Picosure Laser Treatment: How Does the Type of Irradiation Differ? Why the Choice Differs for Age Spots versus Acne Scars

Picosure irradiation methods are selected based on the concern being addressed. For darkly pigmented spots like age spots or birthmarks, color-targeting irradiation is used; for acne scars and skin texture, focus irradiation—which delivers fine, point-like stimulation within the skin—is being studied.[1][2]Melasma has reports of effectiveness, but long-term follow-up studies are still insufficient.[3].

How is a Picosecond Laser Different from Conventional Lasers?

The difference is that the duration of light exposure is much shorter. Because the mechanism of shattering pigment through impact shock is stronger than burning through heat, dermatologic surgery guidelines note that for Ota nevus (a type of birthmark), results equal to or better than conventional Q-switched lasers may be possible.[3].

In studies comparing facial pigmentation concerns, the improvement rate was 56% with picosecond laser versus 38% with conventional laser.[4]For café-au-lait spot (another type of birthmark), the rates were 69% and 55%, showing no clear difference.[5]Because these studies include machines and wavelengths other than Picosure, please view them as reference only.

Which irradiation should I choose for age spots or birthmarks?

For age spots or birthmarks, the basic approach is irradiation targeted at the darkly pigmented areas. Laser and light therapy are strongly recommended for sun-induced age spots (solar lentigines). However, long-term results and comparisons with other treatments are still limited.[6].

One concern is post-inflammatory hyperpigmentation—temporary darkening of color after treatment. With conventional alexandrite laser, this occurred in 47–64% of solar lentigine treatments.[3]Picosecond lasers show a trend toward shorter duration of redness and pigmentation changes.[3].

For acquired birthmarks appearing symmetrically on the cheeks, conventional laser treatment typically requires approximately 5–15 sessions, with hyperpigmentation reported in 12.5–75% of cases.[7]Because the number of expected sessions varies greatly depending on the type of birthmark, determining what type of spot it is first is essential.

What works best for acne scars and skin texture?

For acne scars and skin texture, focus irradiation (a diffractive lens technique) is being studied. Light reaches the skin with strong energy concentrated at small points, surrounded by areas of weaker energy, thought to trigger collagen remodeling within the skin.[2].

In reports summarizing acne scar treatment, this method is used for gradually sloping depressions, and the surrounding skin color and texture were reported to improve as well.[1]For deep, sharp depressions, combination with other treatments is sometimes discussed.

What can be expected for melasma or tattoos?

For melasma, there are reports showing picosecond laser effectiveness. However, guidelines caution that studies with sufficient long-term follow-up are lacking.[3].

For tattoos, there are both studies showing faster clearance with picosecond and studies showing no difference; conclusions remain unclear.[8]For either concern, sharing the expected number of sessions and prognosis with your doctor beforehand will help you feel more confident as treatment progresses.

How does the doctor decide which irradiation is right for you during the consultation?

The key is identifying what the concern actually is. Even if they look like the same "age spots," solar lentigines, melasma, and birthmarks require different irradiation methods and session counts.

During consultation, have the doctor examine the type of spot, the shape of acne scar depressions, and your tendency toward sunburn or hyperpigmentation. Then consult with your doctor to decide on the irradiation type, number of sessions, and how to care for your skin until any post-treatment redness subsides.