Benefits of PICOSURE Pro’s adjustable Fluence – Dr. Oku

Dr. Kentaro Oku is a cosmetic dermatologist and Director of Hills Grace Clinic in Japan, he is a specialist in energy-based devices for total skin rejuvenation and body contouring.  Picosecond laser is one of his favourite technologies to use, particularly for the treatment of pigmentation and dermal revitalisation.  He is one of the first Doctors in the world to use the PicoSure Pro from Cynosure.  Here he gives us an insight into his first look at the latest revolution in Pico-second technology. 

What do we need to revitalize skin, including pigment removal?

I think there would be a lot of answers like IPL, retinol depigmenting agents, and laser. I think each answer is correct. As you know, the issues we face are degenerated skin that has excess melanin accumulation in the dermis or epidermis, low activity of epidermal turnover, and dermal extracellular matrix degeneration. What we must do is clear: 

1. Breaking excess melanin to ease its removal
2. Enhancing epidermal turnover 
3. Remodeling extracellular matrix in the dermis  

We have many choices to get these effects, but with Picosecond technology we can cover all of these at the same time. To achieve a multiple effect with Picosecond laser within the same treatment procedure, it’s important to use the right irradiation method for each aim.  

As you know the Picosecond-Alexandrite laser, PicoSure has multiple handpieces. One, a high fluenced Zoom handpiece for breaking excess melanin, a middle fluence FLAT handpiece for epidermal regeneration, and a fractionated FOCUS handpiece for dermal remodeling.  Although each one has high capability to achieve a result, it’s important to combine them to extract the full potential. The key point is balancing them.  

As you know, all the layers of the skin affect each other. So, if we use a balanced combination technique like this, the adverse effects such as PIH will be avoided in a high number of instances.  I have used this balance for all-layer revitalisation including pigment removal, and the results have been great for the past six years.  However, using this balance requires time and patience.  For many patients, there have been 5-7 treatments required with a spacing of sometimes 3 months between each.  Client satisfaction is high because all the skin troubles were gone without experiencing unwanted recovery time, but some doctors might think this method takes too long to get the desired result. Indeed, it has been impossible to shorten the treatment period because of the limitation of the technology. However, there is now an alternative in the PicoSure Pro pico-second laser from Cynosure.  

The PicoSure Pro has several features that help alleviate the previous limitations in the category.  Among these features is the new adjustable fluence system. As you can see, you can adjust fluence up to about two times with the same spot size. The range of fluence has expanded around any spot size so two-millimeter to five-millimeter spot has the same adjustable fluence.  

For example, if you use a six-millimeter handpiece, your minimum fluence would be 0.58, and the maximum could be two times this at 1.06.  As a result, we can apply high fluence with larger spot size, enough to penetrate thick skin tissue. With this new adjustable fluence, the balance can be changed and we can expand the efficacy. But of course, I think the clinical results are more important than the specifications of the device.

To achieve revitalized skin, it’s important to use and combine the right irradiation technique for each aim. The balance of energy density is to get a high clinical result without adverse events.  With the new adjustable fluence system, we can enhance treatment efficacy and efficiency. – Dr. Oku

CASE 1

This case has seborrheic keratosis around her lower eye lid and rough skin on her cheek. I used larger spot size with the same fluence as a current PicoSure.  As expected the PicoSure Pro decreased the number of treatment sessions with the result after one treatment being almost all the pigment removed, while the texture of her skin was improved. Previously this would have taken about three sessions to remove the hard skin. But the PicoSure Pro had high efficacy with one session.

CASE 2

This case had thick and deep pigmentations on her right zygomatic area. Usually, a high fluence single shot is indicated to this region, but I used medium fluence broad spot shot. With one session of treatment, thick pigmentation and small pigmentations around her cheek were removed. With the effect of the PicoSure Pro, we’re also seeing skin texture improvement.

CASE 3

This case was resistant to other laser treatments. She had melasma on her zygomatic area and a thick seborrheic keratosis on her cheek.  As you know, it’s difficult to remove light color pigmentations without stimulating melanocytes. I treated her with the PicoSure Pro, using the balancing irradiation technique.

After one session her melasma was controlled and pigments of seborrheic keratosis were almost removed. And of course, her skin texture was improved.

CASE 4

This last one is Hori’s nevus. The colour of her pigmentation was lighter and because she has sensitive skin, it would have been difficult to improve her skin with one or two treatments of PicoSure. But with the PicoSure Pro, we achieved the desired result with one treatment session. As you know, the penetration depth of the laser affects the number of treatment sessions. The new adjustable fluence enables me to use high fluence with the same larger spot size.

Thus, with difficult to treat dermal conditions such as Nevus of Ota and Horis Nevus the PicoSure Pro is able to treat the deeper melanin with larger spot sizes and a higher fluence, leading to fewer treatments and greater efficiency.

Interested in learning more about PICOSURE Pro? Watch the video here – Dr Oku at ASCD

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