare have 4 Picosecond wavelengths. Discovery pico has 3 wavelengths. PicoSure has 2 wavelengths.

3. Peak Power 

- high peak power means more Laser energy to break down stubborn pigments, which translates to better results in fewer sessions.

- Discovery pico and Picoplus have the highest peak power of 1.8GW. 


Apart from technical specifications of machines, do consider the following 2 factors which affect results too. 

1. Country of manufacture

- research and clinical protocols for the picolaser are developed based on the predominant skin type of their population (Korean lasers have been studied on korean/oriental skin).

- Korean Picolasers like Lutronic's Picoplus and Wontech's Picocare have been developed to treat stubborn pigments in Asian skin. 

- other picolasers were originally made predominantly for tattoo removal in Caucasian skin. 

2. Experience & Training of the doctor in that specific Picolaser 

- at the end of the day, an excellent picolaser that is suitable for Asian skin is just a tool for the doctor.

- look for a doctor who has been well-trained by key opinion leaders in the laser.


Special note: look at the credibility and track record of the laser manufacturer. 

Syneron which produces Picoway has a history of producing excellent lasers. 

Similarly, Lutronic, which produced PicoPlus, has a legacy of producing top grade pigment lasers like Spectra XT (Q switched laser). 


For more insights on Pico lasers in Singapore, you can read my article on DxD.

Hope that this helps!

Warmest regards,

Dr Justin Boey 

0 764 views 0 Doctors agree Wed Jun 13 2018 15:37:37 GMT+0000 (UTC)
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Dr Elias Tam
Aesthetic
Singapore
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Dr Elias Tam
Aesthetic
Singapore
Answered on Sat Jun 16 2018 04:20:53 GMT+0000 (UTC)

Dear Huiqi,

Before choosing the laser, we should first find out what is the pigmentation that you are having. Different pigmentation response better with different laser. Once that is done, you can then consider what is the best form of treatment. It might not even be laser!

It will be too long to go into the various treatment here. You will need to have a proper consultation and assessment before discussing the treatment plan. I do notice that PICO laser has certain advantages which i could see in my patients after treatment, compared to their previous treatment  using other lasers in my clinic, but it is no miracle on its own.

PICO is just another excellent option in our magic bag when treating patient, not just in pigmentation but also for many other skin conditions. It may also be used in combination with other treatment modalities for better result. PICO may not even be the treatment of choice in some cases.

Have a great weekend ahead. 

Regards,

Dr Elias Tam

0 412 views 0 Doctors agree Sat Jun 16 2018 04:20:53 GMT+0000 (UTC)
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