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MESSAGES TO

Lasers And Pigmentation

A DxD Session with Dr Justin Boey


Ended on Thu Nov 15 2018
Ended

Top Answers


Your skin appears to be quite sensitive and prone to hyper-pigmentation. 

You might want to consider Picosecond Lasers for your pigmentation issues as they tend to be gentler on your skin with lower risks of complications. 

Please speak to a doctor for more details on treatment options.

Hope that this helps!

Dr Justin Boey

15 Apr 2018

Hi,

Thank you for the question. This is a good question that i've received from several patients.

Discovery Pico Laser is one of the brands of Picosecond Lasers.

Picosecond Lasers are suitable even while you are still having active acne.

In fact, it can help to reduce active acne.

It works by killing acne-causing bacteria and controlling oil production.

Over the long term, it can help to reduce brown acne marks.

In addition to picosecond lasers, also do consider antibiotic creams and intralesional steroid injections for your active acne.

Hope that this helps!

Regards,

Dr Justin Boey  

24 Apr 2018

The answer is: Yes. It is safe to do lasers while on Accutane.

The latest research published in February 2018 concluded that "a 6-month delay is not necessary for all procedures". (https://www.ncbi.nlm.nih.gov/pubmed/29488816)

A US research study published in Dec 2017 proved the safety of non-ablative fractional laser 1 month after stopping Isotretinoin - "All patients demonstrated normal wound healing post NAFL treatments, and neither hypertrophic scars nor keloids were observed. Acne scar improvement was satisfactory." (https://www.ncbi.nlm.nih.gov/pubmed/28853175)

This latest research supersedes the older guidelines of waiting 6 months post-accutane for Laser procedure.

This is a Game-changer because there is no longer a need to delay Acne scar Laser treatments

Early treatments will give better final results.

Hope that this helps!

Best regards,

Dr Justin Boey

2 May 2018

Thank you for your question. Post-inflammatory erythema (PIE) due to acne is very common and troubling for many patients. 

To treat PIE, we need lasers that emit wavelengths to target Haemoglobin specifically.

This family of lasers are called Vascular Lasers. 

Examples of Vascular lasers that are commonly used in Singapore to treat PIE include:  

1. Pulsed dye lasers (VBeam, 595nm wavelength)

(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3780804)

2. Gold-toning Q-switched Nd:YAG lasers (Lutronic Spectra XT, 595nm)

(https://www.ncbi.nlm.nih.gov/pubmed/25645645)

3. Copper Bromide laser (Pro Yellow, 577nm)

Apart from Vascular lasers, Fractional microneedling Radiofrequency (eg Infini/Intracel) is also shown to work for PIE by its anti-inflammatory and anti-angiogenetic properties.

(https://www.ncbi.nlm.nih.gov/pubmed/26059315)

As you can see, there are many different Vascular Lasers available in Singapore. All of them are safe and effective when used appropriately.

I personally use the "Gold toning" Q-switch Nd:YAG lasers for PIE. It is effective with minimal side-effects. Several sessions are encouraged for good results.

Hope that this helps!

Best regards,

Dr Justin Boey 

2 May 2018

The best method to get rid of Freckles is using a Picosecond Laser. This laser selectively targets melanin pigment and lightens pigmentation over a course of 2-3 sessions, 3-4 weeks apart.

In addition to Picosecond lasers, you can consider Chemical peels, Retinoic acid-based creams and Sun protection (minimum SPF 30). These complementary treatments enhance the results of laser treatments and prevent formation of new pigmentation.

I suggest that you consult a doctor regarding your pigmentation as there are several types of skin pigmentation. 

A common type of facial pigmentation known as Melasma is a chronic hyper-pigmentary condition that is harder to treat and control than freckles.

Melasma

Hope that this helps.

Best regards,

Dr Justin Boey

7 May 2018

Dear Always, 

Prolonged redness/erythema and Post-inflammatory Hyperpigmentation (PIH) will require different types of Lasers to precisely treat these conditions.

PIH will require Picosecond Nd:YAG/Alexandrite lasers or Q-switched Nd:YAG lasers. Picosecond Lasers are proven to be more effective for stubborn PIH that cannot be removed with Q-switched lasers. (https://www.ncbi.nlm.nih.gov/pubmed/29200769)

Prolonged erythema can be removed with Pulse Dye Lasers or Copper bromide lasers.

The first step to finding a doctor who is proficient in treating the above conditions is to find a clinic that offers the above Lasers.

Next, ask the doctor for before/after photos of the cases that he has treated using these lasers.

Lastly, look for a doctor who can give you a comprehensive treatment plan as these laser treatments usually require several sessions with good post-laser aftercare to ensure optimal results.

Hope that this helps!

Best regards,

Dr Justin Boey

7 May 2018

I agree with Dr Chua. In addition, to answer your question on whether you should post-pone the 2nd session. I personally wait for the redness to subside before performing subsequent ablative laser sessions. Redness might be a sign that your skin has not fully recovered yet.

It is best for you to contact your doctor/clinic for advice regarding the timing of the 2nd laser session.

Hope that this helps!

Warmest regards,

Dr Justin Boey

30 May 2018

Based on your photo, you have a hyper-pigmented macular patch which can be melasma. 

To make an accurate diagnosis, I will need clearer photos, find out more about your medical history and do a thorough assessment of the skin-care products that you have been using. 

In terms of Pigmentation treatment, you should consider medical-grade pigmentation creams and pigment lasers like picosecond lasers to gradually lighten the hyper-pigmentation. Sun-block is also an important step to prevent worsening of this condition.

Please see a trusted doctor for a consult and treatment! Hope that this helps!

Warmest regards,

Dr Justin Boey

5 Jun 2018

I suggest a cautious approach

Laser hair removal is very safe in general. However, there is a small risk of triggering an acute flare of eczema. It is good that your daughter has not had any recurrence for 5 years, which means that she is at a lower chance of an eczema flare.

I suggest that you try laser hair removal with a doctor who is confident of managing eczema. In the rare event that it happens, a range of topical steroids creams and oral steroids are required.

Hope that this helps!

Warmest regards,

Dr Justin Boey

10 Jun 2018

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). 


Hope that this helps!

Warmest regards,

Dr Justin Boey 

13 Jun 2018

Uneven skin tone is a troubling issue but it can be treated.

Common types of uneven skin tone include Pigmentation (brown spots) and Redness/Rosacea (red spots/prominent blood vessels).


For treatment of Pigmentation (brown spots), Picosecond Lasers are the gold standard lasers of choice. You can consider Picosure, PicoPlus and Discovery Pico. 

Rejuran Healer can be used after Picosecond laser to enhance the effects. Both treatments can be done on the same day. 


For uneven skin tone related to redness/rosacea, a vascular laser is needed for best results. You can consider Pro Yellow, VBeam or Excel V.

Other treatments like chemical peels and HydraFacial can also help you to achieve more even skin tone.

Hope that this helps!

Warmest regards,

Dr Justin Boey

1 Jul 2018

Top Questions


I'm a 20 year old male. My skin is dark brown. I would like to get rid of PIH on my face and nose. The dark marks are very unsightly, and affecting my confidence.